Hospital boards are facing a more complex business environment, greater pressure for quality outcomes by payers and the ongoing dilemma of how to oversee quality.
2. 300+ Boards
1,000+ Board Meetings
Over 100 Board Assessments
Š Signature Resources 2015
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The BAD, the frustrated, the disengaged.
3. Who is this Guy?
īĢ Ideal 21C job: Grandparent!
īĢ University professor / administrator
īĢ Hospital administratorâtraditional Board
īĢ International consulting companyâĻ
Touch 20,000 people yr. / Coach 28 Execs / 17 Boards a year
īĢ Past board service: Security First Bank and Counterpart
International
īĢ Current board service: World Future Society
Š Signature Resources 2015 3
4. Who is this Guy?
Governance
Executive Leadership
Organizational Culture
Š Signature Resources 2015
4
5. Leaders are Learners
Š Signature Resources 2015
5
Learning is ânewâ perspectives, knowledge and skills.
AlsoâĻconfirmation of what youâre currently doing!
Governance
Leadership
Organizational Culture
6. My Job Today
Š Signature Resources 2015
īļ A look @ high performance governance practices as
assembled from the governance literature worldwide.
īļ Candid opinions based on work with 300+ boards:
For-profit, non-profit, international, financial,
healthcare, community, national associations.
īļ Likely to challenge assumptions, stretch thinking.
īļ Yes, all ideas will be relevant to large and small hospitals.
īļ Open dialogueâyour question is not an interruption!
6
8. Š Signature Resources 2015
8
Our Learning Journey Today
īą What boards are saying about their own
governance.
īą Board leadership succession.
īą Strategic Thinking and Planning
īą High Performance governance practices.
***********************************************
âĸ CEO / Board Partnership
9. Shaping Our Governance Future
âProfessionals generally know so
much about what they know that
they are frequently the last to see
the future differently.â
Edie Weiner & Arnold Brown, Future Think
Š Signature Resources 2015 9
Getting out of âcommittee mindset.â
âYour biggest competitor
is your own provincial view of your future.â
Watts Wacker, The Visionaryâs Handbook
10. Shaping Our Governance Future
Many of our assumptions about what
health care can become or will
become are anchored in deeply
rooted assumptions that we donât
acknowledge or challenge.
âThe problem is never how to
get new innovative thoughts
into your mind, but how to get
the old ones out.â
Dee Hoc, MasterCard
Š Signature Resources 2015 10
11. Governance and the
21st Century VUCA Future
ī Volatility
ī Uncertainty
ī Complexity
ī Ambiguity
Canadian Special Operations Command
Š Signature Resources 2015
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12. 21CâĻItâs Quite Different
Thatâs Why Strategy Development is
so Important
Speed: blinding, touching every aspect of life.
Complexity: quantum leap in mix of related forces.
Risk: upheaval raises threats and risks of ânew ideas.â
Change: radical, drastic, sudden.
Surprise: unimaginableâchallenging sensibility & logic.
Oversight: healthcare, financial services, privacy, safety.
Disrupters: new models unleashed in traditional domains.
Š Signature Resources 2015 12
13. The Vital Few Building blocks of
Governance Excellence
īž Talent: board with experience and competencies to
oversee a complex organization.
Does this leave out other community voices?
īž Strategic focus: envisioning, positioning and re-
positioning the hospital to remain viable, valuable and
vibrant. EVERYTHING FLOWS FROM STRATEGY!
īž Clarity on organizational performance and riskâthe
vital few performance and risk domains a board should
track.
īž Clarity on governance process: effective then efficient.
Š Signature Resources 2015
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14. Governance Excellence
Vital Few Building blocks
Letâs stop on this for a
momentâĻAnything missing?
ī Talent.
ī Strategic focus.
ī Clarity on organizational
performance and risk.
ī Clarity on governance process.
Š Signature Resources 2015
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15. 21st Century Governance
īŧ Boards as Committees (â50s-â60s)
CEO Driven
īž Boards as Managers (â60s-â70s)
Operational / Fiduciary
īą Boards as Trustees (â80s-90âs)
Policy and Strategy (John Carver)
21st Century Boards
Transformational LeadersâBoard of
Directors must be a strategic asset.â
Š Signature Resources 2015 15
16. Where is Your Board?
ī Dysfunctional: characterized by a lack of trust, information
hording and resistance between CEO and board.
ī Imperial: long board and CEO tenure gives way to CEO
guiding the agenda, board appointments and what the board
gets as information, quite traditional meetings.
ī Entrenched: minimal strategic dialogue with executive team,
solid board policies and satisfactory performance yet canât seem
to break into high performance gear.
