Board Assessment and Development Process

A periodic assessment of the hospital board's performance is now widely considered to be an essential part of the governance process. Here's a sample policy and some ideas about how this process might take place.

Printed Survey

A board assessment survey, which has been tested in numerous healthcare organizations and tailored to fit the needs of each, is often a useful tool to use in this process.

The statistical data produced by printed surveys can provide very clear messages related to perceptions of strengths and weaknesses. It can also provide baseline data to be used in measuring progress through repeated application of the survey in future years.

The limitation of printed surveys is that board members tend to rate themselves very positively, which can lead a board to believe there is no need for change. This interpretation is not always supported when the assessment techniques described below are applied.

Interviews

You may want to consider engaging an experienced governance consultant to assist your hospital in the Board Assessment process. The consultant can help with the survey and interview as well as other aspects of the process.

Face-to-face individual and small group interviews are the most effective means of truly assessing a board's performance. A carefully guided interview can produce extremely useful data related to perceptions of a board's performance. In addition to identifying key issues and concerns, the interviewer can observe the feelings communicated during the conversation and use that data to assess the level of importance attached to each topic. Additionally, the interview process provides opportunity for clarifying the true meaning of various comments.

A limitation of both the interview and the survey process is that each identifies the perceptions of those who are providing the assessment information. Such information is critical in that perceptions are the primary foundation upon which we establish relationships; however, most of our perceptions are distorted. Thus the need for the third assessment technique.

Document Review

The review of available documentation is an essential component of the board assessment process. It is always revealing to conduct an objective review of documents such as board and committee minutes, the profile of the board's membership, attendance records, bylaws, planning and financial documents, quality and risk management oversight documents, and other written policies, procedures and protocols related to the manner in which the board fulfills its role and responsibilities. Such a review typically confirms some perceptions related to the board's performance and, conversely, challenges others.

A board retreat is the most effective approach to reviewing and discussing the assessment findings.

If the assessment process is done well, it will identify a number of critical issues that warrant thoughtful discussion. Board members consistently report that regular meetings of the full board seldom provide opportunity for in-depth discussion of important issues. A one- or two-day retreat provides a rich opportunity for such discussion.

A written action plan is essential if the assessment process is going to result in substantive change.

Board assessments provide rich opportunities for focused conversations among board members themselves, as well as between board members, medical staff leaders, and managers. These conversations almost always create positive feelings and a closer working relationship between the parties involved.

However, it is important to remember that increasing the effectiveness of a board generally requires taking some clearly defined actions related to the board's structure, focus, membership, or working process. There is always a certain level of resistance to making such changes, and real change requires a real commitment.

A written action plan, developed and accepted by the board as its framework for future development, helps to ensure follow-through. It is also important that the Chairman of the Board be committed to using the action plan as a reference point for all development activity.

A written Governance Plan is the foundation for ensuring full alignment within the Board related to how governance of the organization is to occur.

During the past few years, an increasing number of our clients have found it useful to develop a comprehensive Governance Plan which includes: role descriptions of parent and subsidiary boards, role descriptions for individual committees, operating principles of governance, role descriptions for key leadership positions, and role descriptions and performance expectations for individual board members. It also includes concrete guidelines related to issues such as CEO evaluation, managing conflict-of-interest, confidentiality, shaping the membership profile of the Board, etc. Once it is formally approved by the Board, it provides the parameters and standards for effective governance.

Board Retreats

Board retreats can be an extremely useful tool for building relationships and creating alignment among and between board members, medical staff leaders, and senior management. Retreats can be a very effective way to address the results of board assessment processes and to develop consensus related to the organizations future Governance Plan. They are also essential tools for developing consensus among key stakeholders related to future strategic directions.

Retreats typically are preceded by some form of preliminary site visit for the purpose of conducting interviews and reviewing appropriate documents. The retreats are designed to meet the specific needs of individual clients. They typically begin with one or more formal presentations; but the overall design is highly interactive with extensive use of small group activities. An effort is made to ensure that all retreats end with consensus related to a formal set of action items. Following the retreat, written Proceedings which summarize the discussion and recommended actions, are especially useful.

Typical questions to consider when planning a retreat include:

• What is the intended focus and expected outcome for the retreat?
• What type of pre-work needs to be completed prior to the retreat?
• Who should be invited (the ideal number is in the range of 30-40 individuals; but larger numbers are possible)?
• Will it be a day-long retreat or an over night retreat?
• Will it be local or at a distant conference facility?
• Will the event include spouses and families, with time for relaxation and recreation?

How politically sensitive is the agenda; and, therefore, what level of facilitative assistance is needed?

Content Provided by
The Bristol Group

 

 

Shaping the Future of Health Care
33 Fuller Road • Augusta, Maine • 04330 • tel 207-622-4794 • fax 207-622-3073