The Fish Stinks from its Head

Molly Rowe, for HealthLeaders Media, March 7, 2008

Hospital leaders and their boards generally recognize that the board's role is shifting. Boards no longer swoop in quarterly to check financial status and go on their merry way. They are involved in patient-safety rounds. They review quality scores. And they are hospital spokespeople in the community.

For leaders, this means putting another hat on your already crowded head. Your job as board relationship manager extends far beyond the occasional dinner out.

Hospital boards must intimately understand the workings of your hospital and the emerging trends in healthcare. To this end, your role has expanded to include board education and coordination. And although they are more involved, board members aren't clinicians. They rely on you to tell them what they should pay attention to and what they can safely leave to others.

Some organizations have created the Chief Governance Officer position solely to handle their boards. Although this board-centric position sounds good in theory, not all CEOs agree with it.

"The CEO is hired by the board to be the board's agent. In return, one of the fundamental roles that the CEO should be playing is the Chief Governance Officer. When I look at allocation of my time, the care, feeding, nurturing, and maintaining of the board is a significant amount of what I do, and I think that should be it," says Robert Kiely, CEO and President of Middlesex Hospital in Middletown, CT.

So, how do you effectively do all that care and feeding?

Orientate. It's not enough to give new board members a bunch of reading material and send them to conferences. Board education requires hands-on teaching--both about industry trends and your organization itself. Some hospitals hold half-day orientation sessions, taught by their senior management teams, during the first month of new board members' appointment. Whatever your orientation process, make sure you have one.

Educate. Board education shouldn't end with orientation. Increasingly, board members must be able to speak to your organization's quality and patient safety performance--topics that won't come naturally to most board members. They don't need a clinical degree but they have to understand quality measures and hospital performance on an ongoing basis.

While teaching infection rates to bankers may not come naturally, it's essential to board effectiveness. That's why some organizations make quality and patient safety education a part of every board meeting. Sinai Hospital of Baltimore produces a monthly executive report card to show the board where they stand on quality indicators and how that has changed over time.

Evaluate. You've oriented new board members and educated the old, but how do you know if your board's really working? A 2007 Top Leadership Teams winner, Cary Medical in northern Maine, uses an annual Board Effectiveness Survey to evaluate individual board members and the board as a whole on each of the hospital's strategic categories. This four-page survey goes well beyond the typical board self-evaluation done at many organizations, and Cary's CEO uses the survey results over time to predict training needs for new and future board members.

As organizations like the IHI and The Joint Commission put more emphasis on the importance of governance, board members will continue to take a bigger role in your organization. And, as Kiely told me, "The fish stinks from its head"--if an organization's board and senior leaders are out of sync, so too is the organization. Your job as leader is to make sure your board truly is on board.

Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at
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