Trends in Healthcare & Governance

HTNYS’ monthly Trends updates provide trustees with information about emerging developments in governance and healthcare. Published by HTNYS on the second Wednesday of each month, Trends’ timely statistics and insights help trustees fulfill their roles and responsibilities while adapting to the changing environment.

Board lessons learned during the COVID-19 pandemic
May 2021

During the COVID-19 pandemic, hospital and health system governing boards have had to develop crisis management strategies to ensure that their organizations have the right protocols and procedures to care for patients and keep patients and employees safe. They also have had to adapt protocols to govern during the pandemic.

Members of the American Hospital Association Trustee Services committee on governance recently shared the following board crisis management strategies.

Focusing on board culture

The board learned that it became known as the “caretaker” of the organization and was looked to for leadership when the organization faced challenges associated with the pandemic.

Addressing workforce challenges: The board needs to be aware of how employees are coping during times of crisis, the stresses they face and what is being done to help staff cope — overall, to be supportive of employees. Some boards:

  • created special thank-you videos to express their gratitude and appreciation to employees for all they were doing to care for patients; and
  • developed resilience toolkits that focused on internal disaster planning efforts to prepare for unexpected events, like a pandemic; content in these toolkits included checking on the mental health of C-suite members.

Adapting to virtual meetings: Governing boards quickly adapted to meet virtually for committee and board meetings at the start of the pandemic. When it is safe to return to in-person meetings, some boards:

  • are likely to continue to use virtual meetings for committee meetings and possibly some board meetings; and
  • intend to have their board meetings focus more on strategy and generative issues, while having their committees discuss issues in more detail.

Revisiting the basics of governance: While many boards experienced challenges with basic governance, some were successful and plan to continue their new processes. Some boards:

  • developed a successful virtual orientation session for their new trustees that included a brief overview of responsibilities by all members of the organization’s senior leadership team;
  • examined succession planning during the pandemic; or
  • had to decide how to proceed when they didn’t have a quorum for virtual meetings.

Revisiting credentialing and privileging practices: Some governing boards needed to adapt their credentialing and privileging for providers at health systems with facilities and clinicians practicing across state borders. One health system:

developed a new board committee to centralize this process, which enabled facilities to move their physicians to hospitals that needed their services during different time periods to care for a sudden influx of patients.

Prioritizing communication between the board and management

Boards quickly learned that they needed to develop uniform and consistent messaging for all board members so they could be prepared to speak and answer questions effectively when approached by community members. Some boards held special weekly calls with their CEOs to ensure they had the latest information on COVID-19 and knew what was happening at the hospital.

Recruiting a new CEO: Recruitment practices needed to move to virtual interviews with candidates during the pandemic. Boards learned that:

  • interpersonal relationships can occur virtually.

Rethinking strategic planning: Strategic planning needed to continue during the pandemic, which required strategy to pivot. Some boards:

  • recognized the need to add health equity, diversity and inclusion to their board strategy; and

learned that they can persevere and be innovative during times of crisis.

Note: Information on this topic was obtained from AHA Trustee Services. We encourage you to read this article for more details. © Used with permission of American Hospital Association.

Paving the way for board diversity
April 2021

Hospital and health system board and organizational diversity, inclusion and cultural competency are key to addressing the social and economic factors that shape the health of their communities, reducing health disparities and achieving the best possible health for everyone. However, many diversity efforts fail because of misconceptions about what diversity is and what is necessary to achieve it. There’s always more that can be done to achieve diversity of race, ethnicity, gender, age, expertise and experience on healthcare governing boards.

Here are examples of reasons given for why a board’s efforts to diversify have stalled, with potential actions to get back on track:

Misconception: “Our community isn’t diverse, so we don’t need to be diverse.”
Action: Expand your concept of diversity.

Misconception: “We can’t find diverse candidates.”
Action: Expand your sources for locating candidates.

Misconception: “Some populations don’t seem interested in serving on governing boards.”
Action: Expand the way board service is offered to the community.

Misconception: “We recruit diverse board members, but they don’t stay.”
Action: Examine board culture to increase inclusion and equity.

Questions for board discussion:

  • Have we studied all the ways in which our community is diverse? Are we regularly educated on the unique challenges and barriers that marginalized populations face in accessing our services?
  • What efforts have we made to make our board culture equitable and inclusive? Do we hear from all voices at the table, regularly?
  • In addition to our current sources, what additional sources should we be using to recruit diverse candidates? How could we be opening access to our recruitment pool for diverse candidates in new ways?
  • How can we reframe the opportunity and experience of board service to attract and retain more diverse board members?

Addressing the misconceptions directly can help pave the way for achieving diversity goals and at the same time, help develop best practices in recruitment and board engagement. It is important to note that there will be stumbling blocks on this journey and the experience will not always be comfortable.

Note: Information on this topic was obtained from American Hospital Association’s Trustee Insights article, “The Thing About Diversity Is…” We encourage you to read this article for more details.

