Pamela Knecht, president of Chicago consulting firm Accord Limited and an adviser to the Governance Institute, says she has seen a little bit of a trend of nurses joining hospital governing boards, a shift she credits to the heightened focus on patient safety and clinical quality.
The past decade has brought heightened scrutiny from regulators, politicians and consumer watchdogs of how aggressively hospital boards oversee their organizations operations.
Corporate scandals earlier in the decade led Congress to respond with the Sarbanes-Oxley Act of 2002, a sweeping law to bolster corporate accountability. The rules did not apply to not-for-profit hospitals and health systems, but put pressure on boards even as the sector faced inquiries of its own. Demand for greater access to care and improved quality have prompted calls from policymakers and regulators for hospital boards to be more accountable, transparent and assertive (March 2, p. 6).
That attention had raised interest in how boards governand who sits on themfrom outside and within the industry. The Internal Revenue Service overhauled disclosure rules beginning with 2008 tax records for not-for-profits and included more detailed questions on governance policies and board makeup. Meanwhile, good governance efforts within healthcare have increasingly pushed boards to look closely at trustees relationships, personal and professional, and at the skills and experience board members can bring to oversight.
Last year, the Center for Healthcare Governance released the first of two reports on the best practices and necessary expertise for hospital boards. The initial report outlined the composition and size of boards with the most effective cultures and stressed the need for diversity and clinical expertise, and said that clinicians, such as nurses and doctors, should be included on the boards. The second report, issued in February, focused on the skills, education and attributes needed in board members.
John Combes, the centers president and chief operating officer, says its important to get nurses involved in governance and that more boards have done so. Hospitals are basically just large nursing units, he says. Without nurses, hospitals wouldnt exist.
Combes says he sees a growing number of nurses on governing boards and credits the shift to hospital boards increasing responsibilities. Its not just about business and finance, he says. Boards need directors or trustees who understand healthcare delivery and can help improve its quality and responsiveness. More hospital and health systems reported their boards included a quality committee in 2007, 62%, vs. 56% two years earlier, the Governance Institute surveys show.
He rejects the idea that boards must include nurses or any other profession, but says instead a boards makeup should be balanced with skills, background and knowledge to address the issues facing hospitals and to give voices to those who have something at stake.
Accords Knecht says hospitals and systems recruit nurses out of retirement, from college faculty or nonrival healthcare businesses, but need to avoid their own employees to steer clear of conflicts of interest. She describes the potential pool of candidates as not as big as one would like, particularly for more isolated, rural hospitals without nearby schools to draw from.
Nurses may face pressure to put the professions interests ahead of the hospitals needs, Knecht says. As trustees, nurses must also be able to think strategically or risk falling into the trap of trying to manage hospital operations rather than govern. It can be hard to find the right kind of person, she says.
Disch of the University of Minnesota rejected the idea that nurses may be more susceptible to overstepping the role of trustee and director. Anyone on the board can get into the weeds, she says.
Knecht says nurses dont have to sit on the board to contribute to governance. Trustees should review nurse satisfaction and clinical quality data. Nurses can attend board meetings or contribute by sitting on committees, and indeed CNOs should do both, she says. The Governance Institute surveys found that the percentage of nursing chiefs who were not board members but who attended board meetings inched slightly upward to 83% in 2007 from 79% two years prior.
Hospital governing boards should include someone with clinical experience, but that does not mean it must be a nurse, Knecht says. Doctors, physician assistants or nurses can bring such necessary expertise to the board. A nursing background is desirable, but not required, she says.