How to Have Board-led Strategic Conversations

illustration of people having Board-led Strategic Conversations

Strategic conversations are an essential part of the work of a governing board. Understanding how to have these conversations takes intention and practice.

By Kara Witalis, MHA, Principal, and Erica M. Osborne, MPH, Principal, Via Healthcare Consulting

Strategy, in any form, is intent upon furthering the mission. In chess, the mission is to capture the opponent’s queen. In the for-profit world, the mission is to maximize shareholder profits (although that is being challenged by many thought leaders today.) 

In health care, strategic conversations may surround health inequities within communities, accessible, value-based care, or population health needs, to name just a few examples. These are complex topics (to say the least), which are changing as fast as the times, and have local nuances that make them unique for each market.  

Strategic conversations, informed by the special knowledge that local governance members have of these needs within their communities, serve as a way to inform decision-making by a system board and regional boards. Local boards advise and consult on these decisions through robust conversations with CEOs and leadership teams. These conversations at the local level, therefore, serve dual purposes: a) inform the strategic plan set by the system board, regional boards, and management, and b) monitor the translation and activation of the strategy locally, into specific projects and initiatives. 

Yet, a concern we often hear from governing bodies is that their meeting time is often taken up with listening to briefings, presentations, and reports, leaving far too little time for engaging in robust debate, deliberation, and discussion.

Here, we offer a few guidelines that can help clear the way for conversations in the boardroom and are designed to explore, question, and lead to positive change.

1. Take time to reflect on what drives service.

Serving on the governing board of a hospital or health system is as much an emotional journey as an intellectual one. A decision to serve may, in fact, be based on specific personal or professional experiences. These experiences help to inform perspectives, priorities, and decision-making. 

What are those experiences that compel a board member to serve? What are the influences and who are the influencers? A board member’s passion and commitment come, in large part, from personal lived experiences. Understanding at an emotional level the drive to serve will elevate the strategic quotient. 

2. Seek to understand the lived experiences of others.

Impactful strategic discussions not only channel the experiences of those who serve, but also the experiences of those who are served. If an organization is to truly improve the health of all, particularly the poor and vulnerable, board members need to understand who these people are, where they live, and what their realities are that impede health. Board members need to raise the visibility and voice of those citizens whose voices are rarely heard in public conversation.

The local community health needs assessment provides 


specific information on the medical, physical, behavioral, and spiritual needs of a community and can be an excellent tool for understanding what types of services are needed. Beyond the assessment, other internal reports, and even input from leadership, there are other approaches to “getting to know a community.”

Board members might consider investing time in getting out into the community – where the poor and vulnerable live. Attending a local school board meeting or a community festival or visiting a local food bank will help members capture the local experience of those they represent in their service.

These personal experiences will better inform discussions and the questions that should be circling throughout them.

3. Create a board culture and space for deeper conversations.

Board members should allow time to share experiences and develop a group mindset on the value of strategic conversations, especially in areas such as quality and community health. Approaching conversations from a perspective of “appreciative inquiry” offers a possibility focus, a move from “what is” to “what could be.”

Each member should approach the discussion with an open mind, ready and willing to listen. Every member should feel comfortable in joining in the discussion, even if the views may be contrary to those of other members. And, each member should be prompted to engage in the discussion to ensure that all perspectives are voiced.

Also, when discussing potential for success, board members think broadly about the impact of an initiative and how its success should be defined. Currently, with many initiatives, success is defined in terms of the number of people served or the number of activities offered. Success is less often defined in terms of the effect of the initiative on the knowledge, behavior, and health status of residents or the effects on community conditions.


4. Schedule time on the agenda.

How a board spends its time in meetings has real strategic importance. Because governance work is conducted only during meetings, which are limited in number and duration, it is necessary to schedule time on the agenda for these conversations. Setting aside time on the agenda elevates a particular topic as an important issue for board consideration and provides an opportunity to more thoroughly explore the topic. This practice also allows members to prepare for the discussion by reading articles or reports provided by senior leaders or the board chair.

In addition, a consent agenda should be used. The consent agenda is an effective tool for maximizing meeting time. Routine matters that require board approval but no discussion are combined into one agenda item, freeing up time for conversations on strategic matters. Consent agendas are used for such matters as approval of minutes of the previous meeting, routine revisions of policies and procedures, and confirmation of a decision that was previously discussed.

5. Request reports that are at a governance, not operational, level.

Staying on the appropriate side of what can be a very narrow line between governance and management is often challenging. If a board is receiving reports with details that delve too far into the weeds of operations, its questions and decisions will likely focus on operations (management) rather than outcomes (governance).

Board members should request that presentations and written reports be more high-level in nature, focusing on, for example, a comparison of intended vs. real impacts of initiatives, programs, or policies. Removing the operational details helps to clear the table and set the focus on strategic discussions.

Being Intentional with Strategic Board-led Conversations

Creating an environment that allows for rich discussions is an intentional process that incorporates an open mindset, personal readiness, an appropriate meeting structure, and level-appropriate information. Of course, strategic conversations do not equate with setting strategy, but they do provide a channel for engaging in governance work that will enable an organization’s leaders to better fulfill the missions of their organizations and lead to better health care for all.

Questions for Boards to Consider:

  1. How much of our meeting time is spent listening to presentations or reviewing reports, rather than engaging in discussion and deliberations?
  2. How well does our board understand the value of engaging in strategic conversations?
  3. How skilled is our board at engaging in strategic conversations?
  4. What areas should our strategic conversations focus on that reflect the priorities within our communities?
  5. How well does the information we are presented with enable our board to engage in strategic conversations?

Gain Clarity with Expert Support – Strategic Conversations

Navigating the complexities of health care can be daunting. By partnering with Via Healthcare Consulting, organizations benefit from expert support and customized solutions tailored to their specific needs. With over 25 years of experience in healthcare governance, ViaHCC offers invaluable insights and guidance to enhance governance effectiveness. From strategic planning to board development, Via empowers healthcare leaders to overcome challenges and transform their organizations. Book a call today to unlock the benefits of working with Via Healthcare Consulting.

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