Governance in a Hurry

That level of trust is due in part to the openness that is embedded in the culture of the organization. For example, if an opportunity arises, Rice can use an administrative blog to quickly solicit feedback from his senior leadership team. "Within a few hours, you can already see everyone's responses," he says. Rice keeps his board chair informed at all times, and he also involves his medical director in all major decisions.

Rice says his team has a proven track record, so the board doesn't intervene in daily operations. "If all of sudden some of the ventures start failing, I'm sure [the board] would say, ‘We are going to have monitor things more closely,' like a board should," he says.

Strategic committees
When it comes to agility, being small has its advantages. Lakewood is an independent organization that doesn't have to get things approved at multiple levels. In fact, it has no board committees. Lakewood's hospital also merged with the local independent physician clinic in 1997, so everyone's interests are aligned, Rice says.

"Anything that comes up, we run internally through our administrative team, we run by our physicians, then we take it to the board—and half of the board are physicians so they already know about it anyway."

But for larger organizations, having an effective board committee structure may be the key to improving agility. Cors says that hospitals are deceiving themselves if they expect to get business accomplished during full board meetings. "That is absolutely the wrong place to conduct business," he says. "The business needs to be conducted before that full board meeting."

Strategic planning committees composed of administrators, trustees, and medical staff leaders are one way to speed up board decision-making and effectiveness, says Cors. Such committees can be scanning technology, the market, and the needs of the community on an ongoing basis to determine where the hospital should be positioning itself. This kind of continuous refinement is critical, Cors says. "The majority of organizations do episodic strategic planning every two or three years, and I'm just not sure with things changing so rapidly that even a three-year plan is valid."

Here are four keys to ramping up your hospital board's response time.

1. Focus. Staying focused on the mission of the organization can help garner the support of physicians, trustees, and the community faster.

2. Integration. Involving physicians and gaining their support early in the process can help speed up decision-making. Why work on something for weeks, only to discover it doesn't fit in with the doctors' strategic plan, says Rice. "If anything moves us along, it is that we have a culture with our physicians that anything we do is incorporated and we work with them."

3. Accountability. Lakewood's governing board and the hospital administration have a relationship built on trust, which has helped speed decision-making processes. That trust exists because trustees and executives are held accountable. For example, Rice, who has been with the organization for 28 years, is on an annual contract. Every November his contract is up for renewal, so he is incentivized to succeed. In addition, the hospital has two boards to answer to. The district board, which is composed of elected officials, is responsible for the property and debt of the organization, and the system board, which has a management agreement with the public board, oversees the daily operations of the facility.

4. Balance. Governance board and board committees should include representatives from the community, hospital, and physician leadership. "If you get the right people on the committee, the collective give and take will serve as the check and balance," says Cors.