How boards are transforming governance to address the significant shifts now under way in health care was the theme of the AHA Center for Health Care Governance 2012 study of Governance Practices in an Era of Health Care Transformation. Two key study findings were that boards both enable and block progress toward transformational change.

The study, which summarized 37 interviews of board members, executives and clinical leaders and commentary from an expert panel, concluded that boards are at their best when they:

  • Take on the difficult work necessary to adopt best-practice governance.
  • Challenge, support and hold organizational leaders accountable for improving performance.
  • Encourage innovation, tolerate risk and accept failure, while being goal-oriented.
  • Keep what's best for the community at the forefront of their deliberations and decision-making.

Boards are at their worst, the study found, when they:

  • Cherish traditions and local autonomy so highly that they can't objectively consider relationships with other organizations.
  • Fail to act because they fear the board will be a casualty of change.
  • Fail to exercise the board's power and authority to bring about change.

Work based on the study continues this year with development of new tools to implement study recommendations:

  • A self-assessment survey to gauge board readiness for transformational governance
  • An interactive educational program that discusses what changes facing health care organizations mean for board work and engages trustees in applying their learning to governance practice
  • A new Center Governance Assessment Process survey for boards to evaluate their progress toward adopting best practices for governing a transforming health care system.

Conversations about the value of governance in transformational times also continue this year, with wide-ranging discussions among the AHA's Committee on Governance and the Center's National Board of Advisors. A central question guiding these discussions: What does it mean to bring greater value to your community through board service? A sample of perspectives includes:

  • "Boards need to oversee development of health promotion strategies and activities and track progress with performance metrics on health promotion, disease prevention and health disparities."
  • "Boards need to advocate for lifestyle changes in the community to raise overall health status."
  • "Having good quality health care close to home does a lot for a community's health, and social and economic development. Boards need to carefully and thoughtfully engage their communities around these issues."
  • "Boards should see that hospitals deliver good value for an individual's health care dollar, regardless of whether people are covered by insurance or paying out-of-pocket."
  • "Boards must be able to demonstrate to the community what they are doing to help their hospitals improve quality and safety, reduce costs and improve outcomes for individuals and populations. That will be true accountability."

More about these discussions will appear in a fourth-quarter monograph from the Center. Tools based on the 2012 study also will be completed this year and made available to the field in 2014.

John R. Combes, M.D. is president and COO of AHA's Center for Healthcare Governance. You can contact him at&nbsp

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