Bringing new members onto the board has its challenges. In small or rural communities, the pool of potential trustees is often limited, with desirable candidates already serving on multiple boards. Even in bigger urban areas, it sometimes seems the same people rotate on and off the boards of larger community organizations — the Rotary Club, the chamber of commerce, the hospital.

Chairs of board nominating committees have been known to express frustration when they put out the annual call to other board members to suggest names of new people to serve on the board. It’s no wonder when meeting after meeting they remind their fellow trustees to suggest candidates and either get “the usual suspects” or even worse, little to no response.

The plot thickens, say trustees and governance support staff, when the board looks to diversify its membership by bringing up-and-coming community leaders to the board table. These often younger candidates may decline to serve because they are too busy maintaining a career, raising a family or focusing on other interests and obligations.

Recent governance research conducted by the American Hospital Association’s Health Research & Educational Trust and Center for Healthcare Governance seems to support these observations. Data from the 2011 survey suggest that hospital boards are getting older: fewer board members were age 50 or younger in 2009 (24 percent) than in 2005 (29 percent) and more were age 51 to 70 — 67 percent in 2009 versus 62 percent in 2005.

Using an informal, “who do you know” recruitment process may explain the difficulty some boards experience in bringing new blood into the board room. However, others have increased their chances of success by becoming more deliberate and systematic in recruiting new trustees. These boards seek not just viable candidates, but individuals who would be the best fit for board service.

During the search process, boards are providing trustee job descriptions that outline roles, responsibilities and expectations of board service to ensure candidates are fully aware of the commitment before they agree to join the board. Boards also are looking for individuals with more than the time, energy, support for the organization’s mission and personal integrity to serve.

They are seeking people with specific knowledge and skills to address organizational needs. Astute board nominating or governance committees typically compare a current board profile displaying members’ professional backgrounds and personal characteristics, such as age, gender and geographic origin, with the hospital’s strategic priorities. They then aim to close gaps by identifying people with specialized knowledge and skills on which the board can draw to tackle such critical issues as improving quality and safety performance, engaging physicians better or determining whether to partner with other providers to expand access to care.

While these approaches can bring new expertise and perspective into the boardroom they don’t guarantee that the individuals who possess them will leverage their skills and experience in ways that most benefit the board and the organization.

Death and taxes aside, life doesn’t include many guarantees. However, there are ways to improve the odds of achieving success. When it comes to recruiting new members, boards are improving their chances of finding the best candidates by digging deeper to assess an array of behavioral-based competencies that provide insight into how a potential board member actually will participate in the process of governing.

Questions for Discussion

  1. Has our board found it difficult to identify new board member candidates? If so, why is this occurring?
  2. What is our board’s current process for recruiting and selecting new members?
  3. When was the last time we critically examined our process for bringing new trustees onto the board?
  4. What have we done to improve our process and our chances for attracting the best candidates for board service?
  5. Are we, as a board, willing to try a new approach?

Identify and Assess Competencies

The Blue Ribbon Panel on Trustee Core Competencies’ 2009 report defined competencies as “the combination of knowledge, skills, personal characteristics and individual and social behaviors needed to effectively perform a job.” With funding from Hospira Inc., the panel, and a working group that developed tools and resources to apply competencies to governance practices, identified three knowledge and skills competencies and 15 personal capability competencies that hospital and health system board members should possess to govern effectively (see Trustee Core Competencies, page 20).

The panel defined each competency and described a number of behaviors that individuals possessing that competency would be able to demonstrate.

The working group then developed tools, such as a competency-based interview guide, job description and recruitment process guideline, to help boards apply competencies to trustee recruitment and selection and other board processes. (For more information on these tools and others that apply competencies to board orientation and mentoring, trustee performance assessment and board leadership development and succession planning,

The tools were designed so that boards could begin applying competencies to any of the governance practices listed. This approach reflected four principles that guided the efforts of the working group to develop tools that would:

  • support the board as a team;
  • function as an integrated suite of resources;
  • be pragmatic and simple to use;
  • encompass both formal education and peer-to-peer development.

Comptencey-Based Trustee Selection

After gaining some preliminary experience using a competency-based approach to mentoring, the board of Sierra Vista (Ariz.) Regional Health Center incorporated competency assessment into their board member recruitment activities.

“Our board has viewed applying competencies to our governance practices as an evolving process,” says Joanna Michelich, chair of the Sierra Vista board’s governance committee. “As we matured in our governance practices, we felt ready to go to the next level. We knew that trustee core competencies were related to better board performance and that a better board can positively affect the organization’s performance as well.”

