Hospitals are making greater investments in community health. More and more, they are engaging in “upstream” efforts to address the social determinants of health in the communities they serve. These efforts might include assistance with locating affordable housing, elder care, childcare, nutritious foods and a variety of other daily needs. Ensuring the support of your board of trustees and engaging them in these initiatives is key to their success.
In a conversation I had with Todd Linden, CEO of Grinnell (Iowa) Regional Medical Center and a Health Forum board member, he laid out what he sees as the key roles trustees should play in ensuring that the best “whole person” care and services needed and demanded by the communities they serve are delivered.
In an era of value-based payments and higher patient deductibles, the hospital of today will be less relevant than in the past, says Linden. We need to focus on whole person health and understand the needs and desires of our patients beyond acute medical care. Patients are shopping for the best value and the best care. In fact, a 2007 McKinsey & Co. survey showed that only 20 percent of patients’ choice was based on clinical quality, while a remarkable 41 percent was based on the nonclinical experience.
At the board level, we need to encourage a discussion that moves beyond the fiduciary and strategic role to “generative governance,” says Linden. Too often, hospital management utilizes the board to provide a seal of approval or rubber stamp for predetermined or predesigned decisions by administrators, leaving little room for creativity or tapping into the collective wisdom of the group.
For example, a major decision was needed regarding the future of the fitness center at Grinnell. Founded almost 20 years ago with a goal of serving the wellness needs of the community, the center was not performing up to expectations and was losing money and memberships. It seemed to some that this initiative had run its course. Was it time for Grinnell to revert back to being only a provider of acute care services?
Rather than looking at merely the financial pros and cons of operating the center and taking a problem-solving approach, Linden guided the board through a generative approach to rethink the question:
- What does the community need?
- What is the role of the hospital in responding to that need?
- What is the role of the hospital in improving the health of the community?
With these questions posed, the answer from the board was a resounding affirmation of the wellness goal — that Linden and his board would do what it takes to keep the fitness center open.
Once that commitment was made, Linden said, the philanthropic community stepped forward and ensured the center was fully funded. In his view, the full funding by philanthropy at this time was a ratification of the generative process. In one year, membership at the fitness center has doubled.
The right questions
Board members have a birdseye view of the community. Generative governance allows the board to bring that wisdom to the boardroom. Following a model promulgated by William Ryan, Richard P. Chait and others, generative governance is a state of being — asking the right questions and being OK with not having the answers.
Ted Ball, a leadership coach who has written on this topic, says such questions are the only ways in which the board can help the hospital learn how to collaborate with its partners more successfully. Better collaboration enables the hospital to create better and more patient-centered services across the whole continuum of care, not just within the silos of particular hospital services.
What can you and your board do to support whole person health? Here are a few suggestions:
- Encourage your trustees to get out into the community and learn as much as they can about the needs your constituents are expressing, says Debby Pohlson a community activist and former board member of Grinnell Regional Medical Center. In the case of integrative health, for example, encourage trustees to experience a few modalities such as massage and acupressure for themselves to try to understand how and why they work.
- Invite trustees to bring this information, knowledge and insight back to the hospital administration. How can your hospital serve as a bridge between the community and the health care system?
- Study best practices around the country or the world to see what might work for you, says Pohlson.
Every CEO wants his or her board to be successful and vice versa, says Linden. Generative governance — while it might be uncomfortable at first — is a way for organizations to reinvent themselves. What better way to address the often complex challenges faced by our evolving health care system?
Sita Ananth, M.H.A., is a Napa, Calif.–based consultant and writer specializing in wellness, community health and complementary medicine.