Healthcare Issues & Trends

Advice & Insights for healthcare's Leaders & HR Professionals

Effective Boards Embrace "Agenda Innovation"

Posted on July 5, 2016 by James A. Rice, Ph.D., FACHE

Wise Boards break through the complacency of boring reports on finance and patient care volumes; but it is not easy!  Perhaps these three actions can help enliven and enrich the quality of your board meeting conversations:

1.     Break Through 1: Agenda Flip: move the conversation part of the agenda to the first 20 minutes, rather than at the end after the review of standard reports from CEO, CFO, Quality and staffing issues.

2.     Break Through 2: A Patient’s Story: once a quarter remind the board (in a 5 minute recap from a patient at the meeting) that the purpose of all of their good work must map back to improving the lives and health of real people. How does your health programming really impact good or bad a real patient/family?

3.     Break Through 3: Mission Lift: Once a year, elevate the meeting’s focus away from patient care to population health, especially a 20 minute conversation about the implications of the new “UN Sustainable Development Goals” in your community/region. See:

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A Season of Sound Bites

Posted on March 1, 2016 by James A. Rice, Ph.D., FACHE


The run up to elections, and the run up to population health management.

Both journeys subject us to deceptive and frustrating sound bites that suggest there are easy answers to complex challenges.

Both journeys make Boards naively hunger for short, easy answers to tough questions. But board work today is far from easy.

How are board members supposed to make sense out of our rapidly changing political, social, clinical, and financial landscapes?

Can we find any easy answers about how to govern in an age of more transparent decision making, more complicated, integrated clinical care management systems, and more difficult performance score cards?

I don’t think we will unless we recruit and support civic leaders who are passionate about “Governance Innovation.”

We need to be hungrier to continuously enhance and improve the processes, people, practices and information for governing; not only governing our own organization, but governing across the many other health related organizations in our region that we do not control or own.

For high performing governing bodies we need board leaders that continuously seek innovative governance that embraces creative, fresh, and cost-effective new ways to master five types of governance:

  1. Collaborative Governance
  2. Competency Based Governance
  3. Generative Governance
  4. Intentional Governance
  5. Transformational Governance

To encourage health sector executives and board members to examine their local board practices through the new eye-glasses of governance in different contexts, we are also publishing a series of three papers entitled “Dare to Compare,” which explores Great Governance in Canada, Great Governance in US Credit Unions, and Great Governance in the National Health Service of England.

Watch also for our studies this Spring into the challenges and best practices for governing bodies of Local Health Departments, Federally Qualified Health Centers, Long Term Care Facilities, Medical Groups, Academic Medical Centers, Accountable Care Organizations, Critical Access Hospitals, and Hospital Related Foundations.

No easy answers, but intriguing and provocative questions that stretch us out of our comfort zones into the challenging and unchartered waters of “continuous governance improvement for population health management and accountable care.”


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Competency Based Governance

Posted on February 25, 2016 by James A. Rice, Ph.D., FACHE

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.[1] 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.

Personal Capabilities

• Accountability

• Achievement Orientation

• Change Leadership

• Collaboration

• Community Orientation

• Information Seeking

• Innovative Thinking

• Complexity Management

• Organizational Awareness

• Professionalism

• 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.[2]

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.[3] 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.[4] As the US becomes more racially diverse, ethnic and cultural awareness must also be factored into our competency profiles.[5]  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.[6] 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?




[1] Center for Healthcare Governance and Health Research & Educational Trust, see:

[2]Sonnenfeld, Jeffrey A. “What Makes Great Boards Great.” Harvard Business Review September 1, 2002: 106-113 and McDonagh, Kathryn J. The Changing Face of Healthcare Boards.” Frontiers of Health Services Management Vol. 21, No. 3: 31-35 (2005)

[3] See:

[4] See:


[6] See Dr. Scott Carson “Governance and Strategy: Four Tests of Competency” in Boards, Centre for Excellence in Governance, Ontario Hospital Association, November 2013, page 6

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5 Virtues for Frontline Leaders

Posted on February 10, 2016 by James A. Rice, Ph.D., FACHE


How can Hospital and Ministry of Health Leaders from SE Asia master new approaches to leadership and management? To address this question, The US Embassy Singapore developed a two week program involving faculty from the Singapore public hospital system, SingHealth, and USAID supported health sector managers from the US. Bob Stevens, CEO of Ridgeview Medical Center and I conducted four workshops in this program. Twenty-three participants from the health sectors of Philippines, Thailand, Vietnam, Myanmar, Laos and Cambodia were encouraged to avoid common vices of ineffective leaders such as the inability to take risks, and the failure to engage and listen to diverse stakeholders. Effective frontline leaders should embrace the flip-side of such vices by striving to accomplish these five virtues:

Virtue 1: Engage Diverse Stakeholders

Stakeholders have a right and need to understand and guide the good work of clinicians and community health workers to deliver health services that are not only of good clinical quality, but that also satisfy patients, are cost effective and contribute to stronger communities and nations. Smart leaders provide sincere invitations for eclectic and diverse groups of people to engage in important decision-making processes.  

Virtue 2: Ask Smart Questions

Experienced leaders know how to ask smart questions that seek to probe the real meaning of the essential characteristics of a situation, challenge, problem or opportunity. These questions are asked not just of close confidants of the leader, but of diverse stakeholders and especially the most vulnerable and disenfranchised of the organization’s service population.

Virtue 3: Listen to Stakeholder Insights and Advice:

Effective leaders must also listen carefully to the answers and insights gained from the question asking process. Many leaders are not good at listening.

Virtue 4: Take Sensible Risks:

Effective leaders are willing to take sensible risks to overcome obstacles, to yield innovation and to create conditions for health workers and managers in which they can explore new methods and processes for accomplishing their goals and plans.

Virtue 5: Provide Recognition & Rewards:

Great leaders create “celebration cultures” in which health workers, staff and stakeholders believe their ideas, insights and initiatives are needed, welcomed and valued. Smart leaders provide recognition and rewards for participants in their organization’s pursuit of service improvements. These leaders also recognize that sustainable rewards are often more than just money.

To expand your effectiveness, we hope you will avoid the vices and embrace the virtues outlined in this blog.

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Governing in the Context of Health: a global perspective

Posted on January 26, 2016 by James A. Rice, Ph.D., FACHE


In the North America and Europe,  tax-exempt hospitals have benefited from boards composed of community leaders who generally volunteer their time and expertise to enhance the performance of one of their community’s largest employers and essential contributors to the health and well being of the community and its employers

That is not the case in many low and middle income countries in Asia, Latin America and Africa. To explore our prior work to develop good governance practices in Africa, we include a series of blogs here that provide insights into the challenges faced by these hospital governing boards. The first resource is a web based educational program being used by health systems managers and board members in Asia, Latin America and Africa

You can Learn “Governing in the Context of Health” in Eight Hours in a new USAID Unveiled Governance and Health eLearning Certificate Program. To register for the program click here.

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