Trends in Healthcare & Governance

Thoughtful processes to onboard new trustees and ensure ongoing education are imperative to optimize board engagement and performance. The American Hospital Association released the third and final chapter of its triannual National Governance Report (available to AHA members) that focuses on board position descriptions, orientation and education practices. It is based on data collected from hospitals and health systems across the country between August and December 2024.

How do your board practices compare to the following trends?

Board position descriptions

• Thirty-one percent of all respondents reported that they did not have job descriptions for their board members, board chair or committee chairs, consistent with the 2018 survey.
• Trends regarding use of job descriptions were similar among all board types (system, subsidiary and freestanding), with descriptions for board members and board chairs being used most.

Board orientation

• Eighty-one percent reported having a formal new board member orientation, similar to 2018.
• The following activities were most often reported as included in orientation for new board members:
  • meeting with the CEO and/or senior leadership team (93%);
  • having a healthcare governance orientation (84%); and     
  • taking a facility tour (75%).
• Orientation on healthcare was conducted among 69% of respondents.
• Formal mentoring with a senior board member was reported by 42% of system boards, 22% of subsidiary boards and 23% of freestanding boards.
• Only 24% of respondents conduct a formal orientation for new board chairs.

Board education

• Only 32% of all board types reported that continuing education was a requirement for board member service, an increase from 29% in 2018.
• The percentage of health systems requiring continuing education of their board members decreased from 43% in 2018 to 36% in 2024.
• Most systems (53%) and subsidiary hospitals (43%) said they were providing formal board education quarterly to their members, while freestanding hospitals (41%) were more likely to do so annually.
• Board continuing education was reported to be most frequently delivered at board/committee meetings by 73% across all board types. Self-directed (articles, online resources, etc.) was the second most common method of delivery.
• Eighty-one percent of all board types periodically conduct an educational briefing from legal counsel or others on compliance issues, with conflicts of interest being the second most covered topic.

Refer to Chapter 3 of AHA’s report for more details and tips on these practices from a governance expert.

Note: Trends is now available as a PDF for convenient sharing with your board colleagues.

Information for this article was obtained from: 2025 National Governance Report: Chapter 3, American Hospital Association (available to AHA members).