ī Strategic: high commitment to learning about / following best
governance practices, heavily invested in strategic and system
thinking, independent board appointment processes assure
competent members, strong committee processes, regular self
assessments.
Š Signature Resources 2015
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17. Todayâs Governance
From the Literature
Canadian Corporate Governance Best Practices Report, Hay Group 2014, Public
Company Governance Survey, Nat. Association of Corp. Directors (2014)
âWhat Directors Thinkâ (2014), Spencer Stuart
Š Signature Resources 2015
priorities for Boards from national surveys:
â Strategic planning and oversight
investment.
⥠Board composition.
âĸ Board refresh / governance succession.
âŖRisk oversight (beyond financial and clinical).
â¤Board assessments are considered very effective
by 85% of the survey population of NACD.
17
18. Todayâs Governance
From the Literature
â2014 Corporate Governance Best Practices Reportâ
Hay Group & Canadian Society of Corporate Secretaries
Š Signature Resources 2015
priorities for Boards from Canadian survey:
â Board diversity.
⥠Focus on risk management.
âĸ Increased regulation and reporting.
âŖBoard and executive compensation.
â¤Director training and education.
18
19. Governance Revolution
From the Literature
Š Signature Resources 2015
īž Term limits combined with governance leadership succession
initiative keeps board refreshed.
īž 70% of meeting time = âstrategically focused agenda.â
īž Competency based director nominations vs. volunteer or
local politician based.
īž Enterprise-wide ERM oversight through a board committee .
īž Governance Self-assessments become annual routines.
īž Competency development of directors gets serious focus.
19
20. Typical Hospital Board
Governance Development Agenda
ī˛Board makeup and governance succession
planning.
ī˛Strategic Thinking investment.
ī˛Enterprise Risk Management (ERM).
ī˛Self assessments.
ī˛Comprehensive âdashboardsâ beyond $ and
quality: e.g. organizational culture, community
brand.
ī˛And Governance improvement makes it into the
strategic plan.
Š Signature Resources 2015
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21. Perspectives on A High Performance
Governance Discipline
Š Signature Resources 2015 21
22. Talent:
Governance Leadership Succession &
Board Composition
Š Signature Resources 2015
Leadership Succession:
The responsibility an organization has for assuring
the quality and availability of future leaders.
Governance, Executive, Senior Management, Front line.
22
23. Future Governing
Boards
Š Signature Resources 2015
âIn the not to distant future, new
board members, at all levels of
enterprise--from community
organization to corporations--will be
required to âcertify governance
competencyâ to quality for an
appointment / election.â
Les Wallace ī
23
24. How About Governance
Self-Certification?
ī Read these 3-5 governance books.
ī Review these OHA-Governance Center
of Excellence articles.
ī Review this ministry overview.
ī Hospital Annual Report.
ī Hospital Board Dashboards.
Š Signature Resources 2015
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25. Governance Leadership Succession:
Board Renewal
Š Signature Resources 2015
â Identify your desired profile
⥠Identify your candidates
âĸ Cultivate the pool
âŖ Recruit the right members
⤠Orient for active participation
âĨ Involve and engage
âĻ Educate continually
⧠Evaluate your performance
⨠Rotate to stay fresh 25
Create a desired
Board Makeup
Dashboard!
26. Who Guides
This Process?
ī Board Governance or Nominating committee facilitates profile
activity, identification of potential candidates and screening /
development.
ī Frequently one board member and CEO conduct first round
screening interview.
ī Committee hones prospect list to serious contenders (based on
competence and interest).
ī Board Chair and Committee chair pursue final round of screening
for match.
ī Gov. / Nominating Committee identifies finalists and presents to
full board for discussion / consideration.
ī Finalists have face-to-face interactions / interview with full board.
Š Signature Resources 2015
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27. Governance Competency
Governance is less about the technical literacy of a
board member regarding a specific challenge
facing the organization (e.g., HR, marketing,
finance/budget, clinical, legal, IT, etc.)âĻ
âĻItâs more about the set of leadership
competencies that give a board member a
sophisticated peripheral vision to oversee
a complex business enterprise.
Š Signature Resources 2015 27
28. Director Competency Examples
ī Organizational Finance/Budget
ī Business Enterprise
ī Strategic Planning
ī Operational Planning
ī Quality Improvement
ī Marketing
ī Branding
ī Strategic human resources
ī Policy Development
ī Community Relations
ī Leadership Development
ī Enterprise Risk Management
ī Government Relations
ī Mergers/Acquisitions
ī Technology Solutions
ī Innovation
ī Customer Service
ī Governance
ī Health care policy
ī Regulatory/Compliance
Š Signature Resources 2015 28
30. Teasing out Competency
Š Signature Resources 2015
30
īž Create a âdirector/trusteeâ application.
