When leaders of public hospitals are forced out, they frequently aren't able to leave quietly. Ron Anderson, M.D., whose 28-year tenure as CEO of Dallas' Parkland Memorial Hospital ended in 2011, is just the latest example of such a high-profile departure.

Yet, an analysis of hospital CEO turnover, conducted by the American College of Healthcare Executives at the request of H&HN's sister publication Trustee, found that the data don't align with the headlines.

In 2010, turnover rate at the top was 16 percent among 1,100 public hospitals, precisely the same rate among the broader pool of nearly 4,600 U.S. hospitals.

"I think public hospital partings with the CEO may be a little more public by nature," says Thomas Dolan, ACHE's chief executive officer.

Public hospital CEOs do face some unique relationship challenges, many related to the administrator's lack of control over who lands on the board, Dolan says. Unlike boards for nonprofit and for-profit hospitals, directors of publicly funded hospitals must navigate open disclosure requirements and often reach decisions with a mixed bag of personalities at the table, either elected or appointed.

For that reason, it's particularly important that the CEO build relationships with each and every board member, he says.

Annual board retreats can be helpful, even vital, says James E. Orlikoff, a Chicago-based health care governance expert. One way to delve into the board's strengths and weaknesses is to hire an outside facilitator for the retreat. That individual can expose the board's failings without damaging its bond with the chief executive, says Orlikoff, who admits to sometimes assuming that bad cop role. "The CEO then can say, 'Wow, that person really pushed you too hard. She'll never be back here again.'"

When Michael Covert was hired to lead San Diego-based Palomar Pomerado Health in 2003, he pursued a series of steps to establish a better governance structure.

He describes writing job descriptions for each board committee, which the board then edited and ultimately approved. He also conducted a board assessment.

The good news: "They all cared and they were all committed," he says. But often, their verbal exchanges weren't as crisp and effective as they could be, Covert says. In some cases, they hadn't prepared sufficiently for meetings and, as a result, the conversation would become too operational, rather than strategic.

Over time, members agreed to trust the board committees and allow them to handle more of the work, Covert says.

Covert's open communication style has continued, says Ted Kleiter, Palomar's board chair. "He meets individually with board members on a regular basis," he says. "So he is able to react and respond to their individual idiosyncrasies and so on."

By early 2012, Covert was beating ACHE's turnover odds handily, with nearly a decade at the public hospital system, and counting.