It is hard to imagine an industry more turbulent than health care or a position more demanding than hospital board chair. Beyond the challenges of providing oversight for a highly complex delivery system, the chair must stay abreast of changing regulations and increased competition, not to mention the promises of emerging political leaders to enact wholesale changes. He or she must also strike a precarious balance between being involved and being observant.

That’s why grit is a basic ingredient for any successful board chair. So, too, is a high level of awareness, beginning with how one’s actions may affect the trajectory of the organization. When complemented by a clearly articulated and thoughtful set of strategic imperatives, the board chair is in an optimal position to be an effective shepherd or change agent, depending on what is needed most.

The big picture

The chair’s strategic imperatives should stay clear of operational issues. They should focus on core principles that lead to success. What follows are my top five imperatives for a board chair — for the moment when someone waves a magic wand and casts me in the role:

1. A communications imperative: My first imperative is based on the belief that little good can be achieved unless there is clear and honest communication. Unfortunately, I have all too frequently observed senior leaders shielding their board members from vitally important information. In fact, it is sometimes stunning how little board members understand about the key issues affecting their hospital’s viability.

I would establish a trust level with senior leaders so there is no fear of recourse for speaking the truth. The board should serve as an advisory partner, not a judgmental body looking for fault. Most important, there should be freedom on the part of hospital leaders to challenge conventional wisdom and, ideally, to catalyze real growth for the institution in the process. Such trust can require time to establish.

2. A cultural imperative: Early in my career as a strategic consultant, I made the grave error of pooh-poohing the importance of culture, not realizing that it was the greatest rate-limiting factor in organizational performance improvement. In fact, the most astute strategy can be quickly rendered impotent by a dysfunctional culture.

Because I believe that culture is either a great enabler or disabler of change, I would start by creating a cultural inventory to categorize, then assess the values and virtues that drive the organization and whether those values advance the health and well-being of the hospital and its patients, personnel and doctors.

I would suggest that an impartial third party be retained to interview a sampling of major constituencies, including all levels of personnel, physicians, patients, board members, media and philanthropic supporters. Participants should be asked questions to reveal their perceptions of the core values underlying the organization, including concerns such as articulated values that do not appear to be honored in practice.

I would designate a task force to help oversee this process and use the research as grist to formulate recommendations to the board. Based on past experience, I expect those recommendations would likely fall into one of three major categories:

  • Recommendations that reinforce essential values and virtues that are at the core of the organization’s identity.
  • Recommendations that address gaps in those values — gaps considered to be of high importance to major constituencies yet missing from the cultural inventory.
  • Recommendations that mitigate negative attributes that affect perceptions of the organization.

Without wanting to unduly influence the outcome of the process, I would hope to see certain values and virtues embraced, including fairness and equity in all of our dealings, treating our patients and employees with dignity, acknowledging our deficiencies and errors (and working together to correct them), humility (a virtue I often find lacking), shared respect for our physician partners and a consistent commitment to excellence in everything we do.

3. A value-driven imperative: My next task would be to learn everything I possibly could about the breadth, depth and relative value of the services the hospital provides to the community. That’s a bit of a Herculean task for a layperson but is nonetheless an appropriate imperative.

My goal would be to answer two questions: Are we delivering optimal value for every health care dollar spent in our organization? If not, what plans are in place to optimize quality, accessibility, safety and efficiency? There may not be ready answers depending on the sophistication of the organization’s data-intelligence function, which, in itself, can be telling.

Though it might run antithetical to short-term financial concerns, I would also ask what we are doing to maximize the health and well-being of the population we serve while reducing the unnecessary consumption of expensive health care resources. Are we moving rapidly enough toward maximizing population health as part of our value proposition?

4. An environmental imperative: I would ensure that there was an astute understanding of current and forecast trends — locally, regionally and nationally, shaping the environment in which the hospital operates — followed by rock-solid thinking about how those trends could impact the organization. This environmental assessment should align almost perfectly with strategic and capital allocation plans. My goal would be to establish that we are truly forward-looking, not blinded by the demands of daily operations.

5. A governance imperative: Finally, I would take a hard look at how board members are selected, as well as their terms and the expectations for them during those terms. I would seek people who are passionate about the organization and able to foment exciting, challenging and constructive discussions. I would ask each board member to craft a personal plan that articulates how he or she would further the mission of the organization without being intrusive in its operations.

Setting the tone

The job of board chair is, indeed, complex. In simpler times, it was more custodial. Today, it requires dynamic, energized thinking in tandem with an impeccable partnership with the senior leadership team. 

John Leifer ( is the author of The Myths of Modern Medicine: The Alarming Truth About American Health Care and CEO of the Leifer Group, a health care strategy firm in Leawood, Kan.