(September 2023) – The world is becoming increasingly fast-paced, and health care is no exception. What trustees needed to know ten years ago is no longer sufficient in today's health care industry, where governance "knowledge capital" is one of a hospital or health system's most valuable assets.

Governance education is a continual process, not an end result. Education is the vehicle for improved governance knowledge. The end result is greater knowledge, understanding and heightened leadership intelligence ensuring trustees are fully prepared to engage around critical issues and making evidence-based decisions rather than "gut"-based decisions. Well-planned and well-focused governance education builds the "knowledge capital" the board needs to ensure the right decisions will be made, using meaningful information and data.

Working with Individual Trustees to Assess and Meet Education Needs
Trustee knowledge-building must take place continuously and through a variety of venues. Many boards engage in targeted education at every board meeting. In addition, sources of information between meetings include state hospital association resources; webinars, recordings and conferences; reading and absorbing information and ideas in trade journals; and reviewing reports and studies available online, including resources from the Kansas Hospital Association, American Hospital Association, HealthLeaders, Kaiser, Health Affairs and more.

The key to success is to develop trustee knowledge that enables governance leaders to put the bigger issues and challenges into a local market framework, identify market implications and lead with confidence.

A well-planned and financially well-supported focus on education results in:

• Better decisions based on better knowledge and insights
• An improved capacity to be a well-informed advocate for the hospital or health system and its community
• Increased capacity to engage in challenging and productive governance dialogue
• An ability to think beyond "conventional wisdom"

To be successful in evaluating trustee education needs and ensure a successful education process, several factors are critical.

The board must invest in knowledge building, both financially and intellectually. The board should define, for exploration several months in advance, the issues and topics that are the most critical for board members to understand in order to engage in robust discussion and decision-making.

These topics should be drawn from the forces and factors driving organizational success in achieving the mission, vision and strategic objectives. Available resources for delivering the education (meetings, publications, webinars, videos and other online resources, trustees themselves, consultants, etc.) should then be determined.

Once topics are defined and the sources are determined, the board can set a basic education strategy with objectives and outcomes. Success should be evaluated periodically, and new opportunities should be incorporated into the educational development effort as changes occur in the market.

Education should not be a one-time event. Instead, it is an institutionalized commitment to ensuring the governing board has the knowledge and resources necessary to make strategic decisions and be a highly effective leadership body.

Participation should be mandatory as a condition of trusteeship, not a "suggestion." Hospitals and health systems owe it to their patients, physicians and communities to ensure governance decisions are made and directions are set as a result of vigorous scrutiny and informed intelligence. This means, every board member must have a common level of understanding of critical issues, and developments, and their implications for the organization.

Requirements for governance participation should be expressly discussed in trustee recruitment. Governance education requirements should not be a surprise to new trustees after they begin serving on the board. Board members should be fully informed in advance about education requirements, which should be presented as an avenue to best serve the hospital and the community. Prospective trustees should embrace the importance of health care education in their development as a valuable leadership asset.

Education planning should be directed, where possible, by trustees themselves. Trustees may be asked to research certain topics or issues and present the findings, implications and possibilities to the entire board. This level of involvement not only brings credibility to the importance of education, but also results in deeper trustee understanding of the most critical topics.

Education should be individualized and customized. Every trustee is in a different "place" with their level of awareness and knowledge of the issues discussed and the decisions made at board meetings. However, every trustee has the same fiduciary obligation and the same responsibility to be well-informed. Efforts should be made to understand the knowledge needs of each trustee, and plans should be developed to provide each individual with the information they need to be active, engaged and productive participants in the governance process.

Designing an Effective Governance Education Process

Below is an outline of how a board may design a process to ensure the optimum development of leadership knowledge and effectiveness.

• Define the board issues about which every trustee needs to have a common understanding in order to be a high-performance board member. Subjects may include, but are not limited to:
  • Health care payments and reimbursement
  • Health care regulation and current state and federal activity
  • Current trends and issues impacting the hospital or community
  • Workforce issues and challenges
  • Quality and patient safety
  • Transparency of quality and costs
  • Collaboration with the medical staff
  • The board's role in CEO compensation and evaluation
  • Factors impacting patient access to care
  • Understanding social determinants of health
  • Meeting community needs and building community partnerships
  • Communicating community benefit
  • Advocating on behalf of the hospital or health system

The hospital or health system's current strategic plan should serve as a basis for determining the most critical board education topics and current health care trends to focus.

• Assess each individual trustee's awareness and understanding of the issues and situations likely to come before the board in the coming months. This may be done through a board self-assessment, a simple survey or in causal one-on-one conversations, typically between individual trustees and the board chair and/or CEO. The individualized knowledge assessment is not a "test" and should not be intimidating. Instead, it is a conversation to help determine the areas where pinpointed education should be focused to most quickly get trustees "up to speed" on the issues and decisions for which they are fully responsible.

• Assign an experienced board colleague to work closely as a "mentor" with newer trustees to help them understand issues, questions, nuances, etc.

• Develop a 12-month or longer "curriculum" of topics that are essential to effective governance, and determine the most appropriate resources to assess or deliver the information. Ensure trustees are actively involved in the selection of topics and the methodology for presenting the information is conducive to trustee learning styles. Delivery methods may include in-person presentations, facilitated discussions, online presentations, videos, reading materials and more.

• Leverage the improved trustee knowledge, not only for board discussion and decision-making, but also through coordinated outreach. This may include legislative advocacy and building connections with the local community through trustee involvement in community activities, formal and informal community discussions and presentations about the organization and challenges it faces.

• Continuously refine and improve the process. Conducting a regular board self-assessment is one method to measure improvements in board understanding and education effectiveness. It also will help determine potential "knowledge gaps" that still exist.

Building expectations for the growth and development of the board's knowledge capital will result in better dialogue, better decisions and knowledge-based leadership that will drive future governance performance and organizational success.

Special thanks to The Walker Company and governWell™ for use of: Good Governance Starts with a Commitment to Education. Additional trustee resources are available at Kansas governWell and in the Trustee's section of the KHA website.