Six Keys To High Performing Hospitals: Key #4

Continuing my commentary on the list of keys to high performing hospitals based on a study by Lawrence Prybil, Ph.D. and Samuel Levey, Ph.D., today's topic deals with the ultimate authority for a hospital's operations.

4) Committed and engaged Board of Directors

With the hospital's CEO being the one in the spotlight, not everyone realizes the critical role that the Board of Directors plays. In fact, if they are doing their job well, they will remain somewhat in the shadows as the hospital excels. Usually Board members are only in the news when a hospital is in some kind of turmoil. A high performing Board is proactive, well informed and collaborates closely with the CEO and the Medical Staff. This was identified as a must by 8 of the 10 high performing Boards in the study. I think the other 2 just failed to mention it.

It is interesting that many of the high performing Boards spoke of the journey they took to get where they are today. It is clearly a development process. They spoke of the past when they were more passive and had a limited awareness of their environment and the importance of maintaining strong relationships. I remember dealing with a Board member who was strongly opposed to physician representation on the Board. His attitude was that the hospital would run a whole lot smoother if we did not have to deal with the doctors. This kind of thinking will hold a hospital back regardless of what other positive things are happening.

So how did the transformation happen for these Boards? It starts with education and a commitment by all Board members to be engaged in the process. The hospital can not afford to have valuable Board seats occupied by members with their own agenda or passive individuals who just occupy a chair and enjoy dinner. It also involves having the Board be clear on its role versus the role of the CEO. All high performing Boards understood this distinction. Having a strong trusting relationship with the CEO is essential. Finally, much of the work of strong Boards is done through effective committees. Most Boards are too large to have the kind of in depth discussion needed for many issues. Also there are just too many issues to deal with. So having committees that do most of this before the Board meeting is important. At the main meeting, the in depth work of the committees can be summarized rather than totally rehashed. This allows input from everyone without getting bogged in the details.

The Board is the ultimate authority for a hospital. This is not to say that it is more important than a strong CEO or cohesive Medical Staff. But without this third leg of the stool, the hospital will not excel.

More on high performance tomorrow.

Mark Brodeur