The rules of engagement for board members have changed dramatically. Historically, the trustee position was honorary; today, trustees are expected to interact more with management and the community and know more about operations. They also have added accountability for legal and regulatory matters. As this role grows in complexity, hospitals are challenged to prepare and educate board members efficiently to be effective fiduciaries without overwhelming them.

Trustees should form a dynamic team in which each member is comfortable speaking in meetings on all issues the organization faces. They should strive to form a high-performing board that embraces continuous learning for the benefit of the hospital and the communities served.

Boards have an opportunity like never before to drive the future of their organizations. It begins with understanding the board’s role and each member’s responsibilities. The trustees at Windber (Pa.) Medical Center, a 52-bed hospital with 500 employees, accomplish this through commitment, engagement and continuous learning.

Monthly Sessions

Windber board members participate in ongoing education to help discharge their responsibilities better and position the organization for the future. At most monthly meetings, education typically falls into one of two categories: governance education about the board’s role in areas such as community benefit or quality, or education in strategic areas like growth opportunities in service lines or marketing plans. Other topics include issues that trustees may hear about in the community or ideas from other organizations, such as improved patient billing practices.

Windber’s trustees use internal and external resources for education, and all training is done on-site so the entire board can participate. Depending on the topic, executive staff may address the board or engage an external resource such as the state hospital association or other consultant.

As a result of a recent education session on how to be a high-performing governing body and increase awareness of governance best practices, the board restructured its agenda to eliminate the presentation of routine reports on completed committee work. Because trustees are expected to review these reports in advance of each meeting, discussing them is unnecessary unless board members have questions or further action by the full board is required. Using a consent agenda, which allows reports to be approved as a group, has enabled routine matters to be handled more efficiently.

Education sessions also allow the CEO and senior management to provide insight and support to the board and vice versa. Trustees gain greater confidence in management’s ability to run operations, which enables them to focus on governance. For example, management recently presented its physician growth strategy, which led to a dynamic discussion between executives and trustees about medical staff needs and recruitment plans.

Empowered Trustees

An interesting outcome of spending more time educating board members and less on routine business is that trustees participate more in strategic discussions about the hospital’s needs and what impact the board’s decisions have on the organization. A recent educational session explained reform’s impact and led to a strategic discussion about future needs and changing roles.

Education and strategy are interconnected. A board that doesn’t understand its role will struggle to conduct effective discussions about how it can help fulfill the organization’s mission. At Windber, trustees made quality one of two topics for detailed discussion at meetings. Finance always had been a focal point, but quality now requires an equal amount of the board’s attention. Because oversight of quality and patient safety is of utmost importance, management and trustees collaboratively developed a board quality committee. Through the committee, trustees monitor quality metrics using dashboard reports. Including quality oversight as a major responsibility of the board means our trustees also expect it to be a major focus of board education.

The amount of time trustees commit to understanding their role is a critical factor in the board’s success. A strong board with educated, engaged trustees is a major asset for the organization and the community.

Barbara Cliff, Ph.D., FACHE (, is president and CEO of Windber (Pa.) Medical Center.