Governing Boards Must Align Skills with Need

A legacy of self-nominating
That's a legacy of many hospital boards being constituted from a self-nominating process, and largely made up of community members who were willing to serve—not based on the skills needed for a complete board to do its job of leading the organization based on industry knowledge.

Not surprisingly, big, regional health systems are far more advanced than standalone hospitals in evolving their boards based on narrow skills sets, not only because they have a richer pool from which to draw, but also because the prestige level may be seen as higher.

Also, though unheard of in the past, some nonprofit hospital boards are at least considering paying their board members a small stipend.

You can't change those variables, but Gauss argues that small systems or standalone hospitals hamstring themselves in other ways that are addressable. "Even in communities where there are good members representing broad disciplines, there are still areas of expertise that are missing, such as technology and quality," he says.