Costs, payment reform, the push for quality and a new administration in Washington all are putting pressure on health care organizations, rural providers included, Orlikoff said at a general session of the American Hospital Association conference.

rural_orlikoff_story.jpg“The storm is hitting at a particularly challenging time,” Orlikoff (pictured) said.

Orlikoff, president of Orlikoff & Associates health care consultants in Chicago, pointed to statistics highlighting health costs and outcomes in the United States compared with other industrialized countries.

“Our value proposition is not being realized,” he said during his speech, “Ball of Confusion: Trends and Their Meaning for Leadership and Governance of Rural Hospitals.” “It’s up to us to do something about it.”

What can be done, Orlikoff said, is to focus on affordability, consumer engagement, physician alignment and performance, and governance and leadership.

“It’s your job to make yourself relevant to your community,” Orlikoff said.

On the governance front, Orlikoff stressed that hospitals need to think about who serves on boards.  “We’re not doing competency-based board selection” enough in the field today he said, drawing a distinction between expertise and literacy.

“If you want an expert on your board, you must recruit them,” Orlikoff told the audience. “Literacy is a continuing governance-education issue.”

Orlikoff also raised the possibility of paying nonprofit trustees for their work. Conflict on boards is not a bad thing, according to Orlikoff. “The best dynamics and the best decisions come from what is called productive disagreement,” he said.

Other best practices he discussed for health care boards included performance evaluations, a focus on leadership, diversity — especially age diversity — and preparing for board succession.

“What I’m imploring you to do is think beyond yourselves,” Orlikoff said.

Governance issues were a focus of the conference. Orlikoff also held a session on the board’s role in safety and quality and a clinic with rural hospital trustees, while Dottie Schindlinger, executive vice president of BoardEffect in Philadelphia, tackled what can be an elusive concept: generative governance.

rural_schindlinger.jpg“We have to get really good at pivoting,” Schindlinger said to 90 or so people attending a Tuesday session. “That requires a lot of smarts on the part of our boards,” said Schindlinger (pictured).

During “Building Board Engagement Through Generative Governance,” participants — mainly trustees — took part in exercises meant to demonstrate the term. They reframed topics to address the big picture, held generative conversations, looked at case studies and took home tips for their own boards.

Pioneered by Harvard professor Richard Chait, William Ryan and others, the concept of generative governance involves leadership and asking questions, not just fiduciary and strategic responsibilities.

“The problem is when you have boards who never get to the generative, except at their retreats,” Schindlinger said.

Cybersecurity — another recurring theme at the conference — was important for Schindlinger and Orlikoff.

“The more connected we become, the more vulnerable we become,” Orlikoff said. Changes in technology, economics, generational groups, and the legal and regulatory landscape are trends rural health care organizations will have to confront, Orlikoff told his audience.

“We’re at a crossroads. We’re at a disruptive point in the history of hospitals,” he said.