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Hospital and system governing boards do not become excellent by chance. They achieve it by practicing key leadership habits that ensure long-term leadership effectiveness. Boards that pay close attention to the following five leadership habits will find that their governance processes improve, their leadership skills are enhanced, and the quality of their decision-making and strategic focus is sharpened.

  1. Use the mission, vision and values statements to drive strategy. These documents are more than words on paper; they are crucial positioning elements that drive decision-making, strategies, objectives and action plans. Every board decision should strengthen the hospital's ability to achieve its mission, vision and values.

    A clear understanding of the evolving health care environment and community needs is the foundation of successful strategic thinking and planning. This mindset will ensure a flexible, responsive planning process that can adapt to changes. The process also should include a way to monitor progress in achieving strategic objectives.

    Organized, focused governance practices will enable the board to become more productive, and ensure that its time is allocated to the most critical topics. Agendas should reflect the most important strategic issues and priorities to make efficient use of trustees' valuable and limited time; meetings should be designed to maximize trustees' ability to engage in critical dialogue; and committees and task forces should enable the board to focus time on high-level strategic discussion and decision-making.

  3. Balance black, white and gray thinking. A turbulent environment requires organizations to be highly attuned and adaptable to change. Instead of reacting to changes, boards must be proactive in their choices. This requires an early warning system that enables the board to address issues before they become unmanageable. When challenging situations arise, the board should quickly dig below the surface to understand the cause so that appropriate, effective actions can be taken.

    Even with the best processes in place, miscommunication and poor judgment still can occur. Board members can avoid these problems by listening first and talking later, acquiring and absorbing new ideas, listening attentively without rushing to judgment, and internalizing information before offering a definitive response.

    Board members also should be comfortable challenging thoughts, ideas and the status quo. Without constructive challenges to conventional wisdom, the best solutions may never surface. Trustees should regularly confront issues by questioning assumptions and exploring alternatives to traditional thinking. Doing so may cause short-term tension and disagreements, but this tension should be welcomed and resolved through organized, deliberative dialogue.

    Part of challenging conventional wisdom means seeking opinions and ideas that may be different from the board's own. Boards can accomplish this by listening to a variety of voices outside the organization and engaging the viewpoints of people with unique experiences, backgrounds and perspectives. In doing so, boards will expand their knowledge base, build a mutual understanding of diverse perspectives and open new lines of thinking.

    Finally, because board and committee meeting time is limited, every minute should count. Board members must ensure that their conversations are always vibrant, vital and focused on purpose and outcomes. Dialogue should be the board's "social operating mechanism;" that is, consistent, constructive dialogue should be ingrained in the board's culture. Every board member should be expected and prepared to both stimulate and energetically participate in vital discussions that advance governance knowledge, and that lead to well-informed, evidence-based decisions and direction. Through conversations, decisions are made by grappling with concepts, ideas and practical solutions, leading to more informed and rational conclusions.

  5. Avoid crises by watching for details. Becoming overly obsessed with what-ifs can paralyze an organization, but exhibiting a so-called controlled paranoia can push the board to continually think into the future. Boards must take time to consider the possibilities of market change, driven by both internal and external factors. One way to assess the impact of possible events is to predict various futures, and play out scenarios that reveal the actions the organization might take should the scenario, or some version of it, occur. This requires an understanding that in the current health care world, there are no straight lines to the future.

    Creating time on the agenda for meaningful discussion of the most significant issues facing the hospital is one step to ensure that future challenges, barriers and opportunities are considered. The board should focus on understanding trends and strategic priorities, rather than dealing with operational details.

  7. Focus on meaningful transparency. Boards are accountable for the hospital's quality of care, and should lead the organization to provide the best care possible. They also should clearly communicate it to the community. Quality data increasingly is becoming transparent and available to payers, consumers and the community, and hospitals should be at the forefront of making the information understandable and accessible for the community. And while the focus on quality starts at the top, quality literacy should be part of the hospital's DNA at every level.

    Price is a complex matter for hospitals and consumers alike. As consumers assume greater responsibility for where and how their health care dollars are spent, price transparency and easy-to-understand bills will become increasingly important. Boards should work to make clear, meaningful price information accessible to the public. Additionally, charity care policies should be communicated clearly and accessed easily throughout the organization.

    The board also should communicate governance strategies and objectives to employees, stakeholders and the community whenever possible. Governance information should be prominent on the hospital's website, including the names and backgrounds of board members, information about committees and task forces, and an overview of the role of the board.

  9. Form strong community partnerships. Gaining and sustaining the trust of the community is critical to hospital success. Boards must recognize how their actions contribute to building and maintaining a positive image. The hospital should regularly measure public perceptions; by understanding the implications of these perceptions on future success, boards can adjust the ways in which they communicate and deliver services to the community. Forming close community partnerships also will help to build and sustain positive attitudes toward the hospital.

    True community centeredness extends beyond building community trust and relationships. The best way for hospitals to serve the community is by first understanding what is most needed. Boards should secure community input and viewpoints on health challenges and opportunities, which then must be followed by a meaningful implementation of improvement initiatives.

In an accountability-focused world, hospitals must be able to define, measure and report the benefit and value of their activities to the community. It's important to measure the success of hospital initiatives in improving health, and clearly communicate priorities to key stakeholders and the community. The results then should be promoted in an annual community benefit report.

Larry Walker ( is president of The Walker Company Healthcare Consulting LLC, Lake Oswego, Ore. He is also a member of Speakers Express.