Health care is changing, and this transformation is exciting and challenging. As chair of the board of Silver Cross Hospital in New Lenox, Ill., I look forward to the challenges because my fellow trustees and I are more engaged in the organization's decision-making process and viewed as partners with the executive management team. However, this transition can be daunting for the very same reasons it is exciting and challenging.
Dealing with both opportunity and complexity in an environment of fundamental change raises the stakes for board leaders and members. Governing during times of heightened risk (and, potentially, heightened reward), adds greater meaning to board work. But this wasn't always the case.
When I first joined the board 15 years ago, trustees served primarily in an advisory role. We were there to listen and provide input — more to help than to govern. Important decisions were left to the executive team, which also took responsibility for them. That has changed. As health care became more complex, our board moved beyond an advisory role to governing in partnership with our executive and clinical leaders to ensure that the hospital established its vision, fulfills its mission and lives its values.
Continuous Learning Required
To govern in ways that add value for their organizations, today's boards need to answer, among others, two important questions: First, what type and level of expertise is required of trustees to guide their organizations through significant change in health care? And second, how can our board obtain the needed skills and expertise?
I began my board service with a strong background in finance, but soon found there was much more to learn about health care. The amount of information board members are expected to understand today has increased dramatically along with the time they spend on governance, as the number of board and committee meetings, complexity of decisions and the overall workload has swelled.
This gives rise to the related task of identifying a source for the expertise trustees need to govern. Many boards mainly rely on their executive teams for governance information and education. But, to obtain a broad, balanced view of an evolving industry, boards need to be proactive in their search for additional educational resources and to engage in continuous learning.
Silver Cross provides useful information for governance through membership organizations, industry periodicals and outside conferences and board retreats. Yet our trustees, like many others, are challenged to spend the additional time needed to take advantage of these and other learning opportunities that may be needed to gain the well-rounded perspective required to perform their roles and responsibilities.
The good news is that boards are doing important, meaningful work. The opportunity to make a difference should attract talented individuals who want to use their skills and are willing to make tough decisions to ensure that quality health care is available in their communities.
The Board's Air-Traffic Controller
I became the board chair in June 2013, and view my role to be primarily twofold: to facilitate discussions and focus on governance. As a facilitator, I don't share my personal views as much as I did when I was a trustee. My role is to make sure all board members have an opportunity to provide input into discussions. If the chairman asks all the questions or provides most of the input, then meetings become chair-dominated events, which isn't an effective approach. As chairman, I want to make sure that the full board thinks deeply together about the key issues in front of us. To accomplish that, I also work with the executive team to allocate agenda time to ensure we have effective meetings.
The governance aspect of my role requires that I support the board in making the right decisions at the right time with the right information. In a sense, I am an air-traffic controller on governance issues, working with our executives and other board leaders to ensure that issues are handled by the right board committees and brought to the full board with the information and time needed to consider them.
During my tenure thus far, issues that have required my attention include risk oversight, board and leadership succession planning, vetting and ongoing evaluation of new business models, physician integration, and forging relationships with other providers and community organizations to build the care continuum and improve community health. While most boards likely face these same issues, it is the chair's responsibility to help the board and organizational leaders to focus on the issues that are having the most impact locally.
At Silver Cross, we have been focusing on hospital-physician relationships and integration because we believe that changes in the industry are requiring changes in that relationship. We want the hospital and physicians to shape those changes together. To me, it seems the top issues all come back to the root issue of hospital-physician relations and integration. We don't know how it's going to play out, but we view it as an opportunity.
Broad Knowledge Base
The expertise I gained as a trustee helped me to prepare to take on the role of chair. Even though finance is my strength, I rotated among board committees, starting on the quality committee, to broaden my knowledge and expertise. I also chaired several committees to gain depth and experience on governance issues.
I believe that good chairs know the difference between their role and that of the hospital chief executive. I prefer not to meddle in the day-to-day affairs of the CEO, and I don't expect the CEO to manage the board. The board has to manage the board.
These are demanding times for our health care institutions. Boards must understand complex issues, while embracing governing responsibilities that typically are much more than advisory. Because trustees care deeply about their institutions and the communities they serve, I am confident that with the right resources, support and committed board leadership we will all rise to the challenge.
Stephen G. Morrissette, Ph.D. (firstname.lastname@example.org), is chairman of Silver Cross Hospital, New Lenox, Ill. He also is associate professor, College of Business and Health Administration, University of St. Francis, Joliet, Ill., and faculty associate with the American College of Healthcare Executives, Chicago.