BOARD CULTURE

In document NATIONAL HEALTH CARE GOVERNANCE REPORT (Page 46-51)

In 2014, half of all hospitals reported that an executive session was routinely included in the agenda as a part of every board meeting, up from 41 percent in 2011 (see Figure 10.1).

CEO Participation in Executive Sessions

Holding regular executive sessions is a constructive way to build a strong sense of connection and communication between the board and the CEO.

The executive session enables both to engage in the kind of dialogue that is oftentimes difficult during regular board meeting when staff members and, in the case of public hospitals, the press and members of the community, may be in attendance.

In 2014 CEOs participated in the entire executive session in 59 percent of hospitals, and in part of the executive session in 35 percent of hospitals. Few hospitals conducted an executive session without any CEO participation at all (six percent) (see Figure 10.2).

Executive Session

Routinely Included in the Agenda of Every Board Meeting

Figure 10.1

Typical Topics Discussed

The most common topics discussed at executive sessions in 2014 were executive performance and evaluation, followed by executive compensation, miscellaneous governance issues, general strategic planning and strategy with regards to mergers and acquisitions. Compared to 2011, it was reported that more executive sessions now focus on miscellaneous governance issues and strategy with regard to mergers and acquisitions (see Figure 10.3).

There were differences between board chair and CEO respondents’ perspectives on all topics, with the exception of executive performance and evaluation and executive compensation. In nearly all other areas, board chairs reported a higher prevalence of

discussion topics than did CEOs.

Figure 10.2 CEO Participation in Executive Sessions

35% 59%

CEO Participates in Entire Executive Session CEO Participates in Part of Executive Sessions CEO Does Not Participate in Executive Sessions

6%

Figure 10.3 – Topics Typically Discussed at Board Executive Sessions

2011 2011 2014 2014

CEO Board Chair CEO Board Chair

Executive performance and evaluation 82% 84% 77% 78%

Executive compensation 72% 73% 62% 62%

Miscellaneous governance issues 29% 38% 43% 54%

General strategic planning 36% 51% 41% 53%

Strategy with regards to mergers and

acquisitions 40% 44% 46% 51%

Financial performance of institution(s) 28% 49% 32% 47%

Clinical or quality performance measures 28% 47% 33% 45%

Board recruitment and selection 28% 42% 24% 41%

Succession planning 37% 37% 32% 39%

Board performance and evaluation 29% 35% 31% 38%

Government relations 17% 27% 15% 27%

Other 21% 16% 17% 12%

Board Meeting Dialogue and Discussion Board and committee meeting time is limited, and should strive to be purposeful and productive. Board members must ensure their governance conversations are vibrant, vital and focused on purpose and

outcomes. Through critical conversations, decisions are made by grasping with concepts, ideas and practical solutions, leading to informed and rational conclusions.

When boards experience a “dialogue deficit” they miss unique opportunities to explore alternative ideas, choices and courses of action. In many cases a lack of dialogue results in “proforma” decisions that are made with little insight or real understanding. In contrast, there are continual opportunities for board learning that occur when trustees engage in robust discussion, challenge one another’s assumptions and work toward a consensus that is grounded in mutual knowledge, understanding and commitment.

CEOs and board chairs reported that they are spending some board meeting time in active

5 Completely

4 3

Somewhat

2 1

Not At All 100%

75%

50%

25%

0%

Figure 10.4

Extent the Majority of Board Meeting Time Is Spent in Active Discussion, Deliberation and Debate about Strategic Priorities of the Organization

CEO Board Chair Average Score: CEO = 3.2 Board Chair = 3.3

4% 32% 48% 15% 1%3% 38% 46% 12% 1%

discussion, deliberation and debate about the strategic priorities of the organization (rather than listening to briefings, presentations, and reports). On a five point scale, board chairs reported 3.3 and CEO’s 3.2 (see Figure 10.4).

One way to ensure that meetings are focused on where the hospital is headed, rather than where it has been, is to design the agenda to ensure that the majority of governance attention and discussion is on issues in which the board has the greatest impact:

planning, setting policy, making critical decisions and setting future direction.

