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A comprehensive orientation is essential to the successful assimilation of new trustees and to the advancement of continuous governance effectiveness. There's much for new trustees to absorb and learn, and the amount and complexity of information can be overwhelming. What's more, there is no "grace period" for them to catch up: Trustees are legally responsible to understand and carry out their fiduciary duties from the moment they accept their trusteeship.

A substantive orientation is accomplished through a series of meetings and educational sessions. The first orientation should allow new trustees to comfortably ask questions and make sure they understand issues without feeling stress or embarrassment due to their lack of knowledge. When determining the content for the initial orientation, participants on both sides of the orientation effort should be mindful that every trustee comes to the board with a different level of knowledge about health care and governance. The initial orientation should provide information in two areas:

1. Organizational information: history of the organization; mission, vision and values; organizational chart; hospital policies and procedures; hospital bylaws; current strategic plan; and explanation of financial statements and ratios used to measure organizational performance.

2. Governance information: trustee expectations, such as attendance, committee and board meeting participation, advocacy, participation in governance practices and self-assessment, and attendance at educational sessions; background on the health care environment and critical issues facing the hospital; significant issues and decisions made in the past 12 months; governance policies and procedures; fiduciary and legal duties; the effects of the Affordable Care Act and state laws and regulations on the hospital, physicians and other parts of the continuum of care; definitions of key terms; and components of the payer mix.

Roles and Responsibilities

The full board or a governance development committee is responsible for designing the board orientation process and ensuring that it is carried out in a timely manner. Then, the CEO, board chair and other hospital leaders should present and discuss the majority of the information. The CEO is responsible for providing a broad overview of the market, competition, organizational structure and goals. The board chair should cover overall governance and individual trustee responsibilities; the chief financial officer should present financial information and explain key financial indicators, and the chief medical officer should address medical staff and quality of care issues.

The CEO and board chair together should conduct a tour of the organization's care sites with new trustees. The tour should be scheduled prior to a new trustee's first board meeting and should include a visit to each key department or service area, an introduction to the leader of each area, and adequate time for him or her to provide an overview of the area and responsibilities. The overview should include a discussion of the following information, and include relevant materials:

  • the area's organizational structure and key management staff;
  • the key responsibilities and work of the area;
  • the area's culture and environment;
  • other significant information about the area, and its role in helping to achieve the organization's mission and vision.

Mentors Ease the Way

Many new trustees arrive on the board with little or no prior board experience or health care expertise. A strong orientation program and warm welcome to the board is critical to their success as a trustee, as well as to the board's success as a cohesive governing body. Assigning a mentor to each new trustee can help to make board service a rewarding opportunity to contribute to the success of the organization. To help new trustees understand governance business, a mentor should:

  • introduce the new member to the board, administrators, medical staff and others at the meeting;
  • talk with the new trustee prior to the first few board meetings, review the upcoming meeting agenda and explain the significance of the items on the agenda;
  • sit next to the new trustee at board meetings to answer his or her questions and offer insights, background and other information. If appropriate, the mentor can ask the chair to pause the meeting for brief explanations and orientation that will help the new trustee (and likely other newer board members as well);
  • recap critical issues and decisions following the first few meetings;
  • share insights and information, answer questions and generally help the trustee become comfortable working with new colleagues, and confident in the governing leadership role.

Another way to help new trustees understand governance expectations is to give them the most recent board self-assessment to review. This will provide a clear picture of how the board examines itself and evaluates its strengths and weaknesses, and will showcase the values and performance attributes important to the board.

Finally, new trustees should be encouraged to engage in community outreach and advocacy on behalf of the hospital and use their social and political networks to advance understanding of the challenges facing the hospital, and the benefit the hospital provides to the community.

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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