Returning to in-person board meetings
March 2021

Hospital and health system boards quickly adapted and developed best practices for virtual board meetings over this past year. Virtual board meetings:

  • have encouraged governance best practices such as streamlined agendas and thoughtful pre-meeting planning and preparation; but
  • have not reached the level of engaged strategic discussion that is generally present at in-person meetings, which is a serious obstacle, given the critical topics on most 2021 board agendas.

To optimize deliberation, debate and decision-making, consider returning to the boardroom with new safety protocols in place:

  • Consider inviting a hospital or health system physician with infectious disease expertise to address the board about safe meeting practices before reinstituting in-person meetings.
  • Select a meeting room of appropriate size (which may not be the traditional boardroom) to allow for physical distancing. Additionally, share relevant air exchange and HVAC system information with the board prior to meeting in person.
  • Institute a strict mask requirement.
  • Allow remote participation for trustees with health concerns or other special circumstances. Make sure to clarify policies about virtual attendance for designated in-person meetings.
  • Provide a microphone for each meeting participant to improve hearing when speaking through a mask.
  • Skip the meal. Schedule the meeting outside of the routine meal schedule.
  • Continue the streamlined meeting techniques that were developed for virtual board meetings to allow maximum time for discussing strategic matters.

There is no substitute for robust strategic deliberation in the boardroom. Face-to-face meetings facilitate the board’s highest level of performance. Naturally, each board and set of community circumstances are unique and board leadership must recognize the sensitivity of the decision on whether to meet in person.

Note: Information on this topic was obtained from AHA’s Trustee Insights, “The Pathway Back to the Boardroom.” © Used with permission of American Hospital Association

Using data to understand the impact of your hospital or health system
February 2021

Hospitals and health systems across New York play a vital role in improving local economies and communities.

  • They provide critical healthcare and emergency services; contribute vital resources to communities through jobs, tax revenue and capital improvements; and are among the largest employers across the state.
  • They make these tremendous contributions despite facing significant financial challenges, including having the second-narrowest average operating margin in the country.

HANYS recently released our economic and community benefit analyses, updated for 2021:

  • Browse our statewide, regional, legislative district and hospital- and system-specific reports to see how New York’s hospitals and health systems impact their local economies and benefit their communities.
  • The figures in these reports demonstrate the tremendous impact of hospitals across the state. For example:
    • the total economic activity generated by hospitals ($176 billion) is more than 10% of the state’s entire gross domestic product; and
    • adhering to their charitable mission, hospitals provide more than $12 billion in annual community benefits and investments, including covering the cost of care for people in need, subsidizing care and services to low-income, elderly and under-served communities, and continuously investing in many community health initiatives.
  • It’s important to note that the numbers in the economic impact reports, including the statewide financial indicators, were collected before the COVID-19 pandemic and do not reflect the significant financial toll the pandemic has had on New York’s healthcare system.

Trustees are encouraged to explore these reports to better understand:

  • The economic and community benefit impact your hospital or health system has on the communities you serve: Trustees are often called upon to speak on behalf of their hospital and should be well-versed in the total impact of their organization.
  • The importance of protecting and investing in New York’s healthcare system: These reports will aid in your advocacy efforts, as they demonstrate why it is so important to oppose any reductions in vital healthcare funding — not just for the well-being of New York’s healthcare system, but for the well-being of New York’s communities.

Conducting engaging virtual board orientations
January 2021

Last month’s Trends focused on conducting effective virtual board meetings. This month, we continue the conversation with a focus on conducting board activities such as orientations remotely.
In spite of the challenges that the COVID-19 pandemic has posed operationally, boards must continue to conduct informative and engaging orientations for new board members, even if done remotely.
Shifting to remote board orientation is merely a matter of adapting your standard board orientation process to a virtual platform. There’s no need to change the content of your orientation, although it may be a good time to review it anyway.
You should focus on two main areas:

The orientation schedule

  • Consider how to adapt it reasonably for a virtual environment (longer sessions over fewer days or shorter sessions over a greater number of days).
  • Send out the agenda and schedule ahead of the orientation to allow for greater engagement, reduce the number of questions and make the orientation more productive.
  • Think about other people who should participate in all or part of your board orientation, such as seasoned board members and your CEO.

The roles of the facilitator and administrator

  • Their instruction style will have to be adapted to accommodate virtual trainings.
  • It often helps to assign an extra person to handle things such as participants’ technical issues and monitoring the chat field.
  • Decide whether you’re going to allow participants to interject their questions and comments as you go or ask them to raise a virtual hand if they wish to speak.

It’s not known when boards will be able to begin holding in-person meetings again. However, these current circumstances offer new opportunities for healthcare boards to build on lessons learned to help them be more productive and efficient in the future when times are better.

Note: Information on this topic was obtained from BoardEffect.

2020 Trends

2019 Trends

2018 Trends