By LILAH LOHR
ATLANTA — Denver-based Catholic Health Initiatives is running a "thought experiment," said Michael Rowan, CHI executive vice president and chief operating officer, to figure out how to "take a board away from finance committee metrics" and move it into a governance structure with a purview that reaches beyond acute care considerations.
The goals are to expand board members' understanding of Catholic identity in keeping with "signs of the times," Rowan said, and to translate the ministry's work to correspond with a future being ushered in by health reform. In this environment, mission and strategy must become core functions for boards, and local board members will need leadership formation and perhaps new skill sets, CHI believes. A team of CHI leaders explained the board transformation work during a session at the Catholic Health Assembly.
The thought experiment pilot project convened the board chairs and chief executives of five of CHI's 70 hospitals to address "how are we going to govern as the new (health care) world emerges," said Fr. Thomas Kopfensteiner, STD, CHI's senior vice president for mission.
"That (process) is moving the board into generative thinking," he said, for "the health care that we have today is not what it is going to be tomorrow." Generative thinking refers to deliberations that produce original ideas that can grow into larger concepts.
The group started with such basic questions as "does our current (governance) structure meet the needs of the future?" and continued into more in-depth thinking about how health systems, payers and physicians are going to relate in the future and how those relationships and partnerships will be governed across multiple markets.
The process included reviewing bylaws, strategic plans, board composition, agendas and overall board effectiveness; and each site picked an aspect of governance improvement to determine if it could be replicated, eventually systemwide.
The pilot group worked on how to integrate mission and strategy throughout board activities, linking everything back to what it means to be a Catholic organization.
"Oftentimes, strategy is just about the business," said Beth O'Brien, CHI's senior vice president for operations. The pilot group, however, found that new models of governance often called for new board skills and new philosophies for appointing members.
"Combining mission and strategy impacts board selection," Fr. Kopfensteiner observed, adding, it also has implications for board formation and physician formation.
CHI's thought experiment also paid close attention to board structure. Project members proposed making changes ranging from combining or modifying areas such as mission, ministry and advocacy and adding new ones such as physician enterprise.
Physicians are highly influential employees, and they can bring a mind-set that is different from that of nonclinical leaders, Rowan said, and boards must seek new ways for physicians to engage in the governance process.
In the new board structure, mission's role becomes more integrative, strategic and better able to inform decision-making. Also, strategic planning moves to a more central role in the board's work. The board structure also encourages flexibility and responsiveness. There is an imperative link between quality and finance, and part of the board selection process under this model is to seek out people with specific competencies.
"The reality is that we are going to have to help (better) educate our boards for all of our markets," Rowan said. "Local boards' strength is going to be important," especially in their generative thinking ability in examining such questions as "Who are we?" "What's our mission?" and "How do we go about that mission?"
Rowan said the proposed new board structure "involves a more practical application of the mission," including placing the mission leader "at the table for big issues, not just discernment." The structure also requires a non-entrenched viewpoint from the board, "not just report-report-report."
Rowan conceded that some board members have felt discomfort with their new roles as they've shifted focus from governing acute care facilities to governing a system of care across the continuum. Time and experience should reduce that anxiety, he said.
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