2021 Trends in Healthcare & Governance

As a result of the pandemic, healthcare trustees are asking what the future holds for their hospital or health system and how they can best prepare for success.

The following three areas of fundamental change will impact how healthcare in the U.S. is delivered and reimbursed. Trustees should anticipate these changes and ask the following questions to generate dialogue on the implications.

Population health

1. How are value-based payments coming to our market?
2. Is our organization well positioned to deliver population health and value-based care?
3. What actions are legacy and new competitors taking and what are the implications on our business

Cross-vertical competition

1. What is our experience in managing risk?
2. Do we have the right resources and footprint for success as competition for the healthcare dollar evolves?
3. Are there partners that can help us advance our mission?

Capital-driven modernization

1. What functions are core to our business? Should we own or contract for these?
2. Which of our services are vulnerable to external competition from well-capitalized disruptors?
3. What new solutions are, or soon will be, available? When and how should we access these?

In this evolving landscape, boards must undertake comprehensive introspection, take more creative and collaborative approaches and demonstrate differentiation to their communities. The challenge is for trustees to understand how their organizations meet market circumstances and fit into a changing field. Thoughtful and proactive planning will help ensure that their organizations emerge more resilient and thrive in the future

Note: Information on this topic was obtained from the American Hospital Association Trustee Services’ article, Post-COVID-19 Future of U.S. Health Care. Please review the AHA article to learn more.

• An upcoming election of a new slate of board members should signal the start of planning for new member orientation. A board orientation process is central to giving board directors information, context and perspective so they don’t have to pick things up as they go. The more information they have before getting involved, the more they will be able to contribute to the organization.
• Not investing enough time in preparing for and planning a good board orientation is a mistake many boards make. Orientation can be conducted using a variety of approaches, including formal educational sessions, social gatherings to meet existing trustees and senior leaders, pairing new trustees with experienced board members who serve as mentors, use of a trustee manual and observation of board and/or committee meetings.
• Initial activities to arrange for a good board orientation include preparing the materials and the session:
  1. Prepare a binder of materials for each board director to take home, review, read and take notes on before the board orientation meeting. Manuals should provide details about the board, the organization and the environment. Consider these items in custom-designing an orientation manual for your board.
  2. The bulk of the orientation session will be spent in providing an overview of the manual. Key issues that should be addressed during an orientation session include organizational information, policies and procedures, board-specific information and healthcare information.
• Most board members come from various professional backgrounds outside of healthcare. To help provide a comprehensive overview of healthcare governance, HTNYS has developed an orientation program to inform trustees about the fundamental roles and responsibilities of hospital trustees in New York state. The live program was held today, and in the coming days, the recording and a portal of resources will be sent to members via email and posted on our Board Orientation resource webpage.

Board directors who feel well prepared for their new duties and responsibilities will be your most engaged and productive board members, and quite possibly your future leaders.

Note: Information on this topic was obtained from BoardEffect, AHA Trustee Services and HTNYS’ Boardroom Basics.

For years, the news has been full of stories about burnout and stress among healthcare providers. The COVID-19 pandemic has clearly exacerbated what was already a complex staff retention situation.

Board and leadership actions to address concerns from staff and physicians go a long way to ensuring that caregivers feel safe and cared about. This is especially true for pandemic-associated challenges, including vaccine mandates.

Boards may be wondering how to best help management with these important issues. Questions the board could discuss include:

• What are our current retention statistics for key staff and physicians? Have they changed over the course of the pandemic, and do we anticipate that change continuing?
• What does our staff satisfaction and physician satisfaction data tell us about the current situation? How has this changed in the past year?
• Have we learned anything different from our staff and physicians about their intent to stay and any dissatisfiers that are controllable? What are these issues and how have we thought about addressing them?
• What creative ideas have we implemented to help our staff and physicians ‘stay the course’ with our organization? Have we budgeted additional funds for key initiatives (monetary and/or non-monetary) to retain our best performers?
• Are there ways the board can help support management’s efforts to strengthen recruitment and retention?

