Defining the Role of a Hospital Board of Trustees
If a hospital board trustee arrived at the hospital for treatment, chances are pretty good that the medical professionals treating him or her wouldn’t know who the person was. The law requires hospitals to have a board of trustees to provide guidance and leadership over all hospital activities. While hospital board trustees perform very important leadership functions, much of their work is unseen by those who provide daily care for patients.
What Role Do Hospital Board Trustees Serve?
Hospitals and other healthcare facilities need to have a formal structure in place to oversee professional and administrative staff, facilities and medical equipment to deliver safe, high-quality care to the community’s patients. Hospital board trustees have all the same duties as board members in other industries, including hiring and firing the senior executives, appointing board trustees, and overseeing the financial health and stability of the organization. In performing their duties, boards of trustees must abide by relevant laws, governmental regulations and applicable licensure standards.
For-Profit Hospitals Model Good Governance for Nonprofit Hospitals
The laws and regulations for nonprofit and for-profit hospitals are different. Most nonprofit hospitals follow the same principles of good governance as their for-profit counterparts in their duties of providing accountable and responsible leadership.
For-profit hospitals faced new changes in challenges in 2002 with the passage of the Sarbanes-Oxley Act (SOX). The Act mandates new standards for Boards of Trustees related to the qualifications, conflicts of interest, disclosure requirements and other matters. Nonprofit hospitals have voluntarily adopted some of the same standards, although they’re not required to do so.
One of the issues raised by SOX is increasing the number of independent trustees who serve on the board, so that independent trustees are the majority. Inside trustees of nonprofit charitable hospitals are members of the hospital’s management team, physicians who practice at the hospital and any others who receive income from the hospital.
Outside trustees include community leaders such as volunteers, community business professionals, government officials, religious leaders and local political leaders. Best practices for corporate governance recommend that outside trustees should make up the majority of the board because of their independent perspectives. Outside trustees may serve as volunteers, although they may be reimbursed for trustee-related expenses. They serve on the board to give back for the service they received at the hospital and to give back to their communities.
In smaller communities, the lack of leaders creates dual inside and outside roles for some trustees. These situations require trustees to declare a conflict of interest on certain matters, and they must refrain from voting on an issue where there’s such a conflict.
What Is the Interaction Between Physicians and Trustees?
The roles of physicians and other healthcare professionals and the roles of board trustees have clear lines of responsibility. Too often, physicians don’t know enough about the role of trustees and vice-versa.
Generally, physicians could benefit by knowing a bit more about the hospital’s structure and how governance works and affects decisions that come down from the trustees. Trustees can’t make informed decisions without understanding the issues that affect physicians and those they care for, especially in these times of complex systems of healthcare billing and delivery. Board trustees need useful, direct information to oversee their hospitals successfully.
Committees of the Board Provide the Necessary Link Between Trustees and Physicians
The hospital’s mission to deliver safe and high-quality care is dependent on the interaction between physicians and trustees. The formal structure of hospital boards requires boards to form committees, which is where much of the board’s work occurs.
Hospitals create medical executive committees, pharmacy committees and therapeutic committees, in addition to committees that relate directly to governance. These committees meet at regular intervals and make recommendations to the full board. Physicians, nurses, administrative personnel and trustees serve on the committees. Committees where healthcare professionals and trustees serve together provide opportunities for clinical staff to advise trustees on important matters about patient care.
Just as independent trustees provide a well-rounded perspective, the trustees benefit when they receive direct knowledge of the workings of the hospital through the eyes and ears of the caregivers, bypassing the filter of the hospital administrators. Physicians who seek out relationships with trustees help trustees learn more about the particular needs of the hospital, such as new equipment, new services and emerging healthcare issues within the community. The better-informed trustees are, the better decisions they can make for patient care.
Matters of Transparency With Hospital Boards
State laws outline the rules and regulations for nonprofit hospitals. Many states require all or some meetings to be open to the public. Physicians and other healthcare professionals will find schedules of Board of Trustee meetings posted at the hospital and on the hospital’s website. It’s not uncommon for hospital board agendas to consist primarily of financial issues, with little or no focus on the quality of patient care.
Physicians and other healthcare professionals have a right and responsibility to get involved in the board’s business. They are welcome to attend public meetings and to provide valuable input regarding the board’s agenda items. Their input often helps to balance the board’s agenda by placing a much-needed emphasis on quality patient care.
Relationships Between Healthcare Professionals and Trustees Are Mutually Beneficial
Trustees who aren’t well-acquainted with healthcare professionals in their communities have the opportunity to evaluate their caregivers informally every time they make an appointment at a clinic or hospital — or make an unexpected trip to the emergency room.
A planned or chance visit to a healthcare provider can set the stage for a mutually beneficial relationship where trustees and physicians and nurses can share insights about their respective roles in caring for patients in the communities they love. These meetings may open the door for board trustees to encourage healthcare providers to attend meetings of the board to learn more about how boards govern hospitals. Conversely, new relationships between physicians and trustees may open up conversations about health needs in the community that need to be addressed by both parties.
