Board Orientations Discussion Guide

Watch the Board Orientations Webinar Here

Prepared by
James A. Rice, Ph.D.
Brian E. Rice, MHA

Series Preface:

This discussion guide is part of an “ACHD Governance Toolkit” composed of a series of six recorded webinars organized by the Association of California Healthcare District (ACHD) to encourage and support healthcare district boards of directors to further enhance the performance of their governance models and practices. The six topics addressed are:

Community Engagement
Balancing Governance & Management
Board Orientations
Strategic Planning
Board Self-Assessments
Board Education Programming

The six programs consist of an approximately 15-minute video with a downloadable slide deck, and a short discussion guide to stimulate healthy conversations between the CEO and the board about practical ways they can collaborate for more effective and efficient board decision making in each topic. The programs are also intended to help encourage healthcare districts to consider the successful completion of ACHD Certification.

The ACHD Certified Healthcare District Program promotes good governance for healthcare districts by creating a core set of accountability and transparency standards. This core set of ACHD standards is known as Best Practices in Governance and districts that demonstrate compliance are designated by ACHD as a Certified Healthcare District for a period of three years. Find more information on our website.

Each of the six webinars can be optimized when the Board Chair and CEO collaborate to organize a five-step program of education for the coming year.
The five-step process for your board-CEO conversation to address these topics is suggested to be:

The CEO and Board Chair reaffirm their shared commitment to the continuous enhancement of the board’s education and capacity development. Jointly express this commitment at the beginning of each year.
Adopt a board policy of continuous board development that embraces:
* Periodic CEO briefing materials on topics relevant to the strategic plans and challenges of the healthcare district.
* A calendar of speakers in routine board meetings on hot topics to help the district’s vitality.
* Organization of a “Symposium” on board best practices with other community organizations and associations for joint learning and community leader networking.
* Participation in small groups of district board members at ACHD or other state conferences on strategic issues and trends.
* Organization of customized educational readings or mentors for each board member based on their unique needs and requests.
Organize a 30-minute educational session during a Spring and Fall board meeting to focus on one or more of the six Webinar topics. Ask one board member to team with a member of management and/or the staff to jointly present and help guide the discussion around the webinar and this Discussion Guide. This team approach helps build interest, ownership and shared responsibility among the board for its ongoing development.
Encourage all board members to watch to the short video recording of the webinar before the scheduled discussion session. All should come to the discussion session ready to contribute in these ways:
* Assess how well this topic is being addressed in your healthcare district;
* Bring questions and ideas about how your district might better address this topic in the future; and
* Bring some suggested resources that might help your healthcare district enhance its learning and planning for this topic.
Conduct a collegial assessment of each program to see how its value to your district could best be optimized in the coming year. Share your ideas with the ACHD staff.

Thank you again for all you do for the people of your healthcare district, and for the enhanced performance of your healthcare district board work!
Contact ACHD staff at any time with questions, or contact us at jim_rice@governakadimi.org

Let’s begin moving though this discussion guide.

Board Orientations

Introduction

Thank you for your interest in exploring how your healthcare district board might better understand and develop its capacity for enhanced board orientations. We know that effective and timely board orientations lead to enhanced board effectiveness, a more efficient decision-making process with better results, and expanded board member pride.

This discussion guide is not a stand-alone document. The guide is to be used in conjunction with the corresponding recorded webinar and slide deck. We encourage your board and CEO to collaborate in conversations and shared strategic thinking and planning to support your board members, individually and collectively, to be more effective in establishing and nurturing new strategies and structures for more interesting and effective board orientations.

This discussion guide is organized to answer these questions:

What is a “board orientation”?
Why is a good orientation important?
Common issues or challenges?
What can boards do to be more successful?
Where to secure resources for further educational insights on this topic?

Within each of these five sections, we pose a series of questions to guide your conversations about how best to develop board orientations as a means to accomplish the mission of your healthcare district.

1. What is a “board orientation”?

Elected healthcare district board members want to do their board work wisely and well, as soon as they are elected to serve. Unfortunately, some districts have not recently updated their orientation process or program materials. A good orientation program helps the board member understand the scope and nature of their role and responsivities within the unique context found at the intersection of the board’s culture and bylaws, the California Brown Act, and regulatory guidelines from state and federal payers. Our work with healthcare district boards suggests a good orientation has at least these five characteristics:

Prompt: The orientation should be conducted within 30 days of being sworn into board service
Professional: The onboarding process should have orientation content that is tied to the board member’s job description, plans, and “Authority Matrix” adopted by the healthcare district. It usually involves a tour of district facilities and the organization’s strategic plans.
Promotional: The orientation should focus on work that enables the board member to be an effective champion for the mission/vision of the healthcare district.
Packaged: The orientation process needs to accommodate the needs of each unique member; utilize multi-media, modular content, and multiple speakers. It should not just be the CEO that welcomes and orients the new board member to their work and service in the governance of the healthcare district.
Passionate: To avoid the orientation process becoming flat, dull or boring, the program should weave in stories that humanize and personalize the work of the board to the needs of real people that are being met by real people employed by the district.

