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Commentary on New Models of Governance; Article on Board Portals Improving Governance Effectiveness Featured in Spring 2013 Issue of Great Boards
The spring 2013 issue of Great Boards is now available and features a commentary piece on new models of governance, and an article on how board portals are improving governance effectiveness.
In his commentary piece on new models of governance, Barry Bader discusses how the changing landscape of health care is leading to a re-envisioning of board governance. He outlines how health systems are gravitating toward one of three emerging governance models or are “cross pollinating” key attributes from each to form a unique hybrid model. Bader provides a list of questions board members can use to evaluate their readiness for governing accountable, integrated care systems.
In her article “Board Portals: Are They Improving Governance Effectiveness?” Mary Totten talks with governance staff and board members about the impact board portals are having on governance. She provides a list of questions and suggestions boards and governance staff can use to evaluate implementing and sustaining their own use of a board portal.
In addition, a new crosswalk tool from Angela Carman, assistant professor at the University of Kentucky in Lexington, has been added to the Great Boards website. The tool compares the roles of hospital boards and public health departments and encourages collaboration between the two in assessing community health needs. It can be accessed by clicking here.
Information on a New Governance Study; Commentary on Applying Competencies to Determining Board Committee Membership Featured in Winter 2012/13 Issue of Great Boards
The winter 2012/13 issue of Great Boards is now available at www.greatboards.org and features information on a new governance study, “Governance Practices in an Era of Healthcare Transformation,” and a commentary piece on applying trustee competencies to determining board committee membership.
The governance study, conducted by the AHA Center for Healthcare Governance with funding from Hospira Inc., draws on interviews with 37 CEOs, trustees and clinical leaders from four health care organizations and analysis by an expert panel. It identifies transformational governance practices that can strengthen board capacity to guide hospitals and systems as they transition from volume- to value-based health care. The study report offers two sets of recommendations. The first set deals with bold moves boards can make to transform governance. These include ensuring board membership reflects the communities served and adopting governance best practices. The second focuses on bold moves boards and health care leadership can take to transform health care. These include understanding and overseeing continuous improvement in performance and broadening compliance and enterprise risk management. This particular issue of Great Boards reviews the report recommendations and features perspectives from panel members about how boards can take steps to implement study recommendations.
Barry Bader’s commentary reviews trustee competencies needed for effective participation in board committee work. He outlines a series of steps for boards to consider in implementing competency-based committee selection and includes a matrix of specific competencies boards should incorporate in determining the composition of the Finance, Quality and Patient Safety, Executive Evaluation and Compensation, Community Benefit and other board committees. They are:
- Develop a concise list of competencies needed by each board committee.
- Profile the capabilities of the present committee and identify “gaps.”
- Consider the benefits of committee rotation and the future impact of board and committee turnover.
- Consider multiple sources of committee members.
- Use the competencies to plan education and development opportunities.
In addition, over the last few months a number of new resources have been added to the Great Boards website. These include:
- AHA Issue Brief: Moving Towards Bundled Payments
- Integrating Physician Leaders: A Readiness Assessment
- CentraState Healthcare Foundation Board Sample Report Card
- CentraState Healthcare System Board Sample Report Card
- Health Care in Transition: Topics for Trustees Webinars
The fall 2012 issue of Great Boards is now available at www.greatboards.org and features a Q&A with John R. Combes, MD, President and Chief Operating Officer of the AHA’s Center for Healthcare Governance, and Barry S. Bader, governance consultant and contributing editor to the newsletter, sharing their views on the implications of health care transformation for physicians on boards.
Combes and Bader discuss the traditional roles physicians have played on boards and why board service for physicians has become more of a challenge. They discuss how value-based health care will enhance the role of physician trustees as they apply their clinical expertise to determine what adds value to health care and what does not. They also discuss competencies boards should look for in physicians serving on boards and where hospitals and physicians are most likely to find common ground in governance. Other topics include:
- Whether physicians on the active medical staff have conflicts of interest as trustees.
- If employed physicians should serve on boards.
- Common mistakes hospitals and medical staffs make as they change the roles and make-up of physicians on hospital boards.