īž Invite potential candidates to speak to their
experience demonstrating the competencies you
are looking for in a board member (e.g. strategic
thinking, complex problem solving, customer
focus, quality improvement, etc.)
īž Define âconflict of interestâ and have them attest
to none!
īž Indicate a thorough background / bondability
check will be conducted on all candidates.
31. Where / How do you find folks who might
fit the ideal profile?
ī¤ Colleges / Universities
ī¤ The Canadian Chamber of Commerce
ī¤ Specialty Chamber Groups: Black / Latino / Asian / Native American
Chambers of Commerce
ī¤ Business and Professional Womenâs Associations of Ontario
ī¤ Young Professional Groups
ī¤ Professional Associations
ī¤ Small Business Alliance Groups
ī¤ Specialty Legal Societies
ī¤ Ontario Non-Profit Societies
ī¤ CEOs of businesses in your area
Š Signature Resources 2015 31
32. Credentialing Competency
ī Competencies are specific and observable learning
outcomes where the learner has demonstrated
knowledge, skills and applications to their domain.
ī Micro-credentialingâsorting competencies into smaller
learning segments to aid learning.
ī E.G. âFacilitationâ skills may be a smaller domain.
Dealing with disruptive people, staying on agenda,
managing conflict, involving everybody, clarifying
contributions, etc. are smaller subsets of facilitation.
ī MOOCsâMassive Online Open Courses.
ī Badgesâelectronic certificates of learning completion
or competency demonstration.
Š Signature Resources 2015
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33. Credentialing Competency
ī âBadgesâ have become the new currency for
professional credentials.
ī Mozilla, Blackboard, Safe Road Solutions, and
others are way ahead in providing and tracking
badges.
http://www.evolllution.com/opinions/ways-digital-badges-
influence-learning/
https://www.coursesites.com/webapps/Bb-sites-course-
creation-
BBLEARN/courseHomepage.htmlx?course_id=_264998_
1
Š Signature Resources 2015
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34. New Board Orientation I
Offsite materials review
ī History of the organization
ī Mission, vision, values
statements
ī Summary of programs, products,
services
ī Newsletters, press clippings
ī Financial performance past three
years including external audit and
regulatory review findings
ī Annual Report
ī HR org. chart & bio-sketch
professional backgrounds of staff
ī Strategic Plan
ī Board by-laws
ī One year of board minutes
ī Board policy and procedures
ī Current board profile and
professional background bio-
sketches
ī Board commitment and conflict of
interest statements for signing
ī Recent governance self-
assessment results
ī Committee structure and charters
ī Board calendar
Š Signature Resources 2015 34
35. New Board Orientation II
Onsite introductions and briefings
ī Staff leadership welcome
meeting and introductions
ī Key programmatic one on one
meetings
ī Financial briefing from CFO and
review of board financial
dashboard
ī Human resources briefing
including review of board
âorganizational climateâ
dashboard
ī âBrandâ briefing
ī Quality and Safety briefing:
tracking data, improvement
initiatives, responsibilities.
ī Patient / community briefing
including last twelve months
satisfaction and value survey
results
ī Board Chair briefing: Board
composition philosophy and
leadership succession
ī Board committee assignment
Š Signature Resources 2015 35
36. New Board Orientation III
Governance Education
ī Digest assigned articles and booklets.
ī Phone consultation with Governance committee chair
upon completion of reading and orientation.
ī Discuss annual calendar of hospital conferences and
expectations for attendance and learning commitments.
Š Signature Resources 2015 36
75% of Boards in Canada have a formal
orientation program for new board members.
Customarily a full day + site visits and training.
37. Lesâ Thoughts on
Ideal Board Makeup
Š Signature Resources 2015 37
ī 1/3 established, leaders recognized as as
strategically competent with complex enterprise.
ī 1/3 mid-career leaders gaining leadership identity
through business, government, non-profit
engagement, research, educational or institutional
leadership.
ī 1/3 emerging business leadersâgenerally a
younger group than senior or established and
recognized leaders.
38. Governance Diversity
and
Youth Movement
Š Signature Resources 2015 38
âSuddenlyâAge is a Diversity Issueâ
www.cues.org/article/view/id/Good-governance-age-is-board-diversity-issue
41. Š Signature Resources 2015
Strategy
in the 21st Century
Nothing ages faster than the future!
41
42. High Performance Governance
Strategic
īž Strategic plan in place looking 3-5 years out.
īž 70% of board agenda devoted to strategic topicsâfuture facing.
(Meetings: 30% fiduciary; 70% strategic)
īž Annual refresh of strategic plan.
īž Inclusive input from constituent leaders on strategic plan:
ī§ Past board members
ī§ Focus groups of constituents by segment (e.g. generational,
geographical, community leaders, opinion leaders, local business,
etc.)
