Practical Matters

Health care's complex and changing environment has heightened the importance of strong board-CEO relationships. Both parties must build and sustain vibrant, trust-based relationships to navigate the fast-paced health care world. That trust requires leadership excellence in a number of key areas, including understanding each other's needs, and communicating and working together as a cohesive team.

Professional Partners

The board and CEO relationship should be a trusting partnership, where trustees and the CEO unite as a team to achieve the hospital's mission and vision. This relationship is enhanced through a clear understanding of each other's needs and expectations, clear and consistent communication, shared goals and objectives, dialogue-rich and purposeful meetings, and a constant sharing of timely and critical information.

Mutual respect, candor and trust distinguish the very best leadership relationships. Trust, however, is the most critical component. It plays a vital role in the CEO's and trustees' abilities to communicate openly and honestly; without it, individuals may be hesitant to participate in discussions, raise issues or share their viewpoints.

To build mutual trust, the board and the CEO must rely on one another for support, consultation and advice, and complement one another's strengths and responsibilities.
The CEO must develop a positive rapport and a close professional relationship with all board members. He or she must understand what motivates each trustee's involvement with the organization, and be knowledgeable about each trustee's interests and needs.

The CEO also must be aware of any gaps in trustees' understanding of current issues and trends, ensure that board education responds to trustees' needs, and encourage trustees to learn and ask questions in an open, safe environment. This attentiveness to individual trustees' needs demonstrates interest and support, and helps to build a positive, trusting environment for dialogue and decision-making.

Successful relationships give board members confidence in the CEO's ability to lead the organization, and in their own ability to provide useful encouragement, support and outside perspectives. In a strong relationship, the board and the CEO are able to collaborate to design clear, focused approaches to challenges. Both board members and the CEO enjoy a sense of command of the organization and a sense of fulfillment in the roles they play in organizational success.

On the flipside, when the relationship weakens, persistent questions about focus, intent and appropriateness permeate board and leadership discussions and inhibit effective board decision-making. A downward spiral of trust and confidence is often the unfortunate result.

Mutual Needs

Several ingredients ensure a productive board-CEO relationship.

  • Communication is clear, crisp, concise and accurate; candor is the order of the day.
  • Everyone is on the same page and has a mutual understanding of issues from his or her own perspective.
  • Roles, responsibilities and accountabilities are clear and well-expressed.
  • The board has a clear understanding of its policy and strategic place in the leadership continuum.
  • A strong sense of synergy results from a mutual understanding of what the CEO and the board bring to bear in tackling the complex challenges that face the organization.

Board needs. The board needs to have an understanding of emerging issues that will drive organizational success in the future. In addition, members must understand the barriers to success from the CEO's perspective and precisely how they can assist the CEO in dealing with them. Crisp, clear and concise overviews help the board to focus on strategy and avoid the tendency to wander into operational areas.

CEO needs. The CEO needs to understand the information and perspectives the board requires to lead, and to understand the differences in perspectives and informational needs required of lay board members vs. clinical board members. He or she needs intellectually curious trustees and a culture of candor and commitment. This requires energetic participation, creative thinking and a willingness to challenge conventional thinking.

Effective Meetings

The board meeting is the center of communication and relationship success or failure. Unfortunately, it often is not as effective as it could be due to poorly planned agendas, time-wasting routine reports and an overemphasis on operational details.

High-performance boards spend most of their time on important strategic and policy issues. They engage in rich discussion, assess outcomes and participate in ongoing education. They focus on the issues that are most critical to the organization, and where they can have the greatest impact.

The CEO also plays a major role. He or she should ensure that trustees receive materials for review well in advance of meetings. In addition, he or she should work closely with the board chair to ensure that meetings are orchestrated to maximize meaningful dialogue, and a focus on the future.

Board meetings should not focus on mundane details that have little impact on the long-term strategic direction of the organization, and instead focus on the vision, values, governance policies and strategic leadership issues critical to future success. It's essential that all board members, including nonvoting board members, be fully informed about important issues, and that agendas be geared toward the strategic future of the organization.

Larry Walker ( is president of The Walker Company Healthcare Consulting LLC, Lake Oswego, Ore. He is also a member of Speakers Express.

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