2020 Trends in Healthcare & Governance

• The onset of COVID-19 abruptly forced boards to start meeting virtually. This has become a necessary practice for the foreseeable future to keep your board safe and connected.
• The virtual meeting company Zoom reported a significant increase in its usage over the past year:
  • as of December 2019, there were 10 million meeting participants;
  • by March 2020, Zoom served 200 million meeting participants; and
  • that number grew to 300 million in April.
• To be effective, a virtual board meeting must have good facilitation and an engaged board. Tips for boards to be most productive in this new meeting format include:
  • Set basic standards and expectations for videoconference etiquette.
  • Always use an agenda. Scale it down to the most important items because discussions are likely to take a bit longer with video meetings. List emergency items first because these issues take priority over the board’s other work.
  • The board chair should be proactive in making sure that all board members are active while operating virtually. Board chairs may need to make an extra effort to ensure that board members aren’t neglecting their duties just because the board isn’t meeting in person.
  • Since virtual meetings are a new thing for many board members, it’s vital to ask for feedback on how they can improve their effectiveness. Ask the participants how well the technology worked and what you can do differently to make meetings more efficient and effective. Be sure to highlight the positive aspects of virtual meetings as well.
  • Consider holding a virtual meeting to train board members or others on how to run and participate in virtual meetings.
• During this unique time, board members are having the chance to explore new ways of leading and can take what they’ve learned into the future.
• Ensure your board has all of the tools it needs to meet virtually with this helpful resource that includes tips for handling multitasking, advice on how to vote during virtual meetings and sample bylaws clauses.

Note: Information on this topic was obtained from BoardEffect and BoardSource.

HTNYS is collaborating with governWell™ to offer a unique set of governance resources designed to help position hospital and health system trustees for success as healthcare leaders in their communities.

COVID-19 has served as an accelerant for healthcare staff stress and burnout. Now, hospitals and health systems must directly address the enormous emotional toll of COVID-19 on healthcare workers.

The consequences of burnout include increased rates of staff disengagement and turnover; staff shortages; lower staff satisfaction, morale and patient experiences scores; and at the far end of the spectrum, risks to quality and patient safety.

A crisis such as this requires “all hands on deck” and the board can help through active participation, guidance and oversight; for example, listening to employees and gathering their feedback, working with management to uncover issues and creating an action plan for implementing positive change.

Boards can begin to take action by asking the following questions:

• What are the inequities that our staff and workforce face in their communities and lives? What is our role to address these?
• What are we doing to protect the physical and emotional health of our employees?
• Do we have someone designated as a wellness officer? If so, is that individual an integral part of the crisis response team?

For more details on creating a strategic action plan, read All Hands on Deck: Board Support of Employee Wellness in a Time of SARS-CoV-2, by Linda Brady, MD, former president and chief executive officer of Kingsbrook Jewish Medical Center in Brooklyn, NY.

Note: Information on this topic was obtained from Dr. Brady’s BoardRoom Press article and used with permission of The Governance Institute.

For many boards, it’s that time of year to assess current and recruit new board members.

Board composition should reflect the combination of experience, expertise and diversity needed to successfully govern in today’s complex and transforming healthcare environment.

Board assessment, recruitment and succession planning are essential to strengthening board capacity. How well these processes are planned and executed will define the hospital or health system’s leadership success for years to come.

• Boards should begin by conducting a comprehensive governance self-assessment to determine where they may have current and future leadership gaps.
• After identifying needed characteristics and skill sets, the board should seek out and talk with a variety of candidates who may meet their board service requirements.
• Once a new trustee is selected, orientation and ongoing education is critical to ensuring trustee success in providing strong and effective leadership to the hospital on behalf of the community.
• For more details and the key steps in the trustee recruitment process, refer to Succession Planning Today for Tomorrow’s Trustee Leaders from governWell™.

AHA Trustee Services recently released a Proactive Board Renewal podcast featuring Pamela Knecht, president and chief executive officer of Accord Limited. Knecht described how to create and sustain a board with the competencies, skills and perspectives needed to become an effective governance body and valued partner with the executive team. Key takeaways included practical tips and tools for board selection, development, reappointment and succession planning.

HTNYS has updated our Board Recruitment, Orientation & Succession Planning webpage with new customizable resources from governWell™, including a Governance Skills & Experience Matrix, Trustee Candidate Overview and Application, Candidate Assessment Form and Board Member Job Description.

