Leadership Toolkit for Redefining the H:
Engaging Trustees and Communities
2014 AHA Committee on Research
2014 Committee on Performance Improvement
January 2015
Engaging Trustees and Communities
The 2104 Committee on Research and the 2014
Committee on Performance Improvement
embarked on an effort to better understand
where hospitals, trustees and communities are
in their journeys of transformation. The
committees spent the past year looking into:
•Trustee engagement — how it relates to
redefining the “H”
•Community engagement — how hospitals can
engage with community stakeholders to have
conversations about the changing health care
This report includes community
engagement and governance
strategies for hospital leaders.
Redefining the “H”
The AHA believes that changes in the health care 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.
The Triple Aim
As hospitals work to redefine the “H” and achieve the Triple Aim
on behalf of patients and communities, they must actively engage
trustees and communities now in the changes that will inevitably
Engaging Communities
As transformation evolves, hospital leaders and boards must lead
the way in forging community collaborations that:
• Appropriately allocate resources and define a shared
responsibility for improving community health
• Bring insight, perspective and support from the
community into the hospital board room as leaders
consider paths for transformation
• Enter into strategic partnerships for improving
community health and health outcomes
Community Conversations Events
With the goal of educating communities on transformation, the
AHA CPI hosted six community events across the country,
listening and learning from community partners and seeking to
foster further collaboration and engagement.
Common Themes
Collaboration Is Key – No one
hospital or health system has to be all
things to all patients.
Transformation Will Be Local
– Policy changes are needed but
change must start locally
Care Might Look Different –
the health care system transforms,
communities may see changes in the
number of inpatient beds, where care is
provided, and the type of services
Challenges Identified Through
Community Conversation Events
Align Community Priorities and Funding
Behavioral Health Services Are Inadequate
Primary Care Physicians Are in Shortage
Social Determinants of Health Must Be Considered
Stakeholders Need the Ability to Better Share
Information and Data
Different Types of Providers Will Face Unique
Challenges (rural, urban, etc.)
While each community event had its own unique characteristics, the
recommendations below were drawn collectively from all of the
Community Conversations.
Engage in Broad-Based Dialogue
Policy Changes Must Support
Frequent and Ongoing
Communication Is needed
Use the Community Health Needs
Assessment as a Tool
A Holistic Approach to Health Care Is
“How-to” Toolkit
Included within the
report is a complete
“how-to” toolkit that
can be used as a
model for others
looking to host a
Conversation event.
“How-to” Toolkit
The toolkit includes:
• Timeline
• Audience
• Invitation
• Logistics
• Pre-event Survey/Materials
• Agenda
• Moderator’s Guide
• National Perspective Slide Deck
• Breakout Group Questions
• Common Themes to Date
• After the Conversation
Trustee Engagement
The process of redefining the “H” will require leaders
to adopt new structures to effectively govern
increasingly complex organizations. To strengthen the
health care system, boards must understand
community needs and health status as well as:
• Become knowledgeable of changing business models
• Be representative of the community and possess needed
skills and competencies
• Willingly and regularly engage with community
• Consider a local board structure when feasible
• Address several possible business models to
achieve and sustain goals.
Defining the Role of the Board
Hospitals must have a governance and
management structure that facilitates
organization wide vision, oversight and
decision making.
Board Type
Key Roles and Responsibilities
System/Professional Board
Finance, strategic direction, rigorous
oversight of performance and risk
Clinical Enterprise Board
Management of care, management of
clinical risk
Local/Community Board
Understanding of community needs and
perceptions; communicating to system
board; being responsible for local quality,
patient safety and physician credentialing
Four Bold Steps for Trustees
1. Develop Trustees for the Future. Boards must select new
members who posses the skills to govern effectively in the
current and future health care environment, which can even
include looking beyond the immediate community to identify an
individual with specific expertise in transformative change.
2. Ensure the Right Governance Dialogue. Ensuring continual
governance dialogue that is future focused, visionary, adaptive
and innovative is vital. Three governance models that trustees
must balance are:
• Fiduciary
• Strategic
• Generative
Four Bold Steps for Trustees
3. Commit to Continuous Trustee Education and
Knowledge Building. To be true knowledge leaders, trustees
must prepare themselves by continuously improving their
knowledge in order to deliver the penetrating, insightful
leadership that their communities want and deserve.
4. Develop the Courage to Make Difficult Decisions.
Developing a high-performance board culture that does not
shy away from difficult conversations is imperative. To ensure
that the right discussions take place, boards must:
• Ask the right questions
• Disagree agreeably
• Challenge the status quo
• Be willing to leave the comfort zone
Tools for Trustees
The report includes several tools and resources specific to
trustees that offer strategic guidance and overviews of the
following topics:
Current HighPerformance
CompetencyBased Board
Creating the
Seven Steps
to Designing
an Effective
Putting it All Together
As this report emphasizes, the future of health care is
changing rapidly but, at best, uncertain. However, by
strengthening leadership and governance practices and
engaging with diverse community partners, hospitals are,
more likely to be successful in achieving better health
and health outcomes at an affordable cost.
Issues to Consider in a Rapidly Changing
Managing variation in the pace of change
Adapting to new payment and delivery system models with little
experience and knowledge about intended and unintended consequences
Confronting the challenge of disruptive innovators that offer convenience
and reduced complexity for the consumer
Managing new and sometimes difficult partnerships where cultures clash
and missions do not align
Ensuring sustainability in an evolving business model
Assembling and developing the right talent in the hospital and in the
Ensuring diversity of age, gender, race and ethnicity that reflects the
community, at all levels of the organization from the board to
management to frontline staff
Developing a deep understanding of the community’s level of health and
wellness, their burden of disease and their needs to achieve the health
status they deserve
Additional Resources
AHA Hospitals in Pursuit of Excellence
All reports can be found at www.hret.org/guides-reports/index.shtml
•Hospital-based Strategies for Creating a Culture of Health (2014)
•Navigating the Gap Between Volume and Value (2014)
•Building a Leadership Team for the Health Care Organization of the Future (2014)
•The Second Curve of Population health (2014)
•Your Hospital’s Path to the Second Curve: Integration and Transformation (2014)
•The Role of Small and Rural Hospitals and Care Systems in Effective Population Health Partnerships (2013)
•Metrics for the Second Curve of Health Care (2013)
•Second Curve Road Map for Health Care (2013)
•Engaging Health Care Users: A Framework for Healthy Individuals and Communities (2013)
AHA Center for Healthcare Governance
All reports can be found at www.americangovernance.com
•“Trustee Tools for Transformation: Board Readiness Self-Assessment” (2013)
•The Value of Governance (2013)
•“Advent of ‘Care Systems” Means Governance Must Also Transform.” Bader, Barry S. AHA’s Great Boards Newsletter
Spring 2013 issue (www.greatboards.org)
•Making the Transition from Volume to Value, Numerof, Rita E. (2013)
•Governance Practices in an Era of Health Care Transformation (2012)
•AHA Center for Healthcare Governance Blue Ribbon Panel on Trustee Core Competencies. Competency-Based
Governance: A Foundation for Board and Organizational Effectiveness (2009)
•AHA Center for Healthcare Governance Blue Ribbon Panel on Healthcare Governance. Building an
Exceptional Board: Effective Practices for Health Care Governance (2007)

Leadership Toolkit for Redefining the H: Engaging Trustees and