BY: RHODA WEISS
Ms. Weiss is a Santa Monica, CA–based health care consultant and speaker.
In the not too distant past, board members of not-for-profit hospitals were
content to attend periodic directors' meetings at which health care executives
would wax poetic about the newest technology, technique, or medical advance.
Then came the Sarbanes-Oxley Act of 2002,* for-profit inroads into what had
hitherto been a largely not-for-profit sector of the economy, the 1997 Balanced
Budget Act, discerning consumers, bond-rating downgrades, and direct physician
* Named for Senator Paul Sarbanes (D-MD) and Representative
Michael G. Oxley (R-OH), this legislation makes corporate executives responsible
for the accuracy of their organizations' financial reporting. It was
enacted in the wake of the Enron scandal.
Boards in the early 1990s usually included few people of color and few women,
except, of course, in the case of Catholic organizations, where religious sisters
were highly visible. Community board members often had little knowledge of their
hospitals' clinical, financial, or administrative operations. They asked
few questions, putting their trust instead in the hospital executive's
decision-making capabilities and in the good will of the community.
Although people continue to join boards because they believe in the hospitals'
mission and want to do whatever they can to help, the good old days are gone.
Board members can no longer rest comfortably on a pedestal, so to speak, blindly
admiring the hospital executives and being blindly admired by a grateful public.
People are chopping away at that pedestal, challenging boards and hospitals
as never before.
A More Diverse Membership
Emerging now are new hospital and system boards composed of members who
represent diverse populations, professions, ages, and backgrounds. The face
of the board is undergoing slow but much-needed alterations. Today, hospitals
and systems are targeting their recruiting efforts so as to include members
representing diverse populations. Boards are becoming increasingly diverse,
not just because it's the "right thing to do" but because the
excuse "We can't find any of those kinds of people" (that is,
women, African Americans, Latinos, Asian Americans, Native Americans, younger
executives, and others) is no longer acceptable; it is, indeed, impossible to
Today's boards also are recruiting by specialty and business type. A recent
article in Trustee magazine encourages boards to strengthen relationships
with financial executives, probe for clearer and more in-depth explanations
of financial reports, and continually monitor the organization's financial
progress.1 To accomplish this, boards seek financial and business executives
who can quickly come to understand the financial and operational workings of
the often-complicated health care organization. Board orientations now include
classes on financial, clinical, and operational management. Some boards are
even considering "testing" prospective board members on their financial
expertise before offering them a seat at the table.
A Broader Outlook
As hospitals reexamine, define, and communicate their fundamental values,
trustees also are challenged to look deeper into what they now do, can do, and
should do for their communities.
Most not-for-profit health care organizations depend to some extent on philanthropy
to help fund capital projects, technologies, therapies, staff scholarships,
and new programs and services. Because this is so, not-for-profits seek board
members with sufficient influence to tap businesses, foundations, and individuals
for the contributions necessary to keep the organization in the forefront of
Boards today also seek members who can give their organizations access to the
business community. Because of board members' links to the Ford Motor Company,
for example, Oakwood Medical Center, Dearborn, MI, was able to greatly improve
the efficiency of its emergency department, one of the nation's busiest.
Ford engineers redesigned department procedures in a way that cut waiting time
from several hours to 30 minutes.
To improve an organization's functioning, some board members lend it the
expertise of their own business staffs. The trustees of Children's Mercy
Hospital, Kansas City, MO, for example, teamed up with the hospital's physicians
not long ago to make personal calls on the city's top business executives.*
In a typical meeting, a two-person team — a trustee and a physician — would
explain to the executive Children's Mercy's values, services, and
capabilities, and urge him or her to include the hospital among the preferred
providers in his or her company's insurance plan.
Campaigning in California
Board members can also use their influence to further health care reform.
In California, for example, board members of children's hospitals currently
are campaigning to pass a referendum measure that, if successful, will provide
millions of dollars for the much-needed upgrading of pediatric facilities throughout
the state. The Children's Hospital Bond Act, known as Proposition 61, would
authorize the sale of $750 million in bonds, the money from which would be used
to expand children's health care facilities and equip them for the treatment
of seriously injured and ill children.
If the measure is approved, its immediate beneficiaries will be eight private
children's hospitals and five children's facilities affiliated with
branches of the University of California. Together, the 13 institutions treat
more than one million children a year, regardless of their parents' ability
Trustees of the 13 facilities are traveling around the state, urging community
organizations, newspaper editorial boards, and business groups to support the
measure. They especially want to reassure Californians that passage of Proposition
61 will not mean raising taxes.
In some parts of the country, board members are involved in creating healthier
communities. Speaking to businesses groups, chambers of commerce, service organizations,
churches, synagogues, they seek to encourage incremental changes in lifestyle
that add up to improved health.
These new boards can be enormously helpful both in strengthening health care
organizations and in improving community health. Because this is so, the selection
of board members has become a much more important part of an organization's
strategic development than it used to be.
Ms. Weiss serves on the boards of Easter Seals, the Coalition on (organ
and tissue) Donations, and the Public Relations Society of America. She can
be reached at 310-393-5183.
- Jan Greene, "What Every Board Needs to Know," Trustee,
June 1, 2004.
Copyright © 2004 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.