Healthy Boards:
An Introduction to Governance for Health
Care Organizations
James N. Barnes, Ph.D.
Assistant Professor & Director
Program Leader for Community Rural Development
Delta Rural Development Center (DRDC)
LSU Agricultural Center
Phone: 318.428.4029
E-Mail: jbarnes@agcenter.lsu.edu
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Message Number One…
»
Rural health care business is complex and
therefore rural health governance is complex
Why is rural health business complex from a rural hospital
perspective?
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Business Complexity Factors
▪ Payment system is complex
▪ Patient mix
▪ Physician recruitment is costly
▪ Health care regulations change frequently
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Added “Rural” Factors
▪ Small base of people in local area willing to
serve on hospital board
▪ Limited knowledge of health care business
▪ Usually volunteer labor/recruitment difficulties
▪ “Closeness” creates conflict resolution
problems
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Message Number Two…
»
Strengthening the “Governance Skills” of board
members is one approach that can strengthen the
governance and performance of rural hospitals…
and can create a culture that supports the
development of trust among members
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Programs to Strengthen
“Governance Skills”
»
Basics of organization and behavior for high
performance – Healthy Boards
»
Other modules:
Parliamentary Procedures
Meeting Management
Conflict Resolution
Team/Leadership Development
Strategic Planning - BSC
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Teaching Methodology
» Present research based principles for good governance
» Case study approach (Yin, 1994)
» Interaction with group members and analysis of an
existing board situation
» Develop strategies to resolve board situation USING
principles for good governance
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Some Elements of the
Healthy Boards
Workshop
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Healthy Boards Model
Accountability
&
Trust
Organizational
Principles
Social Principles
Healthy Governance
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
An Assessment Exercise
Questionnaire
Discuss scores
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Scoring
*Combine your scores for the preceding statements as indicated below.
Absence of
Trust
Fear of
Conflict
Lack of
Commitment
Avoidance of
Accountability
Inattention to
Results
Statement 4: ____
Statement:1 ____
Statement 3: ____
Statement 2: ____
Statement 5: ____
Statement 6: ____
Statement 7:____
Statement 8: ____
Statement 11: ___
Statement 9: ____
Statement 12: ___
Statement 10: ___
Statement 13: ___
Statement 14: ___
Statement 15: ___
Total:______
Total:______
Total: ______
Total: _____
Total:______
A score of 8 or 9 is indication that you serve on a healthy board.
A score of less than 8 indicates that your board could benefit from additional governance training.
*Based on the book The Five Dysfunctions of Teams by Patrick M. Lencioni
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Top Ten Commandments
for a Healthy Board Member
Thou shalt honor thy community
Thou shalt be honest and fair to those who serve you
Thou shalt evaluate fairly those who serve you
Thou shalt not forsake thy job for political gain
Thou shalt be an informed, active member
Thou shalt be prepared for all meetings
Thou shalt not micro-manage
Thou shalt keep thy mouth shut about closed sessions
Thou art not infallible. Thou can learn new tricks
Thou art only one board member, not the big cheese
Source: Oklahoma State School Board Association, 2004.
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Remember your role…
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Research References for the Healthy
Boards Program
• Barnes, J., Woods, M., Frye, J., & Ralstin, S. (2004). What is a
healthy board? Oklahoma Cooperative Extension Service, F929.
• Holland, T. (2002). Board accountability: Lessons from the
field. Nonprofit Management and Leadership. 12, (4) 409-428.
• Sonnenfeld, J. (2002). What makes great boards great.
Harvard Business Review, 9, 1-8.
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Some Additional Board Governance
Resources
Visit the Journal of Extension (JOE):
The Determinants of a Healthy Board
http://www.joe.org/joe/2006october/tt1.shtml
Building Trust in Local Community Organizations
http://www.joe.org/joe/2006august/tt6.shtml
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives
Impacts of HB Program
• Short term – learning of principles and
increase in trust/accountability among board
members
• Medium term – adoption of other modules to
resolve conflict, set a strategy, etc.
• Long term – how has governance of operations
changed since program (turnover, financial)
DELTA • RURAL • DEVELOPMENT • CENTER
innovate » educate » improve lives