Community leaders who step up to serve on local health sector governing bodies need an increasingly wide array of competencies to be effective. The competency profile also varies between boards that oversee hospitals compared to Accountable Care Organizations (ACOs), County Health Boards, Federally Qualified Health Centers (FQHCs) or Academic Medical Centers.
For hospitals, the Center for Healthcare Governance of the American Hospital Association has published a study that defines a comprehensive set of competencies. This study identified two sets of trustee core competencies for board members of hospitals and health systems.
Knowledge and Skills
• Health Care Delivery and Performance
• Business and Finance
• Human Resources
The AHA panel recommended that all boards, regardless of the type of hospital or system they govern, should include some members with these knowledge and skills competencies. The panel further recommended that the competencies included in the list below should be sought in all board members.
• Achievement Orientation
• Change Leadership
• Community Orientation
• Information Seeking
• Innovative Thinking
• Complexity Management
• Organizational Awareness
• Relationship Building
• Strategic Orientation
• Talent Development
• Team Leadership
Are the trustees of tomorrow ready to deliver these competencies? As trustees are expected both to oversee the performance of management and play a key role in population health management strategy planning and implementation, what makes them competent to do all of this?
The corporate failures of the last decade also are reshaping traditional perspectives on what it means to govern well. It is now clear that the boards of many failed organizations were composed of very
Knowledgeable, capable individuals who were unable or unwilling to prevent these disasters. This
Realization, and a growing body of research linking effective board and organizational performance, are
Motivating us to look beyond traditional notions of board composition or structure as the keys to good governance to also examine board culture and what makes boards work together as effective teams.
In the past, we could point to lists of university degrees, professional designations and previous employment experiences on the prospective director’s resumé. However, in the uncharted waters of population health management and accountable care, traditional credentials are only part of the answer.
What types of competencies are needed to govern organizations dealing with gains in community health, not just gains in health service volume growth? Perhaps we should look at the profiles of those serving in the population health governing bodies in England, Canada and Europe?
In England, their National Health Service (NHS) has called for a new generation of board leaders with diverse competencies. In overseeing the population health performance, board members need to deliver such competencies as: Quality assurance and clinical governance; Financial Stewardship; Risk Management; influencing legislative action and regulations; group decision-making; and also corporate policy making and oversight.
In Europe there is a call for stronger background in epidemiology and systems thinking. As the US becomes more racially diverse, ethnic and cultural awareness must also be factored into our competency profiles.In the population health orientation of Canada, we see four key competencies (alignment, efficiency, effectiveness, and ethics) are needed to govern across diverse community health organizations. They ask for:
Alignment: To plan and oversee strategy, boards need to be able to work as a team and to do this they must be aligned both with their mandate as a board and with each other as members of a functioning unit. Equally, there must be team alignment between the board and management – two teams pulling together toward a common set of strategic objectives.
Efficiency: Self-management of the board as a working unit is important. The board’s annual mandate and work-plan need to be managed efficiently so that all duties are discharged, and in a timely fashion. As well, meetings must be run smoothly and professionally allowing all opinions to be heard and decisions made within the time allotted. Further, since senior hospital administrators provide essential information, reports, analyses and judgments, which take considerable time and effort, boards must use the valuable management asset wisely. Extracting value from management should not exhaust them.
Effectiveness: A board may be able to get through its meeting agenda in a timely fashion, but it might make poor strategic and operational decisions in the process. Effective boards achieve their desired outcomes, not just by being efficient, but also by coming to conclusions that lead to decisions of good quality. Among other things, a board is responsible for the oversight of innovations in patient care, optimizing capital expenditures and enhancing the hospital’s reputation in the community. But there is a gradation of quality in performing these mandated functions. Good governance means not just fulfilling the board mandate, but also doing it at a high level.
Ethical management: Hospitals are social enterprises whose purpose has inherent moral worth. Still, as functioning organizations they must not only embody moral principles of promoting good health and curing the sick, but also plan strategies and operationalize them in terms of institutional policies and procedures that ensure ethical conduct, such as codes of ethics, workplace health and safety, anti-harassment, whistleblowing, etc. Equally, the board must visibly exhibit an exemplary tone at the top as individuals.
So how ready are our US health system boards for new competencies? What can our boards do to recruit and develop trustees and directors that have, and can continuously enhance these type competencies?