The board of Northwestern Medical Center, a 55-bed hospital in Saint Albans, Vt., is in its third year of assessing its performance. The objective is twofold: to provide insight on board strengths and weaknesses and to identify areas to enhance performance in the coming year.

Board members, who are elected by up to 150 local residents, complete an annual assessment and rate performance across several areas of responsibility, such as strategic planning, finance, quality, management oversight and board effectiveness. To ensure 100 percent participation from our 12 board members, assessments are conducted electronically so that directors can complete them wherever they choose. If additional time is needed, assessments are completed at one of our monthly board meetings.

To get the most out of assessments, we believe a full evaluation is imperative. Each area of board responsibility assessed contains six to 10 questions. Questions for evaluating the board's oversight of strategic planning include:

  • Has the board adopted a strategic plan consistent with the community's current and future health needs?
  • Does the board annually review and revise its strategic plan?
  • Does the organization have a three-to-five-year financial plan?

After the assessments are completed, we analyze the results for trends that indicate opportunities to enhance performance. A report on assessment findings is compiled and provided to the board for discussion, and an action plan is then developed. Board members identify where the full board is collectively competent or needs improvement.

Based on results of our first assessment, the board developed a one-year action plan that provided formal educational opportunities through webinars and conferences to address various aspects of its performance at meetings. The board's orientation also was revamped to provide a more comprehensive overview of the hospital and the role of the board.

As a result of our second assessment, we continued providing educational programs and prioritized them as high, medium and low opportunities for governance improvement, based on the board's needs. Results from our most recent assessment suggest that we focus on providing directors with education on more complex topics to further support decision-making and strategy and policy development.

In addition to off-site educational opportunities and supporting continuous learning, the board devotes 30 minutes to education at each of its meetings. Last year, for instance, the board identified health reform as a high-improvement area for governance. National experts attended one board meeting to provide perspective on policy issues such as compliance and risk oversight. At another meeting, local experts discussed partnering and building relationships with other organizations to form an accountable care organization.

Gaining a better understanding of hospital operations was identified as a medium improvement opportunity. By touring the radiology department, the board better understood how the area functions. Employees also had the chance to see directors taking an interest in the staff and their work, which deepened the board's connection with the organization.

Expanding board education is one of the many benefits our directors have experienced through board assessment. Regular evaluation helps to ensure that Northwestern Medical Center board members receive the right tools and resources to govern effectively. We have found that ongoing, formal assessment of board effectiveness is a process that is necessary to support development of a high-functioning board.

Jill B. Bowen, R.N., FACHE ( is CEO of Northwestern Medical Center, Saint Albans, Vt.