Resource Library

Effective decision making often requires different techniques or approaches for different types of decisions. The following techniques and practices can help support and strengthen your board’s decision-making processes.

The organization’s most important stakeholders have been identified/specified. A descriptive/analytic profile has been prepared for each key stakeholder. The interests (needs/wants, expectations and organizational success criteria) of each stakeholder have been documented.

Just as the health industry continues to shift care delivery from a volume- to a value-based model, so too must the health care board evolve beyond its traditional fiduciary and core governance responsibilities to encompass a more strategic and global view. The success of this evolving model depends on shared governance—a stronger alignment and engagement among the board, physician leadership and management.

The road to integration of hospitals and physicians has been a rocky one for many health care organizations. Failed attempts to integrate in the 1990s resulted from the realization that operating physician practices was very different from operating hospitals, leaving many health care providers wary of heading down the same road again.

The Hospital System Board of Trustees Quality Committee shall meet quarterly in order to provide: Visibility and focus for the organization’s commitment to the delivery of high quality medical care; Oversight of quality and performance improvement initiatives across the Hospital System.

Most boards and governance experts say boards should be meaningfully involved in shaping and ultimately approving the strategic plan and major decisions—but if they try to develop plans, they’re bordering on management. The tricky part is distinguishing meaningful involvement from development.

High-performing boards across the country have made great strides in enhancing their effectiveness and efficiency.

Today’s hospital leaders know their trustees must be more adaptable, connected and knowledgeable about the changing health care landscape than any of their predecessors. But do they believe their volunteer community board is truly capable of stepping up to current field challenges?

Here are 10 steps for optimizing the way a board uses its meeting time.

The highest-performing boards across the country share certain key characteristics that can be grouped into five categories - visionary, nimble, intentional, competency-based and objective.

Mergers and acquisitions (M&A) are occurring throughout health care, with transactions happening among entities of all provider types and sizes.(According to the latest analysis by Kaufman, Hall & Associates, LLC, 49 transactions were announced in the first half of 2015, up from 43 transactions in the first half of 2014.)

Securing board approval for a major new project can be a long and tricky process when the CEO proposing it isn’t sure which criteria trustees will use, and the board is equally uncertain what the yardsticks ought to be. At Adirondack Medical Center in Saranac Lake, N.Y., President and CEO Chandler Ralph asked her board to write down and agree on project evaluation criteria. In a two-hour workshop, trustees came up with 14 points that they now apply to every decision about whether to implement a new program.

A physician compact outlines the organization's and physician's responsibilities. Reprinted with permission from Virginia Mason Medical Center.

Patient satisfaction scores are important metrics; they draw attention to the subjective experience of patients who received care from a hospital.

This is a sample committee charter: people and culture committee.

The governance challenges raised in the post-Enron environment are motivating many boards and their general counsels to draft new board policies and tighten up existing ones.

Board self‐evaluation is an important process. Surveys by The Governance Institute have shown that making self‐assessment a board priority is associated with high performing boards. Yet, amidst seemingly more important board business, it’s easy for self‐assessment to become a rote exercise.

These documents are based on CHP’s core values, the CHP board’s roles and responsibilities, and the expectations established for CHP’s board members. They may or may not fit other boards’ situations. Each board should adopt its own individual competencies and evaluation instrument. Reviewing others’ efforts is a helpful reference point, but no sample should be used without modification.

Even before the Enron scandal, which featured directors who didn’t understand the company’s complex financial transactions, and before the Sarbanes‐Oxley Act required publicly owned corporations to disclose whether their boards include directors with financial expertise, it should have been self‐evident that relevant knowledge and experience are prerequisites for effective governance.  

Despite the importance of the role, many boards do not give selection and preparation of the board chair the attention they should. In a recent survey by The Governance Institute, 64% of boards said they had established an explicit process for selection of the board chair but these processes often are little more than a thoughtful conversation among the executive or governance committee about the next chair.