Recruiting board members is a challenge for every hospital and health system, but the task is particularly difficult in small communities. At Benefis Health System, Great Falls, Mont., our pool of candidates is largely limited to the city’s 60,000 residents, despite the fact that we are the tertiary referral center for a population of 250,000 across nearly 40,000 square miles of rural Montana.

We keep the trustee recruitment process relatively simple, which has served us well. We consider certain skill sets — finance, business, health care delivery — to be core competencies for our board. When a board vacancy occurs, we identify the skill set that must be present in candidates for that position. For example, if an open position previously was filled by a financial professional, we likely would replace that trustee with another financial professional.

Our board also draws on skill sets that reflect organizational priorities and needs. Over the past 10 years, we have invested more than $400 million in new construction and renovation projects. Having a trustee with an engineering background was a great asset to the board. Now that this intensive construction period has ended, that trustee retired and was replaced with a nurse educator who has helped the board gain broader clinical expertise and expanded its capacity to understand future health care workforce needs, another system priority.

Our organization recently has focused on developing an integrated information technology platform. In the past, information technology expertise wasn’t a recruitment priority, but considering the money, time and attention we are devoting to IT, having that competency on the board makes sense. This year, we are evaluating several electronic health record vendors, and we are fortunate that our board’s vice chair is a chief information officer at his company.

Growing Our Own

Once the necessary skill sets have been identified, our next step in recruitment is finding candidates with those competencies. We frequently tap our own “farm team,” or advisory boards, for new members.

Benefis established advisory boards for various components of the health system, including hospitals, medical group, health system foundation, a home care and durable medical equipment company, and senior services. The advisory boards are an effective way to increase the community’s awareness of the health system, get more community members involved and develop prospective system trustees. Our most recent system board vacancy, for example, was filled with a member of the health system foundation board.

Scarce Independent Clinicians

All board candidates are vetted, which includes determining whether they meet Internal Revenue Service criteria for independence. We are careful to ensure that our board meets or exceeds these standards. While this mandate may seem straightforward, the size of both our community and our health system limits the local pool of candidates who meet this benchmark. Indeed, practicing physicians and nurses in our area rarely meet these criteria. However, because we consider expertise in health care delivery a core competency, our board includes a nurse educator and three physicians, two of whom are retired and, therefore, are independent. The third, a practicing surgeon, is not an independent board member.

Once a candidate has been vetted, the nominating committee submits its recommendation to the health system board for approval. The board chair and several other board members typically take the potential board member and his or her spouse to dinner to discuss the trustee role and responsibilities and offer the appointment. The chair explains that the role of the board is not operational and that that line should never be crossed. Together, the chairman and candidate review a document detailing the trustee’s responsibilities and general duties, which, upon acceptance of the board position, the candidate signs.

No More Term Limits

Given the complexity of health care and how long it takes for a board member to get completely up to speed, we eliminated board member term limits a few years ago. At the end of each three-year term, assuming the board member meets performance standards, he or she is offered the opportunity for an additional three-year term. The performance evaluation, conducted by the board governance committee, includes an assessment of the member’s participation, value added to the governance process, understanding of the board’s role, meeting attendance, ability to maintain confidentiality and interpersonal skills.

Being a hospital or health system board member is an important responsibility. Our trustees are the health system’s biggest champions and, while they enjoy their service, they also take it seriously because they know how vital Benefis Health System is to our community and the region. 

John H. Goodnow, FACHE (, is CEO of Benefis Health System in Great Falls, Mont.