ī§ External subject matter experts
ī§ Committee members
ī§ Staff! Inclusive input does not mean they vote on strategy.
Š Signature Resources 2015
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43. 70% Strategy Focus
âBuilding a Forward Looking Board,â
McKinsey Quarterly (Feb. 2014).
ī âNot enough time on strategy.â
ī âBoard as strategic asset.â
ī âToo much time looking into the
rear view mirror.â
ī âLack a strategic orientation.â
Š Signature Resources 2015
43
âThe pull of corporate gravity gets us into ruts and complacency.â
Les McKown, Predictable Success
44. Boards as Transformational Leaders
Š Signature Resources 2015
Challenge assumptions & models
Benchmark products / performance with peer group
Empower voice of the Patient, Family, Community
Commit to change
Move with deliberate speed on the vital few
44
45. Transformational
ī Transform: to completely change something.
ī Transformational: a focused effort to make significant
changes to strengthen the relevance and value of an
organization.
Š Signature Resources 2015
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âEvolution keeps you alive;
Revolution keeps you
relevant.â
Gary Hamel, Leading the Revolution
46. Š Signature Resources 2015
46
Strategy is about Transforming the
Organization to Remain Viable, Valuable,
and Vibrant!
So your board needs to beâĻ
īž Strategic thinkers.
īž Change compatible.
īž Focused on transformation of the enterprise.
īž Complex problem solversâĻeffectively navigating
changing funding, regulatory and constituent
demands.
īž Strategic thinking looking three to ten years out.
47. ī Strategy progress updates.
ī Business environment discussions.
ī New models / benchmarking / innovative thinking.
ī Tracking patient & family value shifts in healthcare.
ī Exploring the âlifecycleâ of services, models, and other
elements of healthcare business.
ī Developing partnerships / affiliations.
ī Governance succession and development.
Š Signature Resources 2015
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48. Strategic Thinking
Strategic Planning: âWhat is
our desired business position and
how must we change to get there?â
Strategic Thinking: âHow might
we re-design our business to
leverage leading edge marketplace
and business models?â
ī¤ Identifying an alternative future position
ī¤ Anticipating opportunity and threats
ī¤ Setting change priorities
ī¤ Designing change pathways
ī¤ Evolving / adapting systems
ī¤ Outlining formal plans
ī¤ Three-five year cycle
ī¤ Course corrections regularly
īĨ Challenging core business assumptions
īĨ Re-inventing the hospital model
īĨ Exploration of new paradigms
īĨ Sponsoring paradigm shifts/pilot tests
īĨ Bold innovative movement
īĨ Confirming stakeholder value shifts
īĨProjecting / anticipating lifecycles of
products, services, organizational model
Š Signature Resources 2015 48
49. Scenarios and the
VUCA Future
īą Enhancing Strategic Thinking Through Scenarios
1960s Herman Kahn (U.S. Air Force); 1970s Pierre Wack (Royal Dutch/
Shell)
īą Scenario Thinking
īThe process of visualizing what future
conditions, trends, or events are probableâĻ
âĻwhat their consequences or effects would be
likeâĻ
âĻand how to respond to or benefit.
Š Signature Resources 2015
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50. Scenario Discussion
and Nimbleness
ī A simple discussion of possible
scenarios informs a board so that it can
be more nimble as the future unfolds.
ī Because they have already considered
numerous scenarios and possible
options.
See Linda Parker Gates:
http://www.sei.cmu.edu/reports/10tr037.pdf
Š Signature Resources 2015
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51. Strategy and the VUCA Future
âA good [strategic] theory
incorporates foresight about an
industryâs future, insight into
which internal capabilities can
optimize that future, and cross-
sight into which assets can be
configured to create value.â
âStrategy for Turbulent Times: What is the Theory of Your Firm,â
Todd Zenger (HBR June 2013)
Š Signature Resources 2015
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52. Scenario Discussion
and Nimbleness
Caution:
A strategic planning session that only focuses on SWOT
discussions and doesnât spend some time on a variety
of future scenarios for the hospital will result in a brittle
outcome.
FUTURE PROOFING YOUR BOARD âBusiness
environment scans and lots of scenario
discussion helps insure only âblack swansâ are a
future surprise to your board.â
http://www.signatureresources.com
/our-capabilities/future-proof-your-board-directors
Š Signature Resources 2015
52
53. Scenario Discussion
and Paradigm Shifting
Thomas Kuhn, âThe Structure of Scientific Revolutionsâ
Š Signature Resources 2015
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ī If money were no object?
ī If we were forced to merge to keep
our hospital alive?
ī Whatâs currently impossible to do,
but if we could, would put us in a
more successful position?