As trustees, your leadership role in your hospitals and health systems has been critical during the COVID-19 pandemic. Your crucial advice, guidance and support added tremendous value and was an important resource for management.
Now is the time to prepare for a potential second wave of COVID-19 or another future crisis, if you haven’t started already.

Management should capture lessons learned from the pandemic and document actions taken. Boards should assess their own governance, including what worked well and what didn’t. Specific questions to consider include:

• Which leaders are responsible for communication and to which stakeholders?
• What is the internal single source of information and which third-party sources are necessary?
• Were board members proactive in their oversight of risk identification and mitigation?

Has the board developed or reviewed its own crisis management plan that identifies roles it may play depending on management’s role?

One of a board’s duties is to stay educated. The pandemic serves as a reminder of the importance of board member education to aid in a swift and effective response to a crisis. I encourage you to take a look at the many new resources on our “Emergency Preparedness & Response” webpage.

Trustees and CEOs are also encouraged to take advantage of our free webinar on Sept. 29, Board Leadership in Times of Disruption and Crisis, which will explore essential governance practices needed during times of crisis, including intensified education, role clarification, vision sharing, increased accountability, robust communications and enhanced community connections. This webinar is part of our 2020 Trustee Virtual Education Series: Leading through Healthcare Crisis and Social Change.

Note: Information on this topic was obtained from the American Hospital Association’s COVID-19 Pathways to Recovery — Considerations and Resources to Guide Hospitals and Health Systems.

• As healthcare sets a path to recovery from COVID-19, philanthropy can be a valuable, alternative revenue source to hospitals, with a strong return on investment.
• History shows donors step up in times of crisis. With hospitals at the epicenter of providing solutions in the current COVID-19 crisis, now is a time to invite them to support current needs and to create capacity.
• After the 2008 recession, donors with a history of giving for three years and longer increased their giving by 49% from 2010 to 2015. This proves donor retention through ongoing stewardship and communication is essential regardless of the economy.
• 50% of Americans are more likely to give to health than a year ago.
• Trustees’ credibility and influence as community leaders can be a valuable asset in connecting to the community.
• Board members are four times more effective at opening doors with gifts tending to be five times larger.
• Proactively connect with key donors and friends to check on their well-being, thank them for their past support, and sharing the hospital’s response to the crisis are a few things you can do.
• Faced with this public health issue, your organization’s response to and respectful handling of communication and engagement with donors and the overall community can greatly impact your philanthropy program for years to come.

You may have missed HANYS and HTNYS’ June 3 webinar that explored ways philanthropy can be leveraged for recovery, with Betsy Taylor, one of healthcare philanthropy's most provocative thought leaders. The recording and materials are now available.

Additional resources on philanthropy during a crisis are available on HTNYS’ Emergency Preparedness page.

Note: This information was obtained from Accordant’s COVID-19 Resources.

• Social determinants of health such as food, housing, income, education and living and work environments significantly impact overall health and quality of life for people in your communities.
• In public health emergencies, pre-existing social inequities can be amplified and isolate people from the resources they need to prepare for and respond to disease outbreaks such as COVID-19.
• Information on the effects of COVID-19 on the health of racial and ethnic minority groups is still emerging; however, current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups.
• In New York City, Hispanics have a fatality rate of 34% but make up 29% of the population, African Americans have a 28% fatality rate but make up 22% of the population and whites have a 27% fatality rate but make up 32% of the population. In the rest of New York state, excluding New York City, Hispanics have a 14% fatality rate and make up 12% of the population, African Americans have an 18% fatality rate and make up 9% of the population and whites have a 60% fatality rate and make up 74% of the population.
• To better understand issues that impact healthcare equity, the social, political and historical context of race and ethnicity in this country should be taken into account.
• Now more than ever, healthcare governing boards should take steps to ensure that addressing social factors that influence health is a strategic priority for their organizations, including facilitating community conversations and using results of Community Health Needs Assessments to drive strategic priorities, allocate resources and influence public policy.

As trustees, your roles as community and policy leaders in your hospitals and health systems are essential during these challenging and unprecedented times. To ensure that you are receiving timely updates to effectively meet the demands of trustee governance during COVID-19, HTNYS wants to provide you with the most current resources.

