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Health care is moving at its fastest pace in history. What trustees needed to know five years ago is no longer sufficient in today's world, where governance "knowledge capital" is one of a board's most valuable assets. Trustees who seek to be true governance knowledge leaders must prepare themselves by continuously improving their knowledge in order to deliver penetrating, insightful leadership that the hospital's patients, families, physicians, employees and communities want and deserve.

Leadership Intelligence

Governance education is a continual process, not an end result, and it is the vehicle for improved governance knowledge. The benefit of well-planned, focused education is greater knowledge and heightened leadership intelligence, which enable trustees to engage around critical issues and make evidence-based rather than gut-driven decisions. It builds the knowledge capital needed to ensure that the right decisions will be made in the right way at the right time, using meaningful information and data.

Individual Education Assessment

Trustee knowledge-building should be ongoing and occur through a variety of modes. Sources of information include state hospital association conferences; journals including Trustee, Hospitals & Health Networks and Health Affairs; reports and studies available online, such as the "Kaiser Daily Health Policy
Report;" national newspapers; and through targeted education at every board meeting. The key to success is to develop knowledge that enables trustees to put the bigger issues and challenges into a local market framework, identify local market implications, and lead with confidence.

A well-planned and financially supported effort will result in better decisions based on knowledge and insights; an improved ability to be an advocate for the hospital and its community; increased capacity to engage in challenging and productive governance dialogue; and an ability to think beyond conventional wisdom.

To evaluate trustee education needs and ensure a successful education process, several factors are critical: board dedication to and investment in knowledge building; trustee participation; clearly stated educational expectations; deep trustee involvement; and education that is customized to trustees' unique needs.

The board must invest — both intellectually and financially — in governance education. The process should be undertaken with a firm, defined purpose and the topics for exploration chosen several months in advance. These topics should be drawn from the forces and factors driving hospital success in achieving its mission, vision and strategic objectives. Knowledge-building opportunities and available resources for delivering the education, such as meetings, publications, trustees themselves and consultants, then should be identified. The board should set a basic strategy with objectives and outcomes, periodically evaluate success, and incorporate new opportunities as changes occur in the market. Education should not be a one-time event, but an institutional commitment to ensure that the board has the knowledge resources necessary to make strategic decisions and be a highly effective leadership body.

Participation should be mandatory, not optional. Hospitals owe it to their patients, physicians and communities to ensure that governance decisions are made and directions are set as a result of vigorous scrutiny and informed intelligence. This means that every board member must have a common level of understanding of critical issues and developments and their implications.

The participation requirement for governance education should be expressly discussed during the trustee recruitment process. Trustees should be fully informed in advance about educational requirements, which should be presented as an avenue to best serve the hospital and community. Prospective trustees should embrace the importance of education in their development as a valuable leadership asset.

Where possible, trustees should direct education planning. They may be asked to research certain topics or issues, and present the findings to the entire board, in essence making trustees peer knowledge-builders. This level of involvement not only brings credibility to the importance of education, but also results in deeper understanding of the most critical topics.

Education should be individualized and customized. Every trustee has a different level of awareness and knowledge of the issues discussed and the decisions made at board meetings. Nonetheless, each trustee has the same fiduciary obligation and responsibility to be well-informed. The CEO or board chair should determine the knowledge needs of each trustee and, working with the full board, develop plans to provide each individual with the information necessary to be active, engaged and productive participants in the governance process.

Designing the Education Process

The critical question remains: How does a board go about doing it? That's where commitment, collaboration and consensus come into play.

Following is an outline of how a board can design a process that will ensure optimal development of leadership knowledge and effectiveness:

  1. Define the issues about which every board member needs to have a common understanding in order to be a high-performance trustee (see "Board Syllabus," at right). The hospital's strategic plan should serve as a basis for determining the most critical education topics and current health care trends affecting the board and, ultimately, hospital success.
  2. Assess each trustee's awareness and understanding of the issues and situations likely to come before the board in the coming months. This may be done though a board self-assessment, a simple survey or in casual conversations, typically between individual trustees and the board chair or CEO. The individualized assessment should help determine the areas where pinpointed education should be focused to get trustees up to speed on the issues and decisions for which they are fully responsible.
  3. Assign an experienced board member to work as a mentor with newer trustees to help them understand issues, questions and nuances.
  4. Develop a 12-month or longer curriculum of topics that are essential to effective governance, and determine the most appropriate way to assess or deliver the information. Ensure that trustees are involved actively in the selection of topics, and that the methodology for presenting the information is conducive to individual trustee learning styles. Delivery methods may include in-person presentations, facilitated discussions, online presentations, printed materials and more.
  5. Leverage the improved trustee knowledge not only for board discussion and decision-making, but also through coordinated outreach, including legislative advocacy and connections with the community. Trustees can participate in community activities, and formal and informal community discussions and presentations about the hospital and its challenges.
  6. Continuously refine and improve the process. Conducting a regular board self-assessment is one way to measure year-over-year improvements in board understanding and education effectiveness, and determine potential knowledge gaps that may exist. Building expectations for growth and development of the board's knowledge capital will result in better dialogue, better decisions and knowledge-based leadership that will drive future governance performance and organizational success.

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

Sidebar - Board Syllabus