At the end of 2011, the governance committee began to prepare to use competencies in the trustee selection process, scheduled to occur in March and April 2012. The committee conducted an informal review of each existing board member to assess strengths and weaknesses and to identify areas where competencies could be reinforced or added to the board.

“The committee members struggled a little with the competency review of our current board members,” Michelich says. “We had to zero in on which competencies we really needed to focus on, and we worked hard not to overthink the assessment of any single board member, but to concentrate on what competencies we needed the board as a whole to reflect.”

This gap analysis led the board to focus on four competencies during the upcoming round of candidate interviews:

  • impact and influence
  • innovative thinking
  • organizational awareness
  • strategic orientation.

Using the trustee recruitment interview tool developed by the Blue Ribbon Panel working group as a guide, the governance committee developed questions that focused on these four competencies and added them to their existing set of interview questions (see Trustee Applicant Interview Questions, page 19).

The governance committee and additional board members used the questions in a group setting to interview each candidate. Candidates were given the questions in advance. The committee expected that using the competencies would help interviewers gain a better understanding of each potential board member and be more discriminating in deciding whom to recommend for board service.

After the interviews were completed, interviewers and candidates provided feedback about the overall process and whether the competencies added value to it. Interviewers responded to the following questions:

  • How, if at all, did adding the competency- focused interview questions change the interview give-and-take?
  • What did you learn about each candidate’s competencies through these questions that helped you determine if he or she was a good fit for the board?
  • Did you think the competency focused aspect of the interview process helped you identify strengths that would complement existing competencies or strengthen competencies that currently exist on the board?
  • As a result of seeking feedback on specific competency areas, did you get a deeper insight into the candidates and, perhaps, get to know them better than if you had not pursued this feedback?
  • Based on the candidate’s background and interview, what strengths do you believe he or she would bring to the board of trustees? Weaknesses? Do you have any concerns about the individual’s candidacy as a trustee?
  • Any other comments?
  • Here’s what interviewers had to say:

“The competency-focused questions gave us an opportunity to hear concrete examples of situations the candidates had been part of where they had to exhibit the competencies. … I believe the candidates were able to give more thoughtful answers than past interviews where the questions were less specific. They also gave the candidates an opportunity to explore how they might relate their personal experiences to the hospital board and hospital issues.”

“The depth of information gleaned about this candidate far exceeded information we previously received without such questions. We learned how she processes information; utilizes team members in consultation, collaboration and decision-making; her approach to problem-solving; her understanding of both formal and informal power within an organization; her emphasis on ‘doing her homework’ on issues; her focus on strategic planning for an organization; how she networks with others within and outside an organization; how she utilizes failure as ‘lessons learned’ for future problem-solving; and how she engages others (‘friends and foes’) in strategizing and decisionmaking. These four questions provided insight into how the candidate would approach her position on the board.”

“(The candidate) will provide a professional persona when representing the board or the hospital. The level of experience she has had working with complex issues and various levels of management will provide an added capability to the board. She appeared to be able to deal with controversial issues in a nonconfrontational manner aimed at solving problems and bringing all participants along.”

“(The candidate’s) responses dem - onstrated the following: critical thinking and analytical skills; dedication and diligence; attention to detail and her surroundings; understanding of both formal and informal power structures; the value of clarity in written and oral communication; the sociology of complex formal organizations; an ability to chunk information to obtain a purpose or goal; the benefits of diversity of perspective within a group; and a dedication to the superordinate goals of an organization.”

“I learned of the really broad back ground of this candidate. She provided examples for each of the questions asked. Thid ensured that she would be a good fit for the board.”

“I think the competency-based approach raised the level of trustee selection and illustrated aspects heretofore undiscoverable. Also, I think her preparation for the questions validated the wisdom of providing the questions in advance … it illustrated her willingness to research issues as she will have to do as a trustee.”

“I was skeptical that these questions would add value to the interview. I changed my opinion. Both candidates gave us much more information than we would have gotten by just asking our standard questions. The questions definitely helped us identify strengths we needed on the board.”

“I consider [her] to be a strong candidate and potential future leader of this board.”

“Her responses demonstrated her style in working with the formal structure of an organization to solve problems and to develop the organization. Specifically, she demonstrated that she utilizes the following skills: proactive presentation of new ideas for group consideration; listening and reflection skills; a team approach to problemsolving; ability to deal with diversity and differences; ability to handle conflict at a practical level; the importance of understanding the culture of the organization; the ability to interpret the culture in problem-solving; recognition and respect for differences between and among individuals and how they process information; and the benefits of developing and communicating a clear mission, vision, goals and values to guide an organization. She also demonstrated a clear passion for the local community and ability to work with others outside her organization toward ‘the common/greater good.’”