Little progress has been made since 2011 with regard to the percentage of board meeting time that boards normally spend in active discussion, deliberation, and debate at each board meeting. While just over 40 percent of hospital boards reported spending more than 50 percent of their time in active discussion, deliberation and debate in 2014, 19 percent of board chairs reported spending less than 25 percent of their meeting time on such activities (see Figure 10.5).

Electronic Board Portals

Whether it is an everyday social interaction, patient-physician communication, or interaction between hospital leaders and board members, technology increasingly plays a role. Technology is an unparalleled tool for enhancing and strengthening communication, one that is rapidly changing our culture.

For hospital boards, an electronic board portal reduces waste and administrative time required to prepare for meetings and ensures that governance resource materials are always up to date. Board portals can also offer an ongoing way for trustees to access information anywhere from a mobile device or computer,

including basic organizational information, ongoing education and resources, a board calendar, trustee and administration contact information and more.

Hospitals and health systems must be adept and innovative in leveraging the benefits that technology offers across a variety of settings and for any number of purposes. At the same time, hospital boards, physicians and senior leaders must be cautious to not replace the personal connections and face-to-face meetings that are essential to strong and effective governance leadership. In 2014, over half of hospitals reported using an electronic board portal (56 percent of board chairs and 52 percent of CEOs) (see Figure 10.6).

Figure 10.5 – Approximate Percentage of Board Meeting Time the Board Normally Spends in Active Discussion, Deliberation and Debate

at Each Board Meeting

2011 2011 2014 2014

CEO Board Chair CEO Board Chair

Greater than 0% but less than or equal to 25% 23% 19% 23% 19%

Greater than 25% but less than or equal to 50% 46% 41% 40% 40%

Greater than 50% but less than or equal to 75% 23% 26% 30% 33%

Greater than 75% 7% 13% 7% 8%

Use of Electronic Board Portal Figure 10.6

CEO Response Board Chair Response

0% 25% 50% 75% 100%

Yes

No

56%

44%

52%

48%

• Half of surveyed hospitals reported that an executive session was routinely included in the agenda as a part of every board meeting

• CEOs participated in the entire executive session in 59 percent of hospitals, and in part of the executive session in 35 percent of hospitals

• The most common topics discussed at executive sessions in 2014 were executive performance and evaluation, and executive compensation

• CEOs and board chairs reported that they are spending some board meeting time in active discussion, deliberation and debate about the strategic priorities of the organization (rather than listening to briefings, presentations and reports). On a 5 point scale, board chairs reported 3.3 and CEO’s 3.2

• Little progress has been made since 2011 with regard to the percentage of board meeting time that boards normally spend in active discussion, deliberation and debate at each board meeting

• Over half of hospitals reported using an electronic board portal in 2014

Section Highlights

The transformation from a fee-for-service to a value-based payment system is prompting hospitals to embrace population health management and promote care across the continuum, with goals to improve the health of the community, provide better access to primary care, reduce admissions and readmissions, and make meaningful and measurable improvements in outcomes of care. Hospitals are accountable to their communities, not only for the care provided inside the hospital, but also for improving the overall health of the communities they serve. Many are making that commitment by striving to achieve the goals of the Institute for Healthcare Improvement’s Triple Aim:

improving the patient experience of care, improving the health of populations and unparalleled patient outcomes, and providing care at an affordable cost.1 A recent survey by the AHA of more than 1,000 hospital CEOs, C-suite leaders and board chairs found a general agreement on the direction in which the health care field is heading. These leaders forecast that in five years there will be more hospitals aligned with health systems, greater hospital/physician affiliation, increased ownership of health plans by systems, and increased value-based and capitated payments.1 To better understand how well hospitals and their governing boards are preparing to make this shift, the 2014 survey included new questions focusing on board chair and CEO perceptions of board readiness to govern in the transforming health care delivery system.

SECTION 11

READINESS FOR HEALTH CARE

In document NATIONAL HEALTH CARE GOVERNANCE REPORT (Page 46-51)