He says he makes sure to maintain that focus by stressing seven strategic objectives for the year on the first page of the board package distributed prior to meetings, and credits his predecessor, the outgoing board chair, for moving discussions more toward strategy.
"My expectation will be that if you come, I assume you've read it, and if you have questions, you'll pick up the phone and call the relevant executive before the meeting, get your questions answered, and be prepared to discuss strategy. Having said all that, it's always a battle. If the board is to be of any value, we have to focus on strategy."
Failing the ability to attract certain individuals to the board, Atchison seeks input from a wide variety of sources. Some experts, he envisions, could be guest speakers at part of the board meeting.
Such presentations could help board members understand the constituencies Elmhurst serves or the perspectives it could take advantage of, from managed care to strategic consulting to business development, nursing and marketing and brand management, and corporate leaders, like CEOs and CFO of large companies.
"Volunteer boards often largely take direction of the executive management team," Goldsmith says. "Increasingly, boards need to be more strategic and proactive in orientation and spend less time in oversight of operations."
Ahlquist says historically, this focus on strategy has come and gone in healthcare, especially at the board level. "In past years, changes in our industry tended to be focused on one aspect. Not to say they were small, but when HMOs came in, we saw disruption but not a lot of change at the Medicaid and Medicare level. Now everything is changing," he says.
Now, boards increasingly have to make participation decisions with other providers. They have to make strategic decisions on tech spending or the level of consolidation they're comfortable with. Ultimately, Ahlquist says, boards have to make the "big" decision: "Can or should we stay independent? Can we handle the level of change coming upon us or do we need a partner?"
CaroMont's Mackie says board members sometimes have difficulty recognizing the difference between being in leadership and governance, but CaroMont's board has evolved with what he calls stronger committees, adding that members do a lot of work through the committees rather than the whole board.
Quality gets more agenda time, and so do readmissions, "which we know will impact reimbursements," he says. "We actually do a lot of the standard reporting in the consent agenda so we have more time left to dedicate to strategy."
What about former execs?
Despite all the focus on strategy, however, Newpoint's Geffner says she has seen a lot of interest from boards in recruiting former, perhaps retired, healthcare executives, because they "can assume both a governance and operational perspective."
If a board has an appreciation of the competencies it needs, and if a former hospital exec possesses those, she says, it's a really good idea to have that voice at the table. "Having an understanding of operations is of value in the boardroom," she says.
Many retired healthcare executives serve on hospital boards. Dan Wilford, who retired as CEO of Houston's Memorial Hermann Health System in 2002, is a past director on the board of the Mobile Infirmary Association, parent of the Mobile (Ala.) Infirmary Medical Center, and is currently on the board of St. Joseph Health, an integrated delivery system with hospitals in California, New Mexico, and Texas. Many other former healthcare executives do this, but they are in high demand, says Williams of CHC.
But there's a dilemma. At the same time, Geffner says, if board members defer to the former executive too often, it may cause challenges to meeting their fiduciary responsibilities—not to mention possible conflicts with the CEO and executive team. They should be extra careful, in such circumstances, to encourage diversity of opinion and different points of view.
"If you have former hospital leadership in the boardroom, if practiced well, that point of view can also understand the CEO and executive team's perspective."
But ultimately, she says, it all comes down to developing a culture of openness, transparency, strong leadership, and an investment in being what she calls a "learning board."
"If those practices and points of view are in the boardroom, you will optimize the talents in that room," she says. "But you could take the same people and a culture that doesn't look like that and you're suboptimizing the talent in the room."
This article appears in the May issue of HealthLeaders magazine.