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The changes that are impacting healthcare now, and that will continue to impact the industry for some time, are demanding a closer look at the role of the board and its members.

In January 2014, Becker's Hospital Review published an article (Gamble, 2014) outlining 10 trends for hospital and health system governance. It included:

  • The fiduciary duty for standard of care will become more rigorous.

  • Boards will need an increased level of engagement from their members.

  • A key responsibility for boards will be active participation in strategic planning.

  • The director nomination process will become more focused on candidates who have competencies in areas such as population health, insurance capabilities, healthcare IT, and quality.

  • Boards will become involved in more vigorous compliance oversight.

  • Boards will partner with management to create more rigorous communication mechanisms to monitor and report on risks.

  • Governance structures will be evaluated in terms of board size, composition, committee structure, reporting relationships, and reserved powers.

  • There will be heightened involvement of the board and greater board ownership.

  • There will be an increased focus on the risks related to new health system business initiatives.

  • The role of the general counsel will become more important.

Jim Gauss, MHA, is chair of board services at Witt/Kieffer, a national executive search firm. Executive search firms are specialized recruitment services that are used to source candidates for senior, executive, or highly specialized positions in an organization. Although Gauss has years of experience in executive search, he is now focused on recruiting for healthcare organization boards. He says that hospitals are looking for board members who “know the power of asking the right question at the right time.” A balance must be struck here, of course. He adds that it's important that board members neither get overly involved with the day-to-day responsibilities of the staff of the organization nor sit too quietly.

Nurses are well positioned to serve, he says, because:

  • They have both technical expertise and personal maturity.

  • They demonstrate independence and objectivity.

  • They're out of community, meaning they come from a different community or environment that would provide the board with “greater diversity of thought, gender, and ethnicity.”


Diversity, especially gender and ethnic, is increasingly important in an environment where stakeholders are increasingly diverse.


Hospitals have many stakeholders. Some are obvious, such as patients and their families, or the hospital's employees and medical staff. Others, such as legislators and regulators, are less obvious. Regardless, they have a vested interest in the organization's success and how well it performs.

For example, religious orders or congregations sponsor some nonprofit hospitals. The religious order is an important stakeholder of the hospital and usually reserves the right to make decisions on important matters, such as significant financial expenditures, who sits on the hospital's board of ...

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