It is often said that its meetings are one of the board's most precious resources. Board and committee meetings are where a board actually governs — making decisions, setting policy and providing direction about organizational performance and strategies. Some governance experts even suggest that a board doesn't really exist except between falls of the gavel. Because meetings are so important, all boards can benefit from periodically reviewing how they prepare for, execute and evaluate them. The following questions can help boards identify where meeting practices are solid and where there may be room for improvement. Boards can assess meeting effectiveness as part of a board self-evaluation exercise. Outside experts also can review meeting practices and outcomes, observe meetings and report to the board. Whatever approach you take, don't miss the opportunity to get the most out of one of your board's most valuable resources.

John R Combes is president and chief operating officer of the AHA's Center for Healthcare Governance. You can contact him at

Meeting Preparation

1. Are meeting dates and times calendared and distributed at least a year in advance?
2. Do the board chair, CEO and relevant committee chairs help set the meeting agenda several weeks before each board meeting?
3. Are agenda materials distributed to meeting attendees at least a week before each meeting to allow time for thoughtful consideration?
4. Do board members receive handouts at meetings that include information about actions the board is scheduled to take at the meeting? Does this happen at all or most meetings?
5. Are committee reports structured so that key questions for full board consideration are clearly indentified and given adequate time for deliberation on the agenda?
6. Does the board use a consent agenda for making routine decisions at every meeting?

Meeting Execution

1. Do all meetings start and end on time?
2. What percentage of board members typically attends each meeting?
3. Are board members reminded at each meeting to comply with conflicts procedures, board confidentiality and other applicable policies?
4. Do meetings focus on discussion and debate or primarily rehash reports distributed in advance?
5. Are meetings future-focused or concentrated on reviewing past results?
6. Do board members understand how the board makes decisions and are decisions made accordingly?
7. Do board members ask questions, challenge management assumptions and explore alternatives management considered before voting on recommendations brought to the board?
8. Are executive sessions routinely held with and without the CEO?

Meeting Evaluation

1. Are board members given the opportunity to evaluate meeting effectiveness?
2. Are the results of evaluations reviewed by the CEO and board chair, used to improve subsequent meetings and shared with all participants?

Meeting Value & Contribution

1. What were the three most important decisions the board made this year?
2. How did these decisions drive action that supported mission and strategy fulfillment?
3. How do board meetings improve the quality of care and service the hospital delivers to stakeholders?