In my house, risk management is a fancy way to say "child-proofed." Cupboards and drawers are locked, stairs are gated off and anything that can be swallowed, climbed on or turned into a hammer by my toddler son or infant daughter has been temporarily relocated to a higher shelf or permanently relocated to the Goodwill. We can't protect against every threat—who knew our cat looked edible?—but somehow we're staying safe.

More than ever, hospitals and health systems can't afford the unexpected, whether it's an injury to a patient, an information system security breach or an unanticipated lawsuit. This is why risk management is essential. However, a department-level understanding of incipient threats is no longer adequate.

In our cover story, two health care systems use the principles of enterprise risk management to assess their vulnerabilities on a global level and to respond accordingly. ERM requires a change in mindset, and board members can lead this change by requesting regular updates on potential risks and guiding the organization to an acceptable level of exposure.

Trustees have another difficult job on their plates, and that is guiding their organizations through health care reform. The board's role, according to AHA President and CEO Rich Umbdenstock, is "keeping the institution in sync with the environment in which it operates." Undoubtedly, the environment is changing and will continue to change for the foreseeable future. Like enterprise risk management, adapting to it will require a comprehensive understanding of your organization's strengths and weaknesses.

The interview with Umbdenstock kicks off Trustee's reform coverage. In the coming months, we'll bring you articles on delivery system reform and the link between payment and quality.

How is your organization staying "in sync" with its environment? If you have a moment, let me know at