Alignment of Governance and Leadership in Healthcare: Building a Roadmap to Transformation

The Challenge

Today’s healthcare leaders are confronted with a plethora of complex, time-sensitive demands for decisions in new and unfamiliar areas, and in a policy environment that is uncertain at best. The imperative for meaningful change is countered by resistance from powerful forces, both internal and external, and growing demands for capital expenditures at a time when financial margins are narrowing.

Investments in new data systems are confounded by resistance from physicians, resentful that time with patients is limited by increasing demands for data entry and handoffs to new and unfamiliar team members. Building a more comprehensive picture of patient populations through application of analytic methods and data sharing across organizations is impeded by proprietary concerns, as well as design inconsistencies driven by the profit motives of data technology firms. The focus on quality of care in clinical settings is complicated by the growing recognition that most of what drives the health of our patients is in the external world and outside our control. Our hospitals are increasingly expected to assume financial risk for reducing the demand for acute care medical services for specific populations, when the bulk of financial rewards are for filling beds and conducting procedures. These challenges are particularly acute for safety net hospitals with high percentages of low-income populations who reside in socially and economically disadvantaged communities.

While a growing number of hospital and health system leaders recognize the need for bold decisions, they report to a board of directors whose competencies and orientation are still driven primarily by the legacy focus on fiduciary stability. Gaining their support for actions that move beyond legacy concerns requires both education and a deeper form of engagement; one in which their input informs strategic decisions as healthcare organizations become involved in improving health and well- being in communities.

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