Issue link: https://beckershealthcare.uberflip.com/i/411828
54 Leadership & Management H istorically, hospital boards consisted of local community leaders around a table where presidents of local banks and owners of local businesses discussed hospital matters. Gather a large group of lo- cal leaders together — all of whom have similar vested interests — and the discussions will be, presumably, polite. Until healthcare reform came along, that is. Once a forum for professional networking and community involvement, hospi- tal boards are responding to industry pressures with a more intent strategy. They have taken, for better or worse, a more serious approach to their proceedings. "What you tend to see in boards is that a lot of socialization takes place where everyone tries to be agreeable," says Tom Flannery, a partner at Mercer. "The chal- lenges that healthcare organizations have [now] is not so much for people to just be agreeable but for people to be able to appropriately challenge each other." Finding those board members willing to challenge the status quo is the new focus for many hospital and health system boards, and it is pushing the traditional board recruitment process into new territory. For many systems, their pursuit for specific talent extends outside their communities and into the national level. From board room to situation room As Mr. Flannery said, the tone of hospital board culture has shifted. Board- rooms, which were largely social environments, now resemble Situation Rooms. For a hospital or health system to survive (much less thrive) health- care reform, board members need to navigate some serious obstacles. Many of these obstacles are byproducts of reform, such as hospital and health systems' expansion in size, scope and capacity. As a result, board members may be tasked to make decisions for organizations that are twice or three- times the size of their own. "Hospital and healthcare in the U.S. has grown into a very large business," says Wayne Sensor, CEO of Omaha-based Ensocare, whao was also recruited to the board of St. Paul, Minn.-based HealthEast Care System in February 2014. "You may be talking about a board with a responsibility for a billion- dollar budget. That undoubtedly surpasses the size of the institutions of any of the boards [those members] represent. By sheer magnitude, these are big complex enterprises that require changes." These changes translate into higher expectations of board members than was customary in years past. Ten years ago, personal passion for an institution was a prominent reason for board membership, but passion alone isn't enough anymore, says Mr. Sen- sor. "There's a substantially greater expectation of not only showing up, but showing up prepared to really drill into the topics and have meaningful de- bates for the benefit of the institution." To facilitate those debates and challenge the organization to develop a fo- cused and forward-thinking strategy, healthcare organizations are shifting how they approach board recruitment and redefining the types of people and qualifications they want at their table. First, organizations are increasingly looking for board members with height- ened talent and expertise in areas such as finance, risk management, insur- ance, technology and human resources. As board complexity increases, so does the need for specific experts. "Board members need to understand not only the basic issues of what health- care is about, but the complexities of financing these operations, dealing with major acquisitions, management of governance of physician practices and putting together a coherent care delivery system," Mr. Flannery says. Secondly, the way organizations are approaching board recruitment is more focused on a fluid anticipation of needs to come, not just current issues and concerns. Historically, when addressing an impending vacancy, a nominating committee might throw some colleagues' names into the conversation. The board would approve a name and then extend an invitation to join the board, says Mr. Sensor. "While there's still certainly some of that occurring, I would suggest the migra- tion is toward very intentional board succession planning," Mr. Sensor says. "The board has been thoughtful around key competencies that they will need to drive the institution to its vision and strategy….It's not a static process of simply filling a vacant seat with the same skill set. It is in the context of what knowledge, skills and experience at the board level it will take to move the insti- tution toward its vision and strategy, which is looking down the road." Recruitment turns transcontinental Mr. Sensor is a prime example of a health system looking externally to find the best candidate for the board. Today, he lives in Omaha where he serves as CEO of Ensocare, a care coordination solution provider. Earlier this year, Mr. Sen- sor was recruited by a search firm for his position on the board of HealthEast Care Systems in St. Paul, Minn. Mr. Sensor says the search firm was seeking a thought leader with confidence to question the status quo and experience as CEO of a large institution. (Mr. Sensor previously served as CEO of four other hospitals and health systems, including Omaha-based Alegent Health.) "The trend is consistent across the country — there's a growing realization that we may not have the talent at our immediate disposal, whether we're in a big city or not," Mr. Sensor says. 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