- Emerging best practices related to physician board membership.
- How boards can best engage physicians to maximize their contribution to board service.
The article also includes a “do” and “don’t” list on physician trustee relationships with independent and employed physicians. Actions physician board members should take include communicating with the medical staff about the rationale for board decisions and how those decisions will advance the mission and encouraging the medical staff to choose leaders based on objective competencies and a collaborative work ethic, whether they are employed or independent. Combes and Bader caution physician board members to avoid undermining the board’s decision-making process or being apologists for the board with other physicians.
The home page of the Great Boards Web site also provides links to related resources for physicians in board and leadership roles.
Governing to Address Community Health Needs, Conflict Manager Featured in Summer 2012 Issue of Great Boards
The summer 2012 issue of Great Boards is now available at www.greatboards.org and features these two articles:
Governing to Address Community Health Needs: Deepening Board Engagement – Hospitals have long engaged in assessing community health needs and documenting their community benefit activities. However, new pressures and requirements, including expanded reporting through the IRS Form 990 Schedule H and more recent mandates included in the Patient Protection and Affordable Care Act, are compelling boards to become more knowledgeable about and engaged with their hospital’s community benefit efforts.
This heightened focus on hospital community benefit and community health needs assessment in particular is requiring boards to more fully integrate oversight for these activities into their governance structures. This article looks at four hospitals and health systems from around the country (Dignity Health; Presbyterian Intercommunity Hospital, Whittier, Calif.; Lancaster General Health, Lancaster, Penn.; and Good Samaritan Hospital, Kearney, Neb.) and what they’re currently doing through their governance structure, practices and board engagement with the community to address their community’s health needs.
For example, Dignity Health has revised its board orientation manual to include a comprehensive description of the organization’s community health commitment, policies and programs and provides questions boards can ask about hospital community health and benefit activities. Good Samaritan Hospital works with a community coalition of other health care providers and leaders from area businesses, government, schools, churches and civic groups to assess, prioritize and address community health needs.
Conflict Manager: The Board Chair’s Unsung Role – An important, yet seldom discussed role of a board chair is conflict management. This commentary by Barry Bader says the most common sources of conflict involving the board chair are related to doctors, trustees, the CEO, and the community. Bader describes conflict management as part art, part science and suggests five ideas on how leaders can best resolve conflicts. He also discusses the board chair succession planning process and steps on how to select a new chair.
Hospitals and Care Systems of the Future, a report developed by the AHA’s Committee on Performance Improvement, asserts that hospitals and health systems in the U.S. will face “unparalleled pressures to change in the future.” Multiple, intersecting environmental forces will drive the transformation of health care delivery and financing from volume-based to value-based payments over the next decade, the report says. These forces include everything from the aging population to the unsustainable rise in health care spending as a percentage of the overall economy.
The report cites economic futurist Ian Morrison who believes that as the payment incentives shift, health care providers will modify their core models for business and service delivery. He refers to the historic, volume-based payment environment as the “first curve” and the future, value-based market dynamic as the second curve.
Many hospitals already are broadening their traditional focus on fee-for-service and acute care and evolving into “care systems” that integrate a continuum of patient-focused services and can take accountability for managing quality, health improvement and costs across providers. But – and here’s the rub — will the payment system change fast enough to reward providers who join together to deliver value?
As the report states: “Progressing from the first curve to the second curve will be a vital (but challenging) transition for hospitals, analogous to having one foot on the dock and one foot on the boat—at the right point, the management of that shift is essential to future success.”
Using the Report
The winter issue of the Great Boards newsletter provides report highlights (“Leading Through Change: Cultivating the Curves”) and then suggests how boards can use the report as a provocative framework for strategic thinking, organizational assessment and decision-making. In his commentary “Asking the Edgy Questions about the Future” Barry Bader discusses how boards can use the report to:
- Clarify the organization’s vision and test progress;
- Reveal untapped or underexploited strategic choices;
- Frame strategic choices from the community’s perspective;
- Explore aims not tactics;
- Test the mission fit of strategies and vision from a stakeholder’s point-of-view;
- Challenge the organization’s capacity for change;
- Explore the implications of living between the first and second curves;
- Challenge key governance and leadership assumptions;
- Spur innovation; and
- Challenge the board’s capacity to lead transformative change.