ī If the patient could decide?
ī What strategies might a competitor
use to put us out of business?
54. Open Innovation
Scenario Discussions
Š Signature Resources 2015
54
Open Innovation: the creation of knowledge,
products, and services by online communities
is still in an early stage. How might hospitals
use it to stretch their thinking?
Think: âvirtual focus groupsâ on topics of
relevance for younger families, seniors, the
patient experience, access to services, patient
education, etc.
56. Some Typical Mistakes of
Organizational Strategy:
The Tatooed lady and the
Alligator Man!
Š Signature Resources 2015 56
âComplexity is the enemy of execution.â
58. More Discussion:
Other Elements of
High Performance Governance
ī Basic fiduciary competence.
ī Exceeding basic governance
competence.
ī Transparence / inclusiveness.
ī CEO partnership.
Š Signature Resources 2015
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59. Basic Fiduciary Competence
and Organizational Performance
Competent Governance
ī Financial stability with ample operating reserve.
ī Consistently meeting patient quality standards.
ī Constituent satisfaction and value confirmed regularly.
ī CEO board partnership with open communication, goal setting
and regular feedback.
ī Robust partnership with medical staff.
ī Meetings / Boardroom dynamics efficient and focused.
ī By-laws, policies up-to-date.
ī Board competent and committed.
Š Signature Resources 2015 59
61. Exceeding Fiduciary Competence
and Organizational Performance
Exceeding Competent
īž Real time assessment* of effectiveness following each board
meeting.
īž âBoard Portalâ assures adequate Board information and
communication.
īž Annual self-assessments and development plans drive
improvement.
īž All committees / task forces have written charters and clearly
identified outcomes or deliverable expectations and do annual
reports.
īž Officer development program assures competent officers get
elected.
īž A dose of governance leadership development at every meeting (+/-
15 minutes) e.g. risk, regulation, financial, ethics, etc.). [Ave director
education investment 22.1 hrs. each per NACD survey]
Š Signature Resources 2015 61
62. Š Signature Resources Inc. 2015
62
īą Real Time discussion each meeting.
īą Annual survey assessment of one element of
governance.
īą Full spectrum governance assessment survey.
īą Customized telephone survey.
īą Board member to Board member feedback.
īą Outside Expert Review.
6 Self Assessment Models
http://www.slideshare.net/LesWallace/board-self-assessment-approaches
63. Where is Your Governance?
Ishikawa View
Board
Competency &
Recruitment
Governance
Practices:
Meetings
Committees
Strategic
Focus /
Innovation
Performance
Tracking
Exec Team /
Board
Partnership
Assessment
& Development
64. And then thereâs committee workâĻ
Š Signature Resources 2015
A dark alley down which good ideas are led to be strangled!
64
65. All Committees!
ī Charters: purpose, makeup, annual responsibilities.
ī Annual deliverables: in clear distinct language.
ī Calendars.
ī Completeness: Board Chair Vice-Chair as Coaches.
ī Updates: no action reports; action reports.
ī¤ DO NOT go around the room for updates!
ī Use a âtask forceâ for short term investigation, scoping of
an issue, or fresh eyes on an issue. A
Task Force is a short term assignment that expires.
ī Annual report addresses progress + next year.
Š Signature Resources 2015 65
66. ī No speechesâget to the point.
ī Be prepared.
ī Focus on the problem not the person.
ī Pick your fights.
ī Apply appreciative inquiry to all positions.
ī Explore the minority opinion.
ī Say it in the room not the hall.
ī Support the decisionâmove on when the
board moves on.
Meeting Rules of Engagement
Š Signature Resources 2015 66
67. Agendas Converted to
21st Century Style
ī Convene
ī Consent agenda
ī Financials
ī Quality/Safety
ī Organizational culture and community perceptions
quarterly
ī Strategy (tracking, update and generative dialogue
70% of most meetings)
Š Signature Resources 2015
67
68. CONSENT AGENDA
http://www.boardstar.org/assets/documents/Consent%20Agen
da.pdf
ī A consent agenda groups routine items and routine
resolutions under one agenda umbrella that gets received
and approved in one board action without discussion.
No finance or quality reports here!!!!!!!
ī A Board member may pull any item for the agenda for
discussion during the appropriate section of the agenda.
ī Committee, executive team reports with no
recommended actions go here.
ī âException reportingâ (performance not meeting
expectations or unusual circumstances) go in the
appropriate segment of the agenda.Š Signature Resources 2015
68
69. Executive Summaries
and âFlippedâ Presentations
Š Signature Resources 2015
69
âFlip That MeetingâĻâ
www.signatureresources.com/about-us/nine-minute-mentor
Not all presentations are created equal!
