focusing your board on strategy -...

Focusing Your Board on StrategyKarma H. Bass, MPH, FACHE

Via Healthcare Consulting

Carlsbad, California

Imagine a board meeting where trustees are engaged

in dynamic discussion on matters of strategic

importance without getting stuck in the operational

weeds…

Not a Good Time to Be in“The Hospital Business”

CMS is reducing payment for

outpatient services provided in hospitals

& off-campus hospital outpatient

departments

CMS removed total knee

replacement from the

“inpatient only” list

Anthem will no longer pay for

ambulatory MRIs and CT scans performed

within hospitals

Anthem will no longer pay for

emergency room visits in non-emergency situations

Quoted from Ken Kaurman, September 16, 2018. Cited Sources: Dickson, V.: “CMS Dials Back Plan to Slash Payment for Off-Campus Services by Half.” Modern Healthcare, Nov. 2, 2017; Mundy, R.: “To Knee, or Not to Knee? That Is the Question…” Becker’s ASC Review, Dec. 4, 2017; Anthem Blue Cross

Blue Shield: Imaging program expands to include level of care reviews: FAQs, May 2018; Fox, M.: "Major Insurance Company’s Payment Decision Angers ER Doctors," NBC News, June 5, 2018

Redefining the “H”The American Hospital Association believes that changes in the healthcare field as significant as those likely to occur in the coming decade need to be planned for, not only within the hospital, but also with strong input and engagement from trustees and the community.

• Alternative payment models necessitate cost reductions despite Medicare cost-based reimbursement.

• The market shift to high-deductible plans results in more cost-conscious healthcare consumers.

COST PRESSURES

• CAHs were eligible to receive up to 100% reimbursement for bad debt, but the ACA reduced this in several stages to a final reimbursement level of 65%.

• This cut increased pressure to drive efficiency.

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1 iVantage 2016 Vulnerability Index, in which 673 rural hospitals are classified as vulnerable out of 2,078 included.

BAD DEBT

32% of U.S. Rural Hospitals are Vulnerable or at-risk for Closure

Healthcare Leaders See Disruptions Threatening

• Disruptors will take profitable business and leave us the sicker, older, poorer patients

• Inability to “perfect the product”

• Demand for cost transparency • Commoditization: Hospitals

have to take the price offered• Millennials care about star

ratings, not quality scores

Want to learn more?Watch this: https://www.aha.org/disruptive-innovation-

opportunities-and-challenges©Via Healthcare Consulting 2019All Rights Reserved

https://www.aha.org/disruptive-innovation-opportunities-and-challenges

What’s a Board to Do?

• “Get Comfortable with Being Uncomfortable”• Stop the Infighting• Question Assumptions • Keep Your Eye on the Right Metrics• Look Beyond Traditional Competencies When Recruiting• Engage in Continuous Learning

• Official purpose• Formal rules• Written agenda

• Feelings and needs

• Informal leadership

• Group dynamics

• Decision-making involvement

• Interpersonal communications

Courtesy of ACCORD LIMITED

What Really Goes On in Boardrooms…

Targeted, governance-level packets provided at least a week prior to meeting

Agenda states action desired, estimated time of conversation, and reference materials

60% of time spent on strategic and policy issues At least 75% of time spent in discussions vs. reports Verbal reports of packet material forbidden Consent agenda utilized “Dashboard” performance indicators used Minutes provide an adequate summary of the meeting Healthy board culture

Effective Board Meetings

© Via Healthcare Consulting 2019 All Rights Reserved

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• Talk about how the process component is affecting decisions

• Be aware of the influence of the group dynamics

• Share concerns about possible decisions

• Speak openly about interpersonal communications breakdowns

There’s Power in Naming It

Courtesy of ACCORD LIMITED © Via Healthcare Consulting 2019 All Rights Reserved

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Sample Group Guidelines

• “Lower the water line”• Be honest and kind• Encourage and respect all opinions• Declare ‘devil’s advocate’• Avoid side conversations• Be fully engaged (no smartphone gazing)• Use consensus decision making• Ensure all actions are assigned• Other?