• Navigating the Challenges of COVID-19: As hospital and health system leaders work diligently to respond to COVID-19, boards play a critical role in assuring that policies, processes, structures, communications and resources are in place and ready to meet this challenge. You may be asking, "What are the critical issues for trustees to consider?" and "What information does the board absolutely need to know?" To help, HTNYS is providing Navigating the Challenges of COVID-19, made available through our collaboration with governWell.
• HANYS COVID-19 Resources: HANYS continues to be in constant contact with our members and state and federal policymakers to support New York healthcare providers' response to COVID-19. We are closely monitoring the situation and continuously updating this list of resources to keep New Yorkers informed about this rapidly changing outbreak.
• Governance in the Time of Coronavirus: Another resource for trustees is the American Hospital Association's Trustee Services podcast, Governance in the Time of Coronavirus: What governing boards should do to respond to the pandemic, with governance expert Jamie Orlikoff. On the podcast, available to AHA members, Mr. Orlikoff outlines issues and actions that boards should consider for their organizations to stay ahead of the pandemic leadership curve, as well as anticipate and prepare for unprecedented situations and challenges.

• The future of care: In 2018, 52 million Americans (16% of the population) were age 65 and older. It's projected that by 2060, that figure will grow to 95 million Americans (23% of the population). This generation's healthcare expectations and needs will continue to evolve and impact the landscape of care.
• The new health-tech consumer: The "digital boomer" is a category of baby boomers who aren't just learning the digital world, they're already using it. These "boomers" are accustomed to and comfortable with what technology has to offer. This group is increasingly digitally savvy and driving the demand for virtual health options. In an Accenture health survey, 72% of seniors indicated that they would be interested in using virtual health to receive stay-healthy reminders while 71% said they would use a virtual platform to have an "after-hours appointment."
• A social media revolution: Though it's typical to associate social media with "millennials," "boomers" are making great leaps onto tech platforms. Social media platforms like Facebook have seen the fastest growth among older generations. The use of smartphones among this generation increased from 25% to 68% since 2011. Increasingly, this opens the opportunity for hospitals and health systems to connect and market to the baby boomer generation in a way that engages them on their own terms.

Just a call away: Telehealth has become a buzzword in the hospital boardroom. With younger consumers expecting convenience and transparency, smart phones are increasingly the starting point for health and wellness management. More healthcare consumers are looking to move online for their care needs. According to Accenture Consulting's 2019 Digital Health Consumer Survey, 77% of consumers indicated they would be more likely to choose a provider that allows electronic prescription refills. In addition, 53% of consumers said they would be more likely to go with a provider that uses remote or telemonitoring devices to monitor and record personal health records

There's an app for that: BayCare Health System in Florida has found a way to meet the new generation of digitally-driven consumers on their own terms. In July 2016, BayCare launched its BayCareAnywhere® app, which gave patients 24/7 access to doctor visits without leaving their homes. By downloading the app, patients can be seen, diagnosed and, depending on the condition, prescribed medication — all over a webcam after talking to a board-certified doctor.

What can you do as a trustee?

• Explore. Stay informed about the new technologies being implemented in facilities around the state and across the country. Some of these innovative technologies could be worth implementing at your hospital.
• Educate. By taking advantage of HTNYS' educational opportunities, including our Annual Trustee Conference, you can gain key insights into healthcare disruptors, transformational healthcare leadership and the latest trends on healthcare governance
• Enhance. HTNYS has collaborated with governWellTM to offer a unique set of governance resources on pertinent topics, including setting strategy, which can assist hospitals and health systems as they lead healthcare services in their communities.

• Approaches to primary care: Generational differences are apparent when it comes to reliance on and retention of primary care physicians. Ninety-two percent of the "silent generation" (born 1928-1945) have a primary care physician, compared to 82% of "baby boomers" (1946-1964). This downward trend continues with 73% of "Gen Xers" (1965-1980) and 57% of "millennials" (1981-1997).
• The digital physician: As millennials continue to enter the healthcare consumer market, smart devices and telehealth are increasingly used as alternatives to traditional medical settings. Thirty-seven percent of millennials rely more on their devices and digital health products than on a professional for health management, compared to 9% of baby boomers and 25% of Gen Xers. It's clear that digital health management will continue to grow in popularity among future generations.
• Changing the conversation: As younger generations of healthcare consumers continue to enter the market, trustees need to guide their hospitals into the future of digital savviness. Recruiting younger board members can help increase your generational diversity in the boardroom and prepare for the rapidly changing healthcare landscape ahead. By recognizing the opportunity for healthcare innovation that these generations present, boards can identify ways to meet the needs of a more digitally-connected generation.

For more information on this topic: AHA's 2020 Environmental Scan and Accenture Consulting's Digital Health: When Primary Care is Not Always Primary.