Move more âpresentationsâ to executive summaries
And âflipped presentations.â
70. Meeting Management:
Executive Summaries
Essential components:
â Recommendation or Current Status: 1-2 sentences.
⥠The Context: 1-2 short paragraphs.
âĸ Briefly highlight supportive data and evidence.
âŖ Resource implications?
īž Exceptional executive summaries can be accomplished in
one page. Some with more complex data may require 2.
īž Yes, itâs an artâbut one which smart people can master and
boards can feel comfortable with.
Š Signature Resources 2015
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71. Board Officer
Development
ī Boards assume a popular and competent voice on
the board can become chair (or other offices) with
full competencyânot true.
ī The Chairperson role has become more complex,
and time consuming--natural talent is not longer
enough to chair a hospital board.
ī Boards are moving to early identification of board
member interests in being an officer and outlining
developmental learning to prepare them for the
chore.
Š Signature Resources 2015
71
72. Board Officer Development
ī Future board officers may be required
to âcertifyâ competency to serve.
âThink badges for specific
competencies for a Chairperson.â
Š Signature Resources 2015
72
âĸ Competencies of facilitation, negotiation,
meeting and agenda management, partnership with the
CEO, advocacy, decision making will be specifically
targeted.
âĸ These topics make for good development topics for
the entire board.
73. Fiduciary Focus on the KPIs
âWhat gets measured gets delivered!â
ī Fiduciary performance: finances and ethics.
ī Quality and Safety.
ī Patient and Family Perceptions.
ī Community brand.
ī Organizational Culture.
ī Strategic movement.
ī Governance excellence.
Š Signature Resources 2015
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74. Exceeding Competent
Performance Oversight:
Uses a Balanced Scorecard/Measures Dashboard
īą Monitoring a set of âindicatorsâ across the
âbalanceâ of the organizationâs work.
īą Distilling the âcattle callâ of numbers and
progress reports from management into a
visual report card.
âBalanced Scorecard: Measures that Drive
Performance,â Kaplan/Norton HBR 2/1/2000.
Research on Malcolm Baldridge Award Winners
Š Signature Resources 2015 74
75. Competent Performance Oversight:
The Balanced Scorecard/Measures Dashboard
Business Performance Constituent Performance Employee Engagement /
Organizational Culture
īž Budget performance
īž Capital investments
īž Operating reserve
īž Services expansion
performance
īž Individual services
performance
īž Investments
Robert Kaplan, Balanced Scorecard
īž Quality / Safety metrics
īž Pt. /Family value tracking
īž Patient satisfaction
īž Service specific metrics
īž Population health
īž Brand measures from
community / region
Harry Beckwith, Selling the Invisible
īž Employee climate survey
īž Employee retention
īž Employee development
īž Leadership development
īž Talent succession
īž Employee ideas adopted
īž Internal customer
surveys (tech., HR,
purchasing, facilities, etc.)
Marcus Buckingham, First, Break all the
Rules
Š Signature Resources 2015 75
Other categories are common: âLearning and Growth,â âInternal Processes,â
âCorporate Social Responsibility.â
76. Board Tracking
ī 5-7 KPI indices in each domain of performance.
ī Dashboards provide âquick glanceâ oversight.
ī âException reportsâ explain variation and
improvement plans.
ī âFire Drillâ discussions of urgent variations.
ī Report outs by âex-officioâ directors (e.g. CMO,
CNO) and key executives (CFO, QI Director, HR,
Marketing/Branding).
Š Signature Resources 2015
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77. Big Dot Oversight Theory
Š Signature Resources 2015
77
ī The board stays out of the weeds of
process and moment to moment
management of hospital systems.
ī At the staff and management levels the
professionals get their hands dirty with
more micro data and time tracking in
support of quality and process
improvement.
ī At the board level the high level âoutcomeâ
expectations for performance on the key
performance indicators are tracked to
assure fiduciary attention to performance
and ministry performance expectations.
78. Tracking Scope
Big Dot Cascading Focus
Board
Governance
Executive
Leadership
Management Teams
Work & Quality Improvement
Teams
Š Signature Resources 2015
78
Oversight &
Tracking
âFrom Boardroom to Bedside: How to Define and Measure
Hospital Qualityâ, Michael Heenan and Drothy Binkley
79. When Does the Board Hear About
Little Dots
Board
Governance
High Risk
Exception
Reporting
Work & Quality
Improvement Teams
Š Signature Resources 2015
79
80. High Performance Governance
Community Conversations
īž 4 times a year checks on âpatientâand âfamilyâ value and satisfaction (two
different issues).
Satisfaction = ī
Value = meets my needs.
īž Annual check on community impressions and interests.
īž Focus groups around key services or Brand impressions.
