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Trustees are responsible for making sure that every hospital department has continuous quality improvement processes in place. But how do trustees manage their own continuous quality improvement? How can they determine how well they are performing their leadership responsibilities? And for what do they hold the board chair, the board's chief officer, accountable?

Board Member Assessment

Successful governance practices and performance assessments should include trustees' individual assessments of their own and their peers' performances. The self-assessment process helps to identify personal "leadership gaps" and facilitates the development of personal initiatives to improve leadership performance.

A peer assessment is a good way to evaluate personal governing performance. It enables trustees to evaluate their board colleagues' performance. Trustees can benefit from knowing how colleagues view their performance and their ideas about ways to improve their leadership effectiveness.

Trustees should rate themselves and their colleagues in two areas: governing attributes, the factors that define their performance in fulfilling their governance duties; and personal attributes, the factors that describe the personal strengths and abilities required for effective trusteeship. These are examples of attributes that may be included in a peer assessment:

1. Governing Attributes

  • Demonstrates understanding of the hospital's mission and vision through his or her governance participation
  • Has productive working relationships with the CEO and other board members
  • Understands the key issues and challenges facing the hospital
  • Focuses attention on long-term policy issues rather than operational issues
  • Asks probing and insightful questions intended to further the hospital's progress and performance
  • Has a high level of commitment and interest in the organization
  • Represents the hospital as required in local professional, civic and service organizations
  • Comes to meetings prepared to engage in meaningful discussion and thoughtful decision-making

2. Personal Attributes

  • Can discuss controversial topics effectively and respectfully
  • Works well with other board members and administration
  • Keeps an open mind on issues
  • Willing and enthusiastic promoter of the hospital
  • Meets time commitments
  • Asks for and listens to others' ideas and input
  • Maintains confidentiality
  • Handles ambiguous situations well
  • Continually seeks to improve his or her leadership performance

In addition, trustees should answer one simple question after rating each other: "What suggestions do you have for ways this trustee can improve his or her governing performance?"

After the peer assessments are completed, the results should be put into reports that compare each trustee's personal ratings with the mean scores of his or her colleagues. The reports also should include the conclusions reflected in the suggestions for improvement. The board chair should review the report with each trustee, and confirm a commitment to improvement, if necessary.

The peer review process will provide trustees with unique insights into their leadership attributes and needs based on the varied and well-informed perspectives of their trustee colleagues.

Board Chair Assessment

As the leader of the board, the chair is a vital part of the board's ability to engage in fruitful discussion and focus on the long-term strategic issues driving organizational success. The position demands individuals with extraordinary leadership qualities; a desire to be a catalyst for change; energy; focus; and continual commitment.

Evaluating the chair's performance should be a part of the board's annual assessment of its practices and performance in leading the hospital. Below are sample criteria in six categories for inclusion in the chair assessment:

1. Trustee Performance

  • Motivates board members to elevate their leadership expertise and effectiveness
  • Is attuned to members' personal knowledge and leadership development needs
  • Ensures that each board member adds value to the organization, and that board service is a fulfilling and enriching experience
  • Serves as the chief contact point for members on all governance issues
  • Builds and maintains strong and effective communication and relationships with all members
  • Is competent, decisive and trustworthy in all relationships
  • Inspires confidence among members in their governance endeavors
  • Works with the nominating committee to identify and recruit new board members

2. Relationship with the CEO

  • Ensures communication with the CEO that is based on mutual trust and confidence
  • Works in partnership with the CEO to ensure board actions are successfully carried out
  • Coordinates CEO's annual compensation and performance evaluation with the compensation committee
  • Serves as a counselor to the CEO on governance matters and relationships with board members
  • Assists the CEO in orienting new board members

3. Decision-Making

  • Ensures that all viewpoints are considered before the board makes final decisions
  • Drives the board to reach consensus, even on difficult issues
  • Is objective at all times to avoid influencing board members
  • Nurtures and facilitates member cooperation and a sense of unity and purpose in governance activities

4. Strategic Direction

  • Keeps the board focused on strategic objectives and direction
  • Ensures that annual governance goals and objectives are established and met

5. Organizational Ethics

  • Ensures that the board adheres to the hospital's bylaws, and trustees' role and responsibilities
  • Ensures the integrity and ethics of all governance processes
  • Anticipates and successfully manages conflict

6. Community Involvement

  • Acts as a representative for the organization, when appropriate
  • Energetically advocates for the hospital in the community and in the political arena

Board member peer assessment will strengthen every board member's capacity for leadership improvement. And an evaluation of the board chair's performance will assist the chair in carrying out his or her critical leadership responsibilities.

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.

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