Hospitals rethink how to train trustees

Some hospital leaders think new trustees without healthcare experience need about three years to gain confidence and competence in their role. But Dr. John Combes believes that thinking is dangerously out of date.

The healthcare system is changing far too rapidly to accommodate long grace periods for new trustees, said Combes, president and chief operating officer of the American Hospital Association's Center for Healthcare Governance. “We just don't have that luxury now,” he said.

Combes' view is echoed by other hospital leaders looking to beef up their orientation and training programs to ensure that new board members have the skills and contacts to make difficult, high-stakes decisions for their organizations.

A robust trustee orientation program should have three parts, Combes said. The first is a basic introduction to the organization and to the U.S. healthcare system. The second is ensuring that new trustees have a mentor, ideally an experienced board member who can answer questions and model basic board competencies.

Third, hospitals should incorporate an experiential learning component, such as shadowing an administrator or participating in clinician rounding. “Spending four hours with an ER doctor can really give a new board member a good feel for the organization,” Combes said.

Ninety percent of hospitals that responded to the Center for Healthcare Governance's most recent annual survey said their trustee-orientation program included a basic introduction to their organization and to healthcare. But only about a quarter said they assigned mentors to new trustees. And a very small percentage said they used experiential learning.

Salem (Ore.) Health takes a multipronged approach to training its new trustees. Orientation begins with a two-hour educational session on the basics of the healthcare industry and the organization. Trustees also participate in the hospital's Physician Leadership Institute, a regularly scheduled event that features nationally recognized speakers discussing timely healthcare topics. And trustees are assigned a mentor on the board and encouraged to ask senior leaders questions, said Norman Gruber, CEO of Salem Health.

Each quarter, Salem Health's trustees also spend time alongside clinicians to see how Lean process improvement principles are being applied on the front lines.

Gruber emphasized the importance of choosing the right people as trustees. “We do a lot of work in our governance committee to make sure we choose people who have the intellect and curiosity to do this, people who know what they don't know,” he said.

When Salem Health's current board chair, Bob Wells, became a trustee eight years ago after retiring as Salem's city manager, he was struck by how different healthcare is, especially the myriad regulations governing quality and safety. “It was very different than what I was used to,” he said. “But I felt really supported by the hospital and the CEO. When we needed education, they were great about providing those opportunities.”

The Center for Healthcare Governance offers trustee training materials, including articles, an acronym guide and a webinar orientation series. In addition, state associations offer resources and specialized events. For instance, the Health Care Trustees of New York State offers a preconference event for new trustees prior to its annual meeting. The New York group also offers a publication called Boardroom Basics that outlines trustees' fiduciary responsibilities.

“If you don't have a healthcare background—and most trustees don't—the first three years are so new, especially given healthcare reform and the move from volume to value,” said Sue Ellen Wagner, the group's executive director.

Since 2010, the Minnesota Hospital Association has been holding half-day “training camps” for newer trustees to help them better understand topics such as hospital finance and healthcare reform, said Lawrence Massa, the association's president.

“It gives them an opportunity to network with other new trustees, and they find great value in that,” he said.

Minnesota's preconference content includes a review of fiduciary responsibilities, what it means to serve on a not-for-profit board and an explanation of trustees' role in overseeing clinical quality. The association also has a 35-hour trustee certification program that has nearly 600 enrollees and 115 graduates, he said. The association produces 10 board-orientation videos a year on topics such as billing and collection and HHS' Partnership for Patients program.

“Board education is something we think is so important,” Massa said. “When you engage board members in these conversations, they will devote much more time than you think they will.”