īž On-line surveys around key hospital initiatives: redesign, discharge planning,
ER, birthing, home health.
īž Board voice represents a diverse broad spectrum of community.
īž Strategic agenda helps brand the organization as keeping up.
īž Robust & open communication strategy links community to Board: Newsletter, Tweets,
Facebook, dynamic website, communities blogsâkeep community informed in
real timeâa local branding strategy!
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81. The â3Aâ Community Value Proposition
âI get what I need.â
âWhat could we do to add even
greater value to you our memberâĻ?
Access to: sites, services, partners, etc.
Appropriate: do services fit community needs
(Population Health Management). Whatâs missing?
Acceptable: community well informed, hospital
delivers in a way that meets community needs,
options provided, services meet industry
standards.
Š Signature Resources 2015 81
82. Patient Satisfaction CPRâĸ
âIâm happyâ
âHow well did we deliver on the followingâĻ
Courteous Service: courteous and timely service and
treatment through each contact point and across the
treatment continuum and all engagements with the system.
Providing Information: timely, available, accurate,
transparent, keeps me well informed as a patient?
Responding to individual circumstances: dealing with
problems and goofs, helping me in an emergency, referring
me to helpful solutions/assistance, protecting my interestsâ
warning me of risks.
Š Signature Resources 2015 82
83. Population Health
ī Five per cent of patients account for two-thirds of health care
costs. âĻpatients with multiple, complex conditions. When the hospital,
the family doctor, the long-term care home, community organizations
and others work as a team, the patient receives better, more
coordinated care. Providers will design a care plan for each patient and
work together with patients and their families. For the patient it means
they will :
ī§ Have an individualized, coordinated plan
ī§ Have care providers who ensure the plan is being followed
ī§ Have support to ensure they are taking the right medications
ī§ Have a care provider they can call who knows them, is familiar with
their situation and can help.
Š Signature Resources 2015
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84. Corporate Social Responsibility
TBL: âthe triple bottom lineâ perspective
emerged in 1994
The argument was that companies should be preparing
three different (and quite separate) bottom lines.
1.The traditional measure of corporate profitâthe
âbottom lineâ of profit and loss accounting.
2.The bottom line of a company's âpeople accountââa
measure in some shape or form of how socially
responsible an organization has been throughout its
operations.
3.The bottom line of the company's âplanetâ accountâa
measure of how environmentally responsible it has
been.
John Elkington, Cannibals with Forks: The Triple Bottom Line of 21st Century Business
(1998).
Š Signature Resources 2015 84
85. Community and Planet
Brand Advantage
ī Hay Group/Corp. Sec. CA Society âLess than ÂŊ Canadian Boards have a CSR
initiative.
ī Community service, employee volunteer hours, financial contributions,
executive service on community boards, etc.
ī Promoting communities, chambers of commerce, festival sponsorship, etc.
ī Community partnerships with schools, universities, not-for-profits, etc.
ī Facilities: recycling, energy use, green purchasing, eco-auto fleet, local
sourcing, paperless systems, etc.
ī Is your Hospital / Health System tracking any of these?
ī OHA Green Hospital Scorecard?
https://www.oha.com/CurrentIssues/keyinitiatives/Green%20Healthcare/Gree
nHospitalScorecard/Pages/GreenHospitalScorecard.aspx
âSocial Responsibility: A New Paradigm of Hospital Governanceâ
http://www.ncbi.nlm.nih.gov/pubmed/22481565
Š Signature Resources 2015 85
86. High Performance Governance
Transparent / Dialogic Tone
īž Unrushed board agendas assure generative dialogue occurs with
50%-70% of board agenda (Richard Chait, Governance as Leadership) .
Characterized by candid discussions with appreciative respect for diverse
points of view (âWhen we all think alike no one thinks at allâ).
īž Board votes noted by name!
īž Transparentâno back room agendas, limited use of âexecutive /
closed session.â
īž Transparent--robust information available to constituents through dynamic
web site / publications (board credentials, Ethics and values statement,
corporate social responsibility statement, quality dashboards, Ministry
reporting, etc.).
īž Committee / task force proceedings available to the board in real
time. (Draft minutes available within 48 hours).
Š Signature Resources 2015
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87. Transparency
In Real Time
ī Todays communities are increasingly nosey.
ī âReal timeâ information flow from informal (e.g.
Facebook, Twitter) to formal (more robust web
sites with big data) will answer the call for
openness.
ī Quarterly corporate reports become available
to the community (much like stock exchange
requirements).
ī Long term plans will be more widely
publicized and accomplishment celebrated.
Š Signature Resources 2015
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88. Sophisticated KPI Dashboards
ī The need for better, quicker
performance monitoring and the
demand for greater transparency
will push associations to
improved dashboards.
