Board committees and task forces are an essential component of effective hospital governance. They form the infrastructure that enables the governing board to focus on larger issues of policy, strategy and vision.

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Small, highly focused working groups empower greater governance effectiveness. When the work of the board is correctly balanced among committees, task forces and the full governing board, the entire board becomes more productive and effective. Committees and task forces streamline decision-making by providing analysis and recommendations. They help prepare leadership to understand and lead through the challenges of the future. And they leverage board time for the most important and pressing strategic and policy discussions and decisions.

A solid governance infrastructure enables deep, penetrating analysis and development of alternatives and recommendations that boards would not have the time and resources to accomplish alone. They also provide an excellent opportunity to "test drive" and groom new leaders and, ultimately, facilitate the hospital's strategic success.

Standing committees focus on fundamental functional areas of primary board responsibility, such as quality and patient safety, medical staff credentialing, finance, audit and governance development. They are critical to compliance and accomplishing important board work, and much of the board's work typically is accomplished in its standing committees.

Ad hoc task forces most often are created to address specific short-term issues and can include staff and community members. Typically, once a situation has been resolved or the task has been accomplished, the task force is disbanded. Ad hoc task forces often address such issues as developing a CEO succession plan and exploring potential affiliations.

The American Hospital Association's Health Research & Educational Trust in 2005 conducted a survey of nonfederal community hospitals to which nearly 1,600 CEOs and 906 board chairs responded. Not surprisingly, this research found that almost all boards operate to some extent through a variety of governance committees. The average number of committees was eight.

Of the 16 committees covered in the survey, the five most common were finance, executive, nominating, strategic planning and quality assurance. The five least common committees were government relations, fundraising, personnel, facilities and governance. Almost 1 in 10 respondents indicated that they did not have any of the 16 committees listed in the survey.

The bottom line? Use of these committees, with some exceptions, is highly variable, and depends upon every hospital's unique governance needs. High-performance boards consistently rebalance their board structures to increase efficiency and productivity. That may mean reducing the number of standing committees and replacing them with task forces assigned to delve into high-priority issues.

When Infrastructure Crumbles

Committees and task forces should respond to strategic issues and help the board to lead. When they do not work, it is usually for one of two reasons:

  • The group exists simply due to the board's bylaws or because "we have always had this standing committee."
  • The group did not have clear direction or understanding of its role.

If a group is not functioning well, it likely is suffering from poor planning or does not realize its potential as part of the greater governance effort. This can be avoided with clearly prescribed expectations and an understanding that these groups truly are entwined in the important work of the board. Written records of committee discussions and actions provide a continuous history, refresh members' memories about goals and minimize confusion for new members. Accurate records also help settle differences of opinion, keep members accountable in the event of questions about activities or intentions, and serve as a way to report progress to the greater board.

How do you know if a committee or task force is in trouble? Watch out for such warning signs as:

  • Stagnant or inconsequential agendas that do not drive ideas and recommendations;
  • Lack of purpose and focus of meetings, materials, work plans and recommendations;
  • Composition that lacks the right skills and experience; and
  • Lack of connection to the hospital's mission, vision and strategies.

Zero-based planning. It is important for boards to look carefully at their existing committees and task forces and ask, "Are these groups helping us do our work as a board? What purpose do they serve? What would happen if they ceased to exist?"

The board should consider the type of support it needs, how its current committees and task forces serve these needs, and the structures it would create if starting from "zero" in its infrastructure formation.

When establishing support structures, actions to take include:

  • Keep the focus sharp and avoid work that is too broad to be successfully addressed;
  • Avoid perpetuating outdated structures. Begin fresh every year by assessing what committees are in place, and what others may be needed;
  • Ensure the connection between the groups' work and how the board utilizes that work;
  • Evaluate effectiveness as part of the board's annual self-assessment, reviewing each group's role, contribution to governance success and potential.

Charters. Every committee and task force should have a charter that describes its purpose and responsibilities, how it is to be organized, how frequently it will meet, and how and when it will report to the full board. A charter gives direction, purpose and a clear point of reference. Without a charter, the group may lose its sense of purpose, efficiency and effectiveness.

A typical charter is brief and to the point. Important components include:

  • Purpose and authority, succinctly outlining the primary role of the group;
  • Composition and requirements, which define the number of individuals required, who selects them, the experience required of potential members, and the projected meeting schedule;
  • Duties and responsibilities, which delineate the specific accountabilities of the group and serve as the basis for performance evaluation;
  • Reporting responsibilities, which define to whom or what group the committee or task force reports.

Steps to Infrastructure Success

Here are four steps to ensure infrastructure relevance and performance:

  1. Form a governance committee to determine governance needs. Its primary job is to ensure governance efficiency and effectiveness, and determine ways the board can provide the leadership required to meet the hospital's mission, strategic objectives and vision. The committee should examine the value of board support groups and their work, and make recommendations for changes to strengthen future governance performance.
  2. Develop clear objectives. By clearly defining committee and task force objectives, their members understand how the groups should function, how their work relates to the board's needs, and how success is measured. By discussing and approving the responsibilities of its support groups, the board ensures that the groups are focused on board-approved work that connects to and supports governance success.
  3. Determine resources required. The work of committees and task forces requires resources: time, money and people. Determining those needs will help create groups that have what they need to accomplish their goals.
  4. Evaluate performance and update structures. The board should periodically evaluate the performance of its committees and task forces, and determine their ongoing role and value in supporting the policy and strategy-focused work of the board.

Creating and sustaining a strategic board of trustees is a demanding job. A well-formed, well-managed, high-performance governance structure should facilitate effective governance.

Well-built committees and task forces keep in mind their strategic connection to the board's work; focus upon their purpose; maintain appropriate processes, structure and organization; and are not afraid to press hard to address the unique needs of their board in very specific areas.

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