Who should set the vision, the board or CEO? This question turns out to be a significant point of tension in healthcare organizations today.

Because it’s responsible for guiding the organization – including the CEO – a healthcare provider’s board should ideally influence vision creation and maintenance.

Paul Keckley

Yet, this isn’t always the case, according to Paul Keckley, a Nashville-based healthcare consultant and author. Instead, the CEO often pushes the board towards a vision and strategy, acting as the change agent.

“Bad bets get made because boards don’t fulfill their role,” Keckley said. It’s critical, he added, that the board sets the organization’s direction, own the vision and challenge leadership to make decisions that are consistent with the vision and resources available.

This isn’t meant to paint the state of today’s average healthcare board as all doom and gloom. Under the right framework, the organization, the individuals within it and the community the health system serves will thrive.

The experts quoted in this edition of Art of Change offer these four suggestions to create the appropriate relationship between board and C-suite. Input comes from Paul Keckley, healthcare consultant and author; Dr. Glenn Steele, former CEO of Geisinger Health System and Dr. Susan Turney, CEO of Marshfield Clinic Health System.

The Two-Way Street of Trust and Verification

Healthcare is hard, and changes on the board or in the C-suite are often precipitated by tough circumstances. Navigating hard situations takes communication and alignment and lots of trust. The board must trust the CEO to make daily hard decisions that are consistent with the vision and high-level strategy. The CEO must trust the board to have her back through those operational moves.

Each CEO we spoke with echoed the value of trust between them and their board chair. Advancing the mission of the hospital could not have happened without a good relationship. That said, part of a good relationship is, as we say at Jarrard, “The Kind Truth.” If the board’s role is to own the organization’s vision, it must keep close watch and provide regular, targeted guidance.

Collaborative Respect

Collaboration follows close on the heels of trust. Keckley emphasized the importance of an active, engaged board. Whereas the CEO operates as the change agent in many systems, it should instead be a “dyad” between the board chair and CEO.

Viewing the board and C-suite relationship as a partnership lets the organization cover more ground and gather more intel. For example, the board member who owns a bank in the hospital’s community will likely have insight and connections that the CEO – probably a healthcare industry insider – won’t.

Even Steele, who operated much more as the fulcrum in his role as CEO than others we spoke with (he was the primary change agent, to use Keckley’s terminology), pointed to close collaboration with the board chair as the foundation for change.

Look Outside the Leadership Bubble

Seek feedback from members of the community. This doesn’t mean always saying yes to their suggestions, but it does mean that hospital leadership needs to hear their ideas and concerns. As noted above, this is where the board should serve an important role, acting as the liaison between community and C-suite.

In addition, the board should not shy away from seeking perspectives from industry experts and advisors who can bring a fresh set of eyes to the problem. However, Steele cautions against “becoming addicted” to consultants and using them as a shield for making hard decisions.

Diversify and Fill Needed Competencies

Boards tend to be older because rich experience comes with maturity. But it’s important to begin training younger professionals and rising civic leaders to take on these roles. They will be better prepared to lead later in their careers, and a Millennial will have a different view on the industry than a Boomer – important as the demographics of healthcare consumers change.

Boards should also ensure that they are finding people who 1) represent the community, including ethnically, and 2) fill specific competency needs. Both Keckley and Steele mentioned the importance of having people in the room who have experience in relevant areas of expertise at the moment of change.

Cut Them Loose if Necessary

Sometimes, for whatever reason, people won’t align. At that point it’s best to let them leave. Steele noted that there was significant turnover on the Geisinger board through natural attrition as people retired. In addition, a few people who weren’t entirely comfortable with the new direction left. As the organization’s direction was set, there was organic realignment as some people left and others took their places. Turney, by contrast, has seen minimal board turnover in her five years as CEO. The more alignment (and trust and collaboration) that exists at the beginning, the better the chance of reducing turnover. But some is going to happen regardless, and that’s ok.