We encourage the continuous improvement of your board orientation process and content by asking and answering these questions:

When and how was the healthcare district’s board orientation process and program developed?
What is the relative priority your orientation should assign to each of these possible topics?
- Board member job description and code of conduct
- District by-laws
- Demographic patterns and health needs of the district
- Strategic plan for the next 3-5 years
- Profile of all unique community health partnerships
- Capital and operating budgets
- Organizational chart of legal entities and management teams
- Statistical profile of 3 years of:
  - Services provided, quality, market share by service, financial ratios
  - Provider and staff morale surveys
  - Philanthropy and community support
- Profiles of physicians and providers
- Sample of recent board meeting minutes
- Board policies and procedure manual and use of web-based board meeting portals

2. Why is a good orientation important?

Welcoming a new board member into your governance model is the best way to help ensure that all members are on a balanced footing to more successfully journey as a team to achieve your mission. Good board work is a team sport. As in any good team, whether a chamber chorale, a soccer team, or an orchestra, one weak member can throw off the balance and quality of collaboration among all on the team. We have found in over twenty years of governance work that key benefits of a good orientation are:

More effective & efficient decision making by the board
Less wasted time in meetings and better dialogues
Enhanced messaging & brand enhancement in the district
Expanded engagement & pride with providers, staff, public and donors due to a positive culture established at the top of the organization
Increased ROI probability of the plans and budgets

As your board explores how best to refresh and update your board member orientation, engage with the CEO and other board members to answer these questions:

How would you hope the knowledge and behaviors of a new board member would be enhanced by their participation in your orientation program? What are the proxy indicators that the orientation was a success for the person, and for the board?
What might be the value of inviting current and experienced board members to participate in the orientation program?

3. Common issues or challenges?

Too many boards miss the opportunity for launching a new member’s effectiveness and pride in their board service by under-appreciating the benefits of a good board member orientation. This frustration is a function of several issues, especially when:

The Chair and CEO may not prioritize the orientation process
New members think they already have all the answers - they were elected into the position
The CEO tries to do it all alone, rather than engage a team of staff and providers and other board members in the orientation effort
The process is boring and time consuming, and fails to bring the heritage and plans of the organization to life with stories and modern, multi-media learning techniques and content
The orientation content is narrow and does not map to the district health needs, the mission, and the strategic and financial plans.

To help you overcome these obstacles to great orientations, engage the board and CEO to pose and answer these questions:

Identify the top 2-3 weak spots of your current orientation process, in terms of topics addressed, the depth of information and quality of the content in each of these topics, and the style of multi-media tools used to share the content with a new member. How can these be enhanced in the coming year?
How might you invite new ideas for your orientation from other management staff?

4. What can Boards do to be more successful?

Your board can take action to build upon your current board orientation process by discussing how to consider these strategies:

Make board member orientation a priority via the “Five Ps” of section 1 above
Make your orientation program engaging visually, animated, and tailored to the new member
Make the learning experience digital and easily accessible 24/7 on your board portal
Make it comprehensive & interesting:
- Real patient case stories (but HIPPA compliant)
- Real physician and nurse stories
- Map to “Balanced Score Card” type metrics that visually help “Make Data Sing”
- Include touring with planned presentations by staff
- Encourage “Q Factor” by board members. The Q factor is a technique of asking questions that cannot be answered by a simple “yes” or “no”, but rather ask questions such as: why, what, why not, when, how, how much?

How might your board step-back from your current orientation activities, and refine your process by engaging in conversations around your answers to these questions:

How might your onboarding process best improve its content and learning methods?
How might your board orientation programming best integrate into your broader board annual education programming?

5. Where to secure resources for further educational insights on this topic?

We believe the following resources will support your efforts to strengthen your board orientation programming. What other ideas might you have to enhance your board onboarding session?

Consider ACHD Certification criteria checklist
BoardEffect checklists save time
See Association Checklists for Topics
Dashboard Graphics: Stimulate Thinking is Key
Map to Board Member Handbook links

Thank You

Thank you again for all you are doing to build your boards orientation programming.

Please reach out to ACHD staff for comments or suggestions to improve this board development discussion guide and webinar.

And thank you for all you do for the people you exist to serve in your healthcare district!