Health care organizations are on the edge of major change. Recent legislation,
changes in insurance and government payment policies and advances in technology
ensure that change is here now. For health care organizations, especially
those which have been around a long time and which are culturally ingrained
with image, processes and a proud history, the major change going forward
is the new expectation to care for defined populations. Caring for populations
of people and thinking of ways to improve the health status of an entire
community, instead of just focusing on the recovery of a patient from
an acute episode, requires a whole new mindset. Boards of health care
organizations today are absolutely critical to the success of this aim
and must consider expanding their thinking well beyond the traditional
set of policies, decisions and oversight functions that have been so long
entrenched as the “duty of a board”.
Spending a good part of my formative years working on a large ranch in
Texas, I came to appreciate individualism. I learned lessons about long
hours, attention to detail, adjusting quickly, long term thinking and
absolute respect for clear, unadorned, independent thinking. Ranching
was still much about--"I do it my way and will rise or fall on my
own merit". With decades of time to reflect and think about this
experience, I now know that we, perhaps the last members of an American
iconographic lifestyle, were, in fact, not so independent and individualistic.
We were subject to, and smart enough to adapt to, large forces outside
of ourselves, particularly the price of wheat, meat, and hay as well as
the vagaries of the weather. We were also sensitive to our community and
cultural norms of our environment. We respected and trusted people, we
were kind to strangers as well as neighbors...but, especially our neighbors.
Our neighbors were other ranchers. They were our friends, our competitors,
our advisors, our source for so many things; they-along with the town
folks-made up our community. Even though these neighbors, these ranchers,
were often several miles away we knew that in times of need they would
be there for us, just as we would be there for them. We were proud, autonomous,
tough, and resilient and while independent on one hand, we were also a
part of a larger community, a society that was founded on respect and
dignity, responsibility and knowledge of something outside of ourselves.
In short, even though there was much we could do on our own, indeed because
of the need for efficiency and effectiveness we had to do much on our
own, but we also needed our community, our neighbors and our institutions...and
we made sure they stayed strong and vital—because it was in both
of our best interests.
What does an autonomous, mostly independent life as a rancher have to do
with organizations today? Many institutions today are strong and capable—but
they do not stand alone, just as independent, strong and resilient ranchers
do not stand alone, we both need good neighbors. A spirit of service,
philanthropy, leadership and accountable governance are a fundamental
part of and foundational to our society. In an increasingly complex world,
we have institutionalized "neighborliness" and formed organizations,
some with very corporate behaviors, to address the many needs of our communities.
Our social mores have been canonized into legal obligations. This is likely
a good thing in a complicated, accelerating, diverse and yet interrelated
and mutually dependent world. As our society has evolved, so too the organizations
and institutions through which society lives and expresses itself have
evolved. Existing in this environment, governance of these organizations
has become more focused, intentional, rational, and success driven in
order to meet its fiduciary duty to perpetuate its mission. Most board
directors today subscribe to the notion that by them being a good member
of the board this ensures the board as a whole will, in turn, do its duty
to help guide the organization toward its definition of success....and,
therefore, a successful organization will contribute to the success and
benefit of society. This is a fundamental aspect of organizational governance,
indeed, it is a legal requirement and an obligation.
Most boards focus on and emphasize the following as areas of governance
for their roles and responsibility:
- Determine and affirm, the mission and purpose
- Select, support and evaluate the chief executive
- Set the vision and strategic direction
- Monitor the progress of the organizational strategy
- Oversee the strength and continued need for programs and services and products
- Ensure adequate financial resources, protect organizational assets and
provide financial oversight
- Build and maintain a competent and effective board
- Ensure legal and ethical integrity and,
- Protect and enhance the organizations' public standing
These traditional expectations apply to many types of boards and have been
widely recognized and accepted. They often serve as a guideline by which
boards evaluate themselves. Accrediting agencies, external auditors and
regulators also look for compliance with these, or similar, criteria.
Certainly, there have been egregious violations of these expectations
and of the public trust in the past. Having been widely reported, such
violations have served to renew governing boards focus on their own behaviors
and their accountability. Most of the 1.6 million boards in this country
get an A+ for meeting these expectations and standards and for ensuring
the success of their organization. Conforming to these expectations has
created a degree of comfort and familiarity, but which today may need
reconsidering. What grade should we give governing boards for their response
to building and enhancing the communities in which they live? How good
is our relationship with our “neighbors”?
Is the inward focus, so clearly evidenced in the list of roles and responsibilities
for boards, too much naval gazing, too organization-centric? Most boards
would say “No”,… that they give significant attention
to community need, and they have the surveys to prove it. But is this
enough? In a time of reorienting health care organizations to becoming
responsible for the health of a defined population, is it time to broaden
our horizon beyond the currently accepted list of duties? We need our
neighbor and our neighbor needs us. We can’t do this alone. More
in the next blog.