Board Up

Why would anyone ever want to be on a hospital board? Hospitals can be sticky places rife with internecine feuds. The burden of the board’s responsibility has the weight of a life-or-death institution. The specifics of the healthcare business are often so arcane and unpredictable that even the senior leadership has difficulty articulating a plan for the future. Healthcare is not a business that traditionally welcomes an outsider’s viewpoint. And unlike the cushy boards of many private corporations, lavish perks are relatively few.

In this month’s cover story, HealthLeaders Management Editor Kara Olsen takes a look at the reinvention of governance in nonprofit healthcare. Our coverage finds that hospital trustees are closer to hospitals’ operations than ever, and that the ideal board model today is one that blends oversight and partnership. This more cooperative tone will likely be a cultural shift that dominates governance in the next few years.

In the fervor to get boards to participate more in hospital operations, one question few ask is where the line gets drawn between an "active" board, which is a good thing, and an "activist" board, which is decidedly a disaster. An active board is a partner; an activist board is a bitter enemy. An active board manages; an activist board micromanages.

Most of the 3,000 or so nonprofit community hospitals will be able to manage this potential danger with a suitably vigorous board recruitment program. And the vast majority of board members—I would hope—would have only the best interests of the hospital in mind and have no interest in weaving themselves into operational questions. A good board member lends a particular expertise or community knowledge and will spend most of his or her time helping the senior management focus on the horizon.

Another question that looms over governance like a rock on a ledge is whether we can expect Sarbox-style regulation to come to the nonprofit side. Beyond that is the larger question of whether boards will soon take on more knowledge of, and responsibility for, the quality of care being provided in the institution, and whether they will be paying as much attention to process-measure scores for pressure ulcers and infection control as they do to the monthly board book dashboard that tracks net revenue.

Who in the world would want those headaches? I suppose they would be committed, caring, intelligent individuals with something to offer to one of the few industries that can truly be called essential. Thankfully there are people like that still interested.

Jim Molpus
Editor
jmolpus@healthleadersmedia.com