“I learned a bit about [the candidate’s] style in processing information and making decisions; the importance she places on working together as a team; the value she places on fact-finding, analysis and reflection; and her respect for individual differences as gifts to be used for the common good. In particular, I think her responses demonstrated she possesses effective skills in the areas of impact and influence as well as organizational awareness.”

“The four [competency] areas were our ‘weak’ areas. These chosen questions helped us because the candidate had to explain what she did in certain situations. We were able to learn specifically how the candidate dealt with certain challenges. This definitely expanded our idea of whether the candidate would fit well.”

“This candidate demonstrated her strengths in the areas stated in the questions. Her answers satisfied us that she was open to hearing all sides of an issue, and that she had values that we value, including commitment to the community and desire to strengthen the community together. She demonstrated strength in each of the four areas of our competency questions. I have no concern about this candidate as a potential board member.”

When asked for their reactions to the interview process, the candidates said: “All of the questions were good ones … the last questions were thoughtful and necessary. … I sensed easily the interest and energy and gifts you each bring to this position.”

“… in my previous career I was trying to get my staff away from asking ‘tactical’ questions about skills during interviews to more competency-based questions. It is really important to focus on these types of capabilities for long-term success of an organization.”

Trustee Applicant Interview Questions

  1. Why are you interested in becoming a member of the board of trustees for the Sierra Vista Regional Health Center?
  2. How do you view the role of a hospital trustee in the political advocacy process?
  3. In your perspective, what are some of the challenges facing rural hospitals such as Sierra Vista?
  4. In your perspective, what are the obligations a hospital such as ours has to the community in addition to providing quality health care?
  5. In terms of your personal skills and attributes, what do you feel you will be bringing to a trusteeship with Sierra Vista Regional Health Center?
  6. As you would imagine, there are issues discussed by the board in which confidentiality is paramount. Do you envision having any personal or professional conflict with maintaining confidentiality relative to board discussions?
  7. Serving on the hospital board is a fairly time-intensive commitment. Trustees generally attend one evening meeting and two noontime meetings each month. Our policies require that we attend at least 80 percent of all meetings. Do you have any time constraints that might interfere with your fulfilling this requirement?
  8. \Think of a situation where you were working to persuade, convince or influence others to support a point of view, position or recommendation. What actions did you take to persuade or influence others?*
  9. Think of a situation or situations in which you were involved in reinventing or establishing a new program, product or service in your professional life or as a governing board member. How did you help make complex ideas or situations clearer or more understandable?*
  10. Think of a situation where, in order to accomplish a task or goal, you needed to understand how decisions were made and influenced and the power relationships that existed in an organization or industry. Feel free to reflect on experiences you have had professionally or as a member of a board or other group. Describe how you came to understand these decision-making and power structures and relationships.*
  11. Think of a situation you encountered in your work or as a board member where you had to think strategically and consider the business, demographic, political, cultural and other implications of decisions to ensure long-term success for an organization or undertaking. In what ways did you help the organization align its work and resources with the strategy?*
  12. Are there any questions you would like to ask us?

Trustee Core Competencies

  1. Knowledge and Skills
  • Health care delivery and performance
  • Business and finance
  • Human resources
  • Personal Capabilities
    • Accountability
    • Achievement orientation
    • Change leadership
    • Collaboration
    • Community orientation
    • Impact and influence
    • Information-seeking
    • Innovative thinking
    • Complexity management
    • Organizational awareness
    • Professionalism
    • Relationship-building
    • Strategic orientation
    • Talent development
    • Team leadership

    Source: Competency-Based Governance: A Foundation for Board and Organizational Effectiveness, Center for Healthcare Governance, 2009


    Assessing specific trustee competencies has added value to the process of selecting new trustees for the Sierra Vista board, which plans to evaluate how competencies might be used in additional board practices. It also has changed the way some board members view their trustee colleagues.

    “Being aware of other board members and their competencies has become part of how we view each other and our work,” says Ron Wagner, a Sierra Vista board member. “For example, in the future we will be losing one of our current board members who is planning to move back East. She is our ‘information seeker’ who could always be counted on to ask questions. The next time we look for new board members we will need to look for an information seeker to replace her.”

    “I think the candidates’ responses validated the importance of the competency- based approach,” says Lanny Kope, Sierra Vista’s board chair. “The Greeks called it ethos, pathos, logos. One interviewer focused on this when he said he would have recommended one of the candidates anyway. This would have been based on ethos, that is, his feeling about the candidate. But the competency-based questions focused on the logos of the decision. In essence we not only made a decision, we made an informed decision.”

    Mary K. Totten ( is a governance consultant and content development director for the AHA Center for Healthcare Governance, Chicago.