A few descriptive phrases tell the story of past winners of MODERN HEALTHCARE's Trustee of the Year Award: Committed, compassionate, ready to work on a team, willing to learn.
Such traits make these honored trustees qualified to comment on key issues facing hospital and system board members at the dawn of the 21st century.
MODERN HEALTHCARE*contacted 19 of the 22 past winners to probe their views about characteristics that trustees will need to be more successful champions of the health of their communities and their institutions.
The trustee award winners draw their insights from diverse backgrounds (See chart), with board tenure ranging from a few years to more than four decades in rural and urban markets in 17 states with growing managed-care and cost-containment pressures. Their ideas should remind us of the important role volunteer community leaders must continue to play in guiding healthcare into the new millennium.
As more hospitals chose to pool their resources into systems, trustees asked questions like: "With much of the financial controls shifting through reserved powers to the system board, why do they need us? Do we add any value, or are we just wasting our time?"
While there will be fewer and smaller boards in the future, the trustees' suggestions speak to the importance of local trustees' contributions. Our country needs these local volunteers even more today. They help define community health priorities, assure a focus on service quality and measurable outcomes, and add objectivity and discipline to management by asking the difficult questions.
Have you ever tried jumping from one canoe into another? That seems to be a lot like the challenges facing most hospital and health system trustees today. There's an overarching concern about how to balance institutional and community health. Policy development to address this balance will be difficult in an arena shaped by four big challenges: competition, contracting, cost-cutting and consolidation.
Decisionmaking also must be shared with physicians on the board. How many layers of boards do we need in these integrated health systems? Where to find the time to keep up to speed with an explosion of written materials? How to continually stay educated about pressures for change and improved performance? All are tough challenges cited by the panel of trustees.
They also see that the role of the hospital in our society has changed. They observe: "Whether you think we're the spoke or the hub, we're no longer the whole wheel. We're just a part of the action. We need to be ready to work with others, not just be the best as a repair shop for individual patients, but as a health-status promoter for the larger community. How do we assure fair contracts with the managed-care companies?" These challenges can make trustees of the future uncomfortable.
"It was much more fun on the board when we were growing and expanding," one trustee said. "It's terrible to help oversee downsizing; to go into the grocery store and meet neighbors who have lost their jobs from re-engineering," the trustee said.
Said another trustee: "You know, this board business isn't for the faint of heart. It's hard work. You can't afford deadwood on the board nowadays. We need doers, not socialites. Visionaries and thinkers, not status quo protectors. It's exciting, but a little scary too."
According to these interviews, trustees and directors who "really govern" in the face of these challenges in the 21st century will be those who are:
Loyal to their institutions but committed to their communities.
Smart but open-minded; willing to embrace continuing education.
Comfortable measuring historical financial results but also hungry to champion future community health gain.
Supportive of the management team's role to innovate and cut excess costs, but also of physician partners anxious to add new ambulatory-care access points, new technologies and acute-care substitution options.
Our managers are ready to bite the bullet on bed closings, staff cuts and re-engineering, but they need encouragement and backbone from the board. We can't leave them swinging out there on the end of that cost-reduction limb. Compassion must co-exist with attention to cash flow.
While these personal qualities are essential to better governance, it's also important to worry about how the board works as a group. In the coming years, boards will need to be leaner, smarter and more focused. It's not enough to recruit the best and the brightest. The board must work as a team.
Smaller boards and fewer but better organized meetings focused more on the future than the past are essential. So are smarter policy agendas with intelligent, tightly distilled briefing memos, not reams of photocopied department head reports to management. More trend graphs and fewer eye-glazing statistics would help.
The board membership should be diverse in experience, opinion and background to best convey what the market needs and is willing to use.
There should be fewer and smaller board committees, but a willingness for these committees to invite speakers and seek input from throughout the community, including local clinics, social service agencies, the hospital and even competitors.
To cope, if not thrive, with these challenges the best board members will need attributes that start with the letter "C": committed, caring, creative, cost-conscious, continuously learning, communicative and community-health focused.
It's the type of thinking that makes it easy to see why these trustees have been celebrated. It's this type of thinking that's needed to revitalize healthcare for the 21st century.