Boards must remember that they work in partnership with the organization’s CEO with the mutual goal of reaching the best decisions and actions for the current and future well-being of the hospital or health system. Appropriate expectations include the following:

  • The CEO works both with and for the board. Most CEOs are members of their boards by virtue of their positions. In this capacity, the CEO works as a strategic partner with the board. However, both will need to remember the board is definitely the employer and the CEO is the employee. As such, the CEO may not be included in every board decision, such as the CEO evaluation. Today’s publicly traded companies are required to have executive sessions without the CEO, even when the CEO is also the chair of the board.
  • The CEO implements the board’s policies and directives. It is the job of the CEO to put into action the plans and directions set by the board. In this role, the CEO functions at 5,000 feet to implement the board’s 30,000-foot-level decisions. The CEO deals with hospital personnel, the medical staff, outside contractors, and many others as necessary to ensure the hospital runs smoothly, patients are cared for effectively and efficiently, and the hospital fulfills its mission as set by the board.
  • The board’s priorities are the CEO’s priorities. The CEO will provide information to the board about a variety of topics and projects and offer her perspective about the board’s proposed course of action; however, once a decision has been made by the board, the CEO becomes the board’s hands in getting the work done. The CEO should strive to not get too far ahead of the board or head in a different direction strategically, and she must stay attuned to the board’s top priorities for the organization.
  • No surprises. The CEO should make sure the board does not receive any surprises. The CEO should involve the board early regarding major upcoming decisions so that they can proceed together. Boards do not like to review material and be asked to make major decisions that appear to have already been made. The board should also know both good and bad news before the general public does. It is embarrassing if the media or someone outside the hospital confronts a board member about something that has happened in the hospital if the CEO has not yet informed the board.
  • Involvement in strategic thinking. An important goal of any board is to ensure the organization is pursuing a winning strategy. The best way to achieve this goal is for the board to be constructively engaged in the hospital’s strategic planning process. If the board is not involved in developing the direction, they may not give their full support for implementing the plan. The board must work closely with the CEO to understand the hospital’s needs to ensure the appropriate development, execution, and modification of the organization’s strategy.
  • User-friendly board packets. Before board or committee meetings, board members should not receive thick packets full of management material. Their packets should only contain information related to the decisions they will be making and educational materials to keep them abreast of changes in the healthcare industry. Any CEO who continually does otherwise will lose the support of board members or encourage them to manage rather than govern.
  • Educational opportunities. The CEO should ensure the board receives relevant industry materials, journals, and educational sessions and attends a well-planned retreat every year. The strongest boards, assisted by their CEOs, will be the ones who know the most about the healthcare industry, what the key issues are, how to function as a board member, and where the hospital should be headed strategically.
  • A program to groom potential board members. The CEO should work with the governance committee on methods to develop a pool of potential board members. Some hospitals elect board members from the hospital’s foundation board or allow individuals who are not board members to join board committees.
  • Board member recognition. The CEO should feature board members and communications about the hospital’s newsworthy events, including stories for local media as well as the organization’s newsletters and publications. Board members often volunteer many hours each year to the hospital, and this type of attention is an easy way to provide recognition and thanks for their service.
  • Avoiding healthcare jargon. The board should expect the CEO to refrain from unnecessarily using healthcare jargon. There are numerous abbreviations and acronyms In the health care field, and members will become familiar with many of them. However, members should not have to sit through meetings without understanding what is being discussed. The smart CEO will cut the use of the jargon as much as possible, and the smart board member will ask questions if something is not understood.
  • Knowing individual board members. The CEO and board members should develop a mutual understanding and respect for each other’s knowledge and strength. Even in a small community, the CEO should make a point to have lunch at least once a year with each board member. Board members will mention things to the CEO they would never say in a regular board meeting.
  • CEO evaluation. As mentioned previously, the CEO expects to be evaluated annually to know where improvements need to be made and to have positive achievements recognized.
  • Working with the entire board. In striving to meet expectations, the CEO should work with the entire board, not just the more powerful or vocal members or only the members she gets along with best. Both the CEO and the board will benefit as different members emerge as leaders within the board.

Reprinted with permission from Healthcare Governance, second edition, by Errol L. Biggs, pages 72 to 74.

Errol Biggs, Ph.D., FACHE, Vice Chairman at Practical Governance Group, also is Director of the Graduate Programs in Health Administration and Director for the Center for Health Administration at the University of Colorado Denver. Here he teaches governance in the center’s graduate on-campus and executive programs.

For more information, please call Practical Governance Group at 678-296-6775.

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