Every trustee is responsible for fulfilling leadership duties and responsibilities, but perhaps the most critical leadership role is that of the board chair. The chair is responsible for molding board members into a cohesive and effective strategic leadership team. Good governance depends upon the chair's ability to nurture trusting relationships with the chief executive officer and fellow trustees, develop compelling and focused strategy-based agendas, and guide purposeful governance discussion.

The chair has several primary responsibilities. She must work closely with the CEO so the work of the board is closely aligned with the hospital's challenges, opportunities and strategic direction; understand board members' skills, experience and perspectives; and inspire trustees to govern with a focus on achieving the organization's mission and vision. Specifically, the board chair should:

  • serve as trustees' primary contact on governance issues;
  • ensure that clear board goals and objectives are established and met;
  • ensure that members are actively involved in committee and other board-related activities;
  • motivate trustees to grow and excel in their governance responsibilities.

While serving as the board's leader, the chair may face challenges that have the potential to become obstacles overlaid on top of already existing demands. Common challenges that may inhibit board chair success may include:

  • lack of a well-defined, board-approved role description;
  • lack of formal development or preparation to carry out the chair's duties;
  • leading and coalescing the leadership capacity of individuals with varied experience, interests, motivations and objectives;
  • governance misalignment or micromanagement.

Building and Sustaining Trust

Trust plays a vital role in the ability of the CEO, chair and trustees to communicate openly and honestly. Without it, individuals may hesitate to participate in discussions, raise issues or share their views. The chair and the CEO must rely on one another for support, consultation and advice, complementing one another's strengths. The chair should communicate regularly with the CEO to ensure that the board is leading and supporting the organization's strategic direction.

The chair also must build a positive rapport with all board members, understanding their individual motivations for involvement with the hospital and their interests and needs. The chair also must be mindful of gaps in their knowledge, ensuring that regular board education addresses these gaps and encouraging them to ask questions. The chair's attention to individual trustees' needs demonstrates interest and support, and helps to build a positive environment for dialogue and decision-making.

Ensuring Productive Meetings

Board members dedicate their time to the community by serving on the hospital's board. It is the chair's job to use that time well by adhering to the agenda and eliminating side conversations and other distractions.

Poorly planned agendas, routine reports and too much emphasis on operational issues waste valuable meeting time. Meetings should focus on the vision, values, governance policies and strategic leadership issues critical to future success. It is essential that all board members be fully informed about important issues and that agendas be geared toward the organization's strategic future.

The CEO and chair are jointly responsible for developing the meeting agenda. It is the chair's duty to communicate with the CEO to ensure that topics are relevant to long-term strategy. Agendas that are purposeful, engaging and outcomes-focused maximize board time spent on important issues. The chair facilitates the meetings by directing the flow of conversation, which includes ensuring that appropriate time is allotted to each topic and engaging members in deliberative dialogue. When the board gets sidetracked, the chair leads members back to the agenda. He also starts and ends meetings on time.

Strong, consistent chair leadership is essential to the board's ability to engage in mission, vision and strategy-focused discussion and decision-making that lead to organizational success. The position demands individuals with extraordinary leadership qualities, energy, focus and a desire to be a catalyst for change.

Larry Walker (lw@walkercompany.com) is president of the Walker Company Healthcare Consulting LLC, Wilsonville, Ore. He is also a member of Speakers Express.


Responsibilities and Expectations

Organizational Focus

1. Understand the hospital's issues, strategic direction and governance objectives.

2. Understand the hospital's strengths and weaknesses, and the personal interests and needs of all board members.

3. Work with the board of directors and paid and volunteer leadership, in accordance with hospital bylaws, to establish and maintain systems for:

  • planning the organization's human and financial resources and setting priorities for future development;
  • reviewing operational and service effectiveness and setting priorities for future development;
  • overseeing financial progress;
  • acquiring, maintaining and disposing of property;
  • ensuring community involvement;
  • ensuring that the ethical standards and values of the hospital are consistently followed.

Leading the Board

1. Articulate and lead a clear, sensible, achievable purpose for the board.

2. Improve the effectiveness of the board by setting goals and expectations, cultivating leadership among individual board members and working with the governance or nominating committee to make board development a priority.

3. Establish accountabilities to keep the efforts and actions of trustees on track toward achieving organizational strategic goals.

4. Inspire others to work diligently toward achieving the hospital's vision.

5. Oversee the hiring, evaluation and compensation of the CEO and work to develop an executive succession plan.

6. Assist the governance or nominating committee in identifying potential individuals to recruit for service on the board.

7. Take part in board member orientation, development and evaluation.

8. Appoint trustees to key leadership positions, including positions as committee chairs.

9. Serve as an ad hoc member to all board committees.

10. Support fundraising with financial contributions; set the example for other board members.

11. Promote the work of the organization in conversations, speeches, interviews and other day-to-day activities.

Effective Meetings

1. Work with the CEO, board officers, committee chairs and individual trustees to develop agendas for board meetings, and preside at these meetings.

2. Bring order and purpose to the boardroom.

3. Motivate board members to attend and actively participate in meetings.

4. Call special meetings as necessary.

5. Ensure 100 percent participation in the annual board and individual trustee self-assessment.

Managing Relationships

1. Develop relationships based on respect, trust and communication with other board members, the CEO, physicians and other providers, and the media.

2. Build successful working relationships and open communication with the CEO and other trustees.

3. Understand and adhere to the boundaries among the board, the chair and the CEO, and balance the needs of each.

4. Act as counselor to the hospital CEO on matters of governance and the CEO's relationship with the board, and as a counselor and mentor to board members.

5. Be involved in the community as an ambassador for the hospital's interests. — L.W.