ī Info-graphic technology will make
this both easier and interesting.
ī Identifying the KPIs (Key
Performance Indicators) will
continue to be a significant board
responsibility.
Š Signature Resources 2015
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90. High Performance Governance:
Sampling the Literature
Assessment
1. Is Our Board Composition Right for the Challenge?
2. Are We Addressing the Risks That Could Send Our Company Over the
Cliff?
3. Are We Prepared to Do Our Job Well When a Crisis Erupts?
4. Are We Well Prepared to Name Our Next CEO?
5. Does Our Board Really Own the Companyâs Strategy?
6. How Can We Get the Information We Need to Govern Well?
7. How Can Our Board Get CEO Compensation Right?
Š Signature Resources 2015 90
91. High
Performance Governance
Assessment
8. Why Do We Need a Lead Director Anyway?
9. Is Our Governance Committee Best of Breed?
10. How Do We Get the Most Value out of Our Time?
11. How Can Executive Sessions Help the Board Grow?
12. How Can Our Board Self-Evaluation Improve Our Functioning and Our
Output?
13. How Do We Stop from Micromanaging?
14. How Prepared Are We to Work with Activist Shareholders and Their
Proxies?
Š Signature Resources 2015 91
93. CEO / Board Partnership
Š Signature Resources 2015 93
94. High Performance Governance
Clarity in Direction to the CEO
âThe Boardâs job: help the CEO be as successful as
possible!â
īž Platinum quality alignment between Board and CEO on goals and
performance.
īž Twice a year performance feedback to CEO (brief mid-year &
full annual review)âcompetency based.
īž CEO/ key staff reports are âoutcomesâ & âexceptionsâ based
vs âactivityâ based; strategic vs administrative detail. Effective
use of âexecutive summariesâ and âconsent agenda.â
Š Signature Resources 2015 94
95. What Stresses Your CEO?
īą In addition to running a challenging businessâĻ
īą âĻA Board can be one of the biggest CEOâs stressors!
ī Lack of clarity to the CEO.
ī Board members not literate in governance.
ī Get in the âweedsâ [details] of management.
ī Not up-to-date on hospital & healthcare issues.
ī Irregular feedback and evaluation to CEO.
ī Conservative to the point the hospital gets behind
the innovation and patient value trend.
ī Board makeup doesnât match future needs.
Š Signature Resources 2015 95
96. CEO Leadership
and Board Partnership
If the CEOâs not scaring the Board regularly, Itâs not a
robust partnership!
Š Signature Resources 2015
âBut Les Wallace said to scare them!â
96
97. Partnership: What CEOs Usually Ask Me
to Remind Boards!
ī A professional relationship: not bowling, golfing, or skiing buddies.
ī Feedback / direction / inquiry should be conducted in an executive manner
not @ the bar, airplane, or banquet dinner.
ī Rules of engagement should exist:
īŧ Commit to face-to-face meetings outside of Board meetings.
īŧ Have an advanced agenda for the conversation.
īŧ Effective communication is specific not general: have examples & data.
īŧ Good feedback is timely!
īŧ Instruct the CEOââScare us with big ideas!â
Crucial Conversations (Patterson)
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100. Les Wallace, Ph.D.
President, Signature Resources Inc.
Les@signatureresources.com
ī¤ Dr. Wallace is recognized for tracking business environment and workplace trends and their impact
upon business and government. His publications have appeared in Leadership Excellence,
Personnel Journal, Credit Union Management, Public Management, and Nation's Business as well
as numerous research and conference proceedings. His latest book, co-authored with Dr. Jim
Trinka, A Legacy of 21st Century Leadership, outlines the leadership organizations need in a global,
fast moving business environment. His book, Principles of 21st Century Governance (2013) is being
used by many boards in the profit and not-for-profit sectors to design governance development
approaches.
ī¤ His new book, Personal Success in a Team Environment (2014) is used by individuals and
organizations to improve teamwork, career building and success at work.
ī¤ Les is a frequent consultant and speaker on issues of organizational transformation and leadership,
employee engagement, strategic thinking and board of directors development and governance. His
clients include Fortune 100 businesses, Government agencies, and not-for-profit organizations
world-wide. Dr. Wallace is also the host resource on the 9Minute Mentor, a series short video
tutorials governance.
ī¤ Les has served on the Board of Security First Bank and Counterpart international. He currently
serves on the international Board of the World Future Society. He is a member of the National
Association of Corporate Directors. Les writes an on-line column for CUES Center for Credit Union
Board Education.
ī¤ Preview his video series on governance: www.signatureresources âDr. Wallace on Camera.â
ī¤ https://twitter.com/9MinuteMentor
Š Signature Resources 2015 100