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1. Promote and protect the mission of the hospital2. Act in a manner consistent with the hospital’s values3. Respect the confidentiality of deliberations at

meetings4. Complete the annual conflict of interest questionnaire5. Contribute to a climate of mutual respect, honesty,

and open discourse during meetings and with the CEO6. Attend the mandatory orientation within __ (#)

months7. Attend a minimum of __ (%) Board meetings annually8. Prepare for each Board / Committee meeting

Sample Code of Conduct


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• A person dominates the meeting

• A person is consistently quiet

• A group digresses from the topic, loses focus

• There is silence, no one is talking

Behaviors that Impede Group Progress


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How to Disagree without Being Disagreeable

1. Speak with civility. 2. State your view

about the subject not about the person.

3. State opinion as opinion, not as fact.

4. Avoid absolutes about other people.

5. Think yes not no.6. Communicate to learn

not to win.7. Get out of your comfort

zone.8. State your inference as

an inference, not as the speaker's intention.

Source: Kate Nasser, The People Skills Coach™www.katenasser.com

Almost all conflict is the result of violated

expectations.Blaine Lee

• Help the board prepare• Create a great agenda• Work through tough issues• Stay at governance /

strategic level• Advise the CEO if asked to

play that role• Facilitate a productive

meeting• Ensure the board and its

committees are effective and efficient

• Develop a healthy board culture


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Board Chair’s RoleNote: Board Chair does not normally

have any special authority

What to Look for in a Chair• Understands board roles and responsibilities • Passion for, and commitment to, the mission• Respect for collaboration and group decision-making process • Ability to hold others accountable without being demeaning or

seeming bossy• Appreciation for the fact that the board chair must be a role

model for the rest of the board• Respect of other board members, the CEO, physicians, and staff• Strong facilitator who knows how to run a successful meeting• Great communication skills and understanding of the important

role communication plays in successful group dynamics.• The time to do the job and do it well


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Excerpted from Dr. Laura Otten’s “Choosing a Board Chair” Nonprofit Center at La Salle University’s School of Business http://www.lasallenonprofitcenter.org/choosing-a-board-chair/

Profile of a Successful System or Hospital CEO

• Intensely competitive, confident, and emotionally resilient. They also "crave the limelight.”

• Personality is a "vital factor in leadership success."

• Passionate about getting results, decision making and driving execution. "We found that leaders who are successful stay laser-focused on outcomes and demand specifics on how results will be achieved."

• Talented in quickly evaluating complex business situations and focusing on customer needs.

• May need encouragement to focus on serving as an inspirational leader.

• May have a tendency to default to the short-term.Source: Development Dimensions International report, “High Resolution Leadership” 2018

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CEOs get frustrated by…• Inappropriate involvement in operations

• Unclear expectations of CEO

• Lack of honesty with CEO

• Cop mentality

• Going around the CEO

• Leaks of confidential information

• Insufficient healthcare knowledge

• Late and/or absent members

• Grenades in meetings


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Boards get frustrated by…• Fully baked cakes• Excessive time expectations• Being kept in the dark• Smoke-filled room decisions• Overloaded board packets with

too much jargon• Too many reports by staff• Tension between administration

and physicians• Insensitivity to need to live and

work in the community

BOARDPACKET

Succeeding with Your Board Members or CEO• Get to know him or her• Ask what he/she expects • Offer support – help him/her succeed• Socialize appropriately• Ask for input• Maintain professional boundaries and

foster warmth • Be prepared; make him/her look good• Give your board or CEO credit for

successes• Offer ways for him/her to receive

feedback© Via Healthcare Consulting 2019 All Rights Reserved

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• Job descriptions• Orientation and education• Board succession planning • Board self-evaluation• Annual board goals • Effective committee structure • Written board policies • Focus on effective meetings

A Solid Foundation in Governance Effectiveness Can Make All the Difference


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