Center Voices Logo. Center for Healthcare Governance

Three years ago the board at Hendrick Health System, a 504-bed medical center, changed its meeting structure from a passive, report-driven format to one that is strategic. The new meeting structure enhances trustees' purpose and allows them to better focus on the hospital's annual goals.

Bringing more accountability to the board and the organization was the driver behind the change, as the board wanted to have more responsibility for the decisions it made and for staff to have more accountability in carrying them out.

The process of holding strategic meetings begins with developing a number of goals each year that management and the board are held accountable for achieving. This approach creates a heightened sense of awareness among trustees and compels staff to perform at a higher level.

Four to six overarching goals are established by the board at the beginning of the year. Some of the goals are systemwide, such as financial or patient satisfaction targets, and are coordinated through the president and CEO. The remaining goals are more specific and are handled by the organization's vice presidents. The overarching goals are then passed down to each board committee, which develops its own goals in support of them. The committees' goals are submitted to executive staff who develop their goals to support the committee and board's goals. Staff is responsible for implementing all board, committee and executive staff goals.

The 15-member board monitors the progress of each overall goal via staff reports at the board's bimonthly meeting. Though the vast majority of trustees' time is spent discussing the goals, board members also take part in an educational session at every board meeting highlighting a particular department. This has a strategic element because it gives trustees a better understanding of how the hospital works. In addition, board meetings are not only longer but are also more in-depth. This helps the organization focus on issues at hand and brings added meaning to trustees' committee roles.

The process for achieving strategic board meetings also involves looking strategically at the board's committee structure. In our case, we combined a number of committees. This made for fewer meetings to attend, allowing trustees and staff to focus on particular areas of interest and not get distracted with other issues that may arise.

A benefit of the strategic meeting structure is it gives board members clarity of purpose, which is especially important for a volunteer board. By examining goals throughout the year, trustees know they have a chance to accomplish concrete objectives.

Here's an example of how the new meeting and committee structure works. One of the overarching goals for the year is to increase the number of physicians on the medical staff. This goal was given to the medical staff development committee—composed of four hospital board trustees, four community members and four physicians. The committee was charged with strategically reviewing medical staff recruiting needs for the coming year, particularly with regard to specialty physicians. The four community members—mostly business leaders—provided insight into the physician needs of their employees. Their feedback gave the board a unique and unbiased perspective. With only a physician viewpoint, the board might have received differences of opinion on what specialties and numbers of physicians were needed.

The committee's findings were submitted to executive staff and then delegated to direct reports in charge of recruiting physicians. Staff provided regular progress reports to trustees. The process gave board members insight into the organization's physician needs that they might not otherwise get.

At the end of each board meeting, trustees complete a brief questionnaire about specific topics that were on the day's agenda. The goal is for staff to get detailed feedback while the meeting is fresh in trustees' minds. Sample questions might include: "Did you have adequate information ahead of time on the items you voted on?" or "Should the meeting day or time be changed?"

Even outside of board meetings, trustees work to make their board meetings more strategic. For example, the board attends a two-day strategic planning retreat every three years. At the most recent retreat, the board agreed to create a new governance committee that would look at specific things board members should be doing, such as self-education. The governance committee, for example, made the decision that all trustees would attend one outside educational conference during their three-year term. This ensures trustees interact with board members from other health care institutions and learn about other best practices.

The most important aspect of our strategic board meetings is that trustees have the opportunity to spend time at the beginning of the year thinking and discussing issues that have a long-term impact on the hospital. This approach keeps trustees focused and provides sustainable success for the organization.

Tim Lancaster, FACHE (, is president and CEO, Hendrick Health System in Abilene, Texas.