He also suggests questions boards and leaders should avoid in using the report to engage in generative governance, a more visionary and creative mode of board work that moves beyond more traditional fiduciary and strategic approaches to governing.
Read and download the issue now at www.greatboards.org where you also can download several sample tools to apply ideas discussed in the report and newsletter.
The fall issue of Great Boards, our first since Great Boards joined the American Hospital Association family – is now available on the Great Boards website. The issue features these stories:
National Call to Curb Health Disparities – Health care access and outcomes should not be dependent on an individual’s race or ethnicity, but disparities in care remain, says the lead story. “There’s ample evidence that indicates that differences persist in the way healthcare is delivered, that certain health needs of racial and ethnic minorities and other subgroups remain unmet, and that the health status of these populations varies from that of other subgroups. Data show higher rates of infant mortality, hypertension, death from heart disease and stroke, and preventable hospitalizations among blacks compared with other populations. When hospitals look at their patient diagnoses data by race and ethnicity they also can uncover less obvious health needs.”
In July, these findings drove a group of leading health organizations, including the American Hospital Association, American College of Healthcare Executives, the Catholic Health Association of the United States, the National Association of Public Hospitals and Health Systems and the American Association of Medical Colleges, to issue a national “Call to Action” urging hospital and health system leaders to take three steps to help eliminate disparities and improve quality of care for all. These steps include:
- Increasing the collection and use of race, ethnicity and language preference data;
- Increasing cultural competency training; and
- Increasing diversity in governance and leadership.
This article by Great Boards managing editor Mary Totten describes action steps boards can take to provide leadership on reducing health disparities.
Avoiding Bad Big Decisions – Boards and senior management teams often make three mistakes in decision making that lead to flawed, suboptimal decisions. This commentary by Barry Bader says boards need to pay attention to their process for decision making, and it offers practical ideas for making decisions effectively.
Also look for several sample resources, including a charter for a board Cultural Diversity Committee, a Racial and Ethnic Disparities Dashboard and a Policy on Strategic Planning, on the Great Boards site home page under Related Resources.
Bader & Associates founded the Great Boards website and newsletter in 2001 with the singular goal of promoting excellence in the governance of hospitals and health systems. Since then, more than 40 issues of the newsletter have covered the gamut of board best practices, and the website has grown into a rich resource of model documents, tools and templates for boards in the healthcare field, all provided at no cost to subscribers.
Earlier this year, Bader & Associates and the American Hospital Association joined together to announce that the Great Boards newsletter, website and blog now will be published by the AHA through its Center for Healthcare Governance, in conjunction with Bader & Associates. This collaboration will enable Great Boards to significantly expand its outreach to new readers and to develop new content based on the combined capabilities of Bader & Associates and the AHA.
What will this mean for subscribers? Beginning this fall, the tangible benefits you’ll see will include:
- Redesigned Great Boards newsletter, published quarterly, with in-depth articles and practical tools on emerging governance issues such as health disparities and strategic planning for the care systems of the future
- New tools and templates to help boards implement best practices
- Redesigned Great Boards website to make it easier to locate the right resource
- Streamlined access to AHA’s extensive resources on governance, current health policy issues, and performance improvement, including the Hospitals in Pursuit of Excellence website
- New interactivity tools to expand dialogue opportunities with AHA and throughout the trustee community.
Some things will not change, including Great Boards’ mission of providing valuable and extensive resources without cost to the healthcare community. Barry Bader will serve as an editor and contributor, and will bring his 35 years of experience in governance to AHA as a Senior Consultant to the Center for Healthcare Governance and as a member of the Center’s National Board of Advisors. Mary K. Totten, Director of Content Development for the Center, will be the managing editor of Great Boards.
The first issue of the Great Boards newsletter to be produced jointly will be released shortly and address two important subjects: how boards can take action to reduce health disparities among racial and ethnic minorities, and how to implement effective decision making processes at theboard level.