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Hospital boards do not become excellent by chance. They build excellence, superior leadership and high performance in large measure by engaging in rich, purposeful dialogue that challenges conventional thinking, explores alternatives and scenarios, and dives deeply into defining solutions to issues and challenges.

Good board meeting fundamentals are critical to ensuring productive board meetings that will energize and engage trustees, and maximize governance dialogue on the issues that matter most to hospital success. Having basic meeting practices and expectations in place as part of the board's DNA helps to ensure a culture of respect, inclusion, responsibility, accountability and high expectations.

Board meeting time is limited, and every minute should count. Deep, decisive dialogue should be the board's "social operating mechanism" through which decisions are made by grappling with and grasping concepts, ideas and solutions that can lead to well-informed and rational conclusions.

Advanced preparation is critical for purposeful participation. The management team should provide board members with meaningful, actionable information that prepares them to be knowledgeable, highly engaged participants in robust governance dialogue. Board members must commit to reviewing these materials in advance. They should expect concise executive summaries of issues to be discussed that describe the issue, define why it's important, explore the pros and cons, and define the choices for board consideration. Part of trustees' meeting preparation also should include contact with the board chair if trustees have additional agenda suggestions or questions to explore.

The board chair orchestrates the meeting. It is the board chair's responsibility to keep discussions on task, ensure that all voices are heard, and keep the board focused on meeting objectives and outcomes. To aid in setting the stage for discussion, the board chair briefly should frame each issue to be discussed when moving from one agenda item to another, describe the issue's importance, highlight questions for discussion, and tell trustees in advance if a vote on an issue is expected.

Deliberation is where issues are framed and opinions are formed before evidence-based votes are taken. Excellent deliberation always begins with a definition of the challenge. The issue or challenge should in some way tie directly to the hospital's mission, vision or strategies, and the importance to the hospital and community should be clear. Solutions should be proposed, alternatives suggested and varied opinions should be heard before voting takes place.

Trustees should be active and vocal. Successful governance decisions require all board members to understand the diverse opinions of their colleagues. All trustees must participate actively and express their viewpoints during board discussion so that their colleagues fully benefit from their perspectives. Board members should be mindful not to dominate or overpower discussion, and ensure that everyone has both the time and encouragement to share their unique viewpoints in the governance discussion. Board members should listen attentively without rushing to judgment, and absorb information before coming to a decision.

One way to ensure that all trustees weigh in with their viewpoints is to invite each trustee to share his or her perspectives and insights on the issue being discussed. Trustees should not share how they plan to vote during the "round robin" discussion, but should instead provide their opinions to further shape the discussion before decisions are made.

In addition, trustees should be encouraged to take the lead on researching and presenting certain agenda items or facilitating discussion on a topic of interest to them. Personally investing time and energy into board decisions elevates trustees' engagement and discourages them from being passive meeting attendees.

Staff presentations and reports should take center stage. Staff presentations during board meetings should be brief and focused. Ideally, the presenter should stand at the front of the room and use a PowerPoint presentation to keep trustees' attention focused on highlights of the information being presented. In addition, staff should avoid simply making reports, and instead use this valuable meeting time to provide critical information and context for a decision the board will make, either at the meeting or at a subsequent meeting.

Distractions should not distract. It is vital that board members are keenly engaged at all times in all governance discussions. Outside distractions, including email, texting, reading not related to the discussion or side conversations should not occur during meetings to ensure trustees' full attention to and understanding of the issues being discussed.

Every meeting should be assessed. Conducting a brief meeting evaluation for board members to complete prior to adjournment will help the board chair and CEO fine-tune the board's meeting processes and maximize meaningful agendas and dialogue at future meetings.

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

Sidebar - Dialogue Assessment