District Hospital Boards Face Unique Challenges

Recently Via Healthcare Consulting has been working with a number of California District Hospitals.  The governance challenges typical to the not-for-profit hospital board – including the board-management distinction, how best to oversee hospital quality, and the need for a responsive decision-making process around strategic planning, among others – can be exacerbated by features inherent to a District Hospital Board.

Publicly-elected Board Members

Since District Hospital board members are individually-elected public officials, they approach their role with very different expectations from that of a not-for-profit hospital board member.  District Hospital board members have an understandable need to be personally accountable to the people who elected them.  They may feel the need to understand hospital activities on a highly detailed level without realizing their inquiries cross over from the purview of a board into the realm of the CEO or management.

Another difference is that District Hospital board members must be re-elected every four years.  In order to raise their profile in eyes of the electorate, some may decide to constantly question or challenge the CEO and/or other board members in order to appear tenacious or to be ‘the strong one’.  This can cause disharmonious meetings and get in the way of a positive board culture.

Lastly, District Hospital board members may have decided to run for election on a particular platform or representing a particular constituency.  A hospital CEO once told me about a board member who ran (and won) solely in order to change the hospital’s policies around family planning services.  This can result in grandstanding behavior by individual board members that slows down the meetings and causes the organization’s most important issues to be sidetracked.

Open Meeting Law

Healthcare Board Members

Another unique challenge of District Hospital boards is the requirement that nearly all their business be conducted in meetings open to the public. This can cause difficulties when contentious or sensitive issues arise because board members may not feel comfortable speaking openly for fear that the public might misinterpret their words.  Board members may also be reluctant to allow their point of view to evolve on an issue for fear of appearing wishy-washy.  This can result in stalemates and intractable board members, drawing decision-making processes to a grinding halt.

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