PHOENIX — While many of you elsewhere in the country have spent the last several days shivering and shoveling, a couple of hundred hospital representatives are here in summery Phoenix trying to wrap our minds around today’s hottest health care issues.
The focus of the Center for Healthcare Governance’s winter symposium is how board members and management teams can work together to make sure their hospitals thrive in the midst of dramatic change. While strategies will vary from one organization to another, the first step for all leaders “is not to look for the right answers, it’s to look for the right questions,” governance expert Jamie Orlikoff told attendees Monday. Without well-considered, well-formulated questions, whatever answers you come up with are bound to fail, he warns. [Orlikoff also has some thoughts on the outlook for rural hospitals, in a video interview.]

Trustees typically are brought into a discussion far too late in the process, says William P. Ryan, another well-known governance consultant. In many cases, executives present a thoroughly developed strategy at a board meeting, trustees are given very little time to ask questions or comment, and then they rubber-stamp whatever the CEO has put in front of them.

A better process is what Ryan calls “generative governing” in which a particular issue is presented to a board at the earliest stage possible and trustees are encouraged to debate a range of critical factors and implications. As an example, he cited a faith-based health care system that is thinking about outsourcing its patient financial services operation to India. Early on, the board might ask executives:

  • Is this the right place to find savings?
  • Are our values aligned with this option?
  • Are we meeting our mission if we increase unemployment in our community?
  • On the other hand, do we care more about workers here than in India?
  • What would we never outsource?

Rich Umbdenstock, president emeritus of the American Hospital Association, says today’s board meetings in large part should always be a referendum on some very fundamental questions:

  • Do we have the right strategic plan in place?
  • Do our numbers support that we are progressing on that plan?
  • Do we have the right leadership in place — both in the executive suite and on the board?
  • Can we move with agility in the face of constant change?

CHG President John Combes, M.D., spoke for all the expert presenters yesterday when he declared that today’s hospital trustees have the hardest volunteer job in the country. They must be well-prepared to ask their executives tough questions — and executives must enthusiastically encourage them to ask. Without that kind of effective governance, no hospital can successfully navigate the revolution now taking place in health care.


Tomorrow: Stay tuned for two questions every hospital trustee and executive must ask.