The Board as Think Tank: Moving Beyond Legacy Roles in a Time of Transformation

The Imperative for Change
Hospital and health system leaders are faced with perhaps the most significant set of challenges in the history of modern medicine. The sheer scale and scope of change demanded by the shift in financial incentives is daunting. At present, fee-for-service is still the primary form of payment in most markets, and reduced impatient stays and procedures represent lost revenue for hospitals. While the pace varies in different states and regions across the country, there is inexorable movement towards a financial incentive to keep people healthy and out of inpatient facilities. Resources from multiple sources, within and external to the healthcare sector, will need to be shifted to preventing, rather than just treating diseases.

It is no longer sufficient to focus simply on the delivery of the best-quality acute-care medical services. Administrative and clinical leadership must now broaden their scope of analysis and engagement to diverse stakeholders in the communities and regions in which they function. Efforts to strengthen care coordination will have to be expanded to address social determinants such as housing quality, access to affordable healthy foods, and broader environmental conditions. Efforts to manage chronic diseases such as diabetes will have to be expanded to broader community level and policy strategies to reduce its incidence. In general, leaders will need to take bold steps, building internal skills and capacity, establishing new working relationships across sectors, and developing and advocating for policies that contribute to improved health and well-being.

Setting the stage for transformation of the healthcare sector will require changes in the way we do business, and senior leaders will also need boards with the competencies and the depth of engagement necessary to inform and monitor progress. For many organizations, this will require adjustments in both membership and roles. As a starting point in the review of relevant options and their implications for the field, this article will draw from a series of white papers published by the Governance Institute (TGI) over the last five years, as well as a 2006 publication from a TGI series entitled “Elements of Governance”, which serves as a primer on board-senior leadership roles, dynamics, and history. Read the full article here.