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Can Today's Healthcare Boards Become More Like a Rancher?

Can Today's Healthcare Boards Become More Like a Rancher?

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:

  1. Determine and affirm, the mission and purpose
  2. Select, support and evaluate the chief executive
  3. Set the vision and strategic direction
  4. Monitor the progress of the organizational strategy
  5. Oversee the strength and continued need for programs and services and products
  6. Ensure adequate financial resources, protect organizational assets and provide financial oversight
  7. Build and maintain a competent and effective board
  8. Ensure legal and ethical integrity and,
  9. 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.