The Institute for Healthcare Improvement surveyed staff in long-term care facilities, which were greatly impacted by the pandemic, and provided a summary of ideas for clinician retention:

• ensure staff are safe;
• provide employee assistance programs and other support;
• offer staff appreciation and enjoyable diversions;
• strengthen communication and build knowledge; and
• offer practical assistance.

For more details and a sample list of ways communities have come together to support frontline caregivers, read governWell's BoardBrief on staff retention. While HANYS is in daily discussions with state officials to highlight critical staffing shortages at many of your facilities and request financial and personnel support, this resource may provide you additional ideas in supporting management’s staff retention efforts.

Note: Information on this topic was obtained from governWellTM.

In these complex times, healthcare boards and executives need to have strategic discussions and work together to determine the potential impact of external trends and internal operational challenges on their hospital or health system.

However, the average board devotes only 31% of its meeting time to active discussion, deliberation and debate about the strategic priorities of the organization.

Potential barriers to a healthcare board’s involvement in strategy may include:

• Healthcare expertise. Most hospital and system board members come from outside of healthcare, so are not experts in the field.
• Strategic experience. Not all board members have participated in the type of sophisticated strategic thinking and planning processes used in healthcare.
• Regulatory expectations. Healthcare is a highly regulated field and boards need to ensure that management is compliant with all regulations (e.g., patient safety).
• Board practices and culture. Many board agendas are built around reviewing reports from management and board committees, leaving little time for forward-looking conversations about strategic issues.

Boards and their leadership teams need to engage in strategic conversations throughout the year, not just during the formal strategic planning process. The key to engaging trustees in strategic conversations and overcoming the challenges listed above is robust board education:

• a thorough orientation at the beginning of their term, and
• an intentional, ongoing board education plan.

Hospital and health system boards are participating in continuing education in several ways:

• board and committee meetings: 75%
• outside conferences: 59%
• self-directed education (articles, online resources, etc.): 58%
• board retreats: 54%

Ideally, each board will use all of these methods for educating their board members so they are ready to participate in strategic conversations.

HTNYS is here to support your organization with board education. Check out this year's virtual Annual Trustee Conference that combines education with an opportunity for customized strategic planning. Further, stay tuned for information on our new, virtual New Hospital Board Member Orientation Program coming this fall.

Investment in board education will equip leadership to be able to engage in well-informed decision-making that supports the future of the organization.

Diversity and inclusion have been rising initiatives over this past year in healthcare, where governance representation can be a real challenge.

• According to the American Hospital Association’s 2019 Governance Survey Report, survey respondents reported that African American and Hispanic people represented only 6% and 3%, respectively, of voting board members.

Healthcare trustees who understand the root causes, issues, needs and cultures of patients and communities:

• can provide deeper insights that result in better decision-making about how to serve local communities;
• have deep connections with other community leaders who can help hospitals and health systems address social determinants of health and help to achieve community health goals; and

have richer discussions with broader perspectives that help their organizations avoid missteps in implementing new programs and services for patient populations.

AHA’s Trustee Match Program can help hospitals and health systems increase diversity on their boards, councils and executive committees.

It is designed to help hospitals and health systems recruit diverse candidates with the right kind of experiences required on the board to meet the organization’s current and anticipated needs.

In partnership with the National Urban League and UnidosUS, the program offers a vetting process to help identify and appoint community leaders with the competencies and skill sets required to serve in hospital governance roles.

By forming a new talent pool made up of diverse trustee candidates of varying races, ages, orientations, genders, disabilities and more, AHA helps hospitals and health systems find matches well suited to their organizations.

To learn more, visit the AHA Trustee Match Program website.

By increasing diversity and inclusion on governance boards, hospitals and health systems can accelerate advancements in addressing health equity for patients and communities.

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.

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:

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.

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

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.

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.