Healthcare Governance and Leadership Development: Why Stop at the C-Suite?

My favorite quote is, “The first job of leadership is to define reality,” from the former President and CEO of Herman Miller office furniture company, Max Depree. As someone who has sat both in the hospital executive suite and at its board table, I have some thoughts about the reality of leadership in healthcare governance.

First, let me define what I mean by governance. Today, the word governance is used for multiple purposes, from managing technology solutions to overseeing fiduciary approvals. But, I’m referring to governance in its original business intent: a Board of Directors that oversees the administrative efforts and leaders of an entity.
My opinion about the state of healthcare governance might surprise you. But first, some background on the topic.

Governance Matters

Most would agree that excellent organizations start with excellent governance. In the healthcare sector, and particularly the community-based not-for-profit sector which dominates healthcare, this is especially true. I mean no disrespect whatsoever to the administrators, physicians, nurses, and others that are in the trenches every day. But, governance matters, and it matters a lot.

It is the rare organization that is not investing substantially in their administrative and clinical leadership teams in the form of team development and training. More often, we are also seeing organizations finding value in and leveraging focused executive coaching of high potential leaders. To those I say, ‘Right on and don’t slow down!”
Most of us have moved well beyond the notion that coaching is reserved for those on a performance improvement plan. Leadership coaching is anchored in the notion of emotional intelligence, defined as an assessment of one’s self-awareness, recognition of how we impact those around us, and our ability to modulate our behaviors to be increasingly more effective in our work. Finally, we must be able to do all of this in the context of the distinct culture of our organization.

You may ask, “Okay, so what does that have to do with excellent governance?” So here it is, my opinion about the state of healthcare governance, and it comes in the form of a question:
Why do we stop at the C-suite when it comes to coaching and leadership development?

If we really believe that excellent governance ultimately trickles down to create excellent organizations, then why do we not move beyond functional board training to real board development at a personal level in the context of the organization being governed?

Perhaps there are many answers and opinions to that question but let me share with you my thoughts on a couple of fundamental flaws in our assumptions.

Board Leaders are Already “Good Enough” at Leadership

We tend to assume that excellent leaders in the community who have demonstrated their competency/capabilities/success outside of healthcare can automatically ‘catch on’ and become excellent healthcare governors overnight. The truth is that healthcare is uniquely complex.

Understanding and navigating the relationship interface and hierarchy among physicians, nurses and other clinical professionals, administrators, and governors is not something you can grasp by reading a book or through a session at a conference. Recognizing how clinicians process and integrate information to reach critical decisions, likewise, can be a huge challenge for those who have had different life experiences.

Additionally, former executives, whether from healthcare or not, who were successful in administrative leadership may be surprised at the different leadership muscle that is required to lead through a governance role. I will refer to the often-coached leadership adage of “what got here, won’t get you there.”
These skills take awareness, context, and practiced application.

The CEO to Board Relationship is Simple

We tend to oversimplify the relationship between the CEO and board. While most such relationships start off well after the CEO is hired, we make the perhaps faulty assumptions that both parties have a deeper understanding of each other personally, for example, their communication styles, how they manage change and conflict, how they prioritize work, how they manage key relationships, and so on.

Add to the complexity the often multi-tiered governance structures of larger healthcare systems, and newly integrated mergers, and we have ourselves a multifarious environment that is ripe for leadership challenges and opportunities.

If we think that awareness of these sort of things is important for hospital leadership teams and key managers, then why do we allow ourselves to ignore it, for the most part, when it comes to the most critical relationship(s) in the organization – the governors and their chief executive officer?

What Do YOU Think?

While I clearly have an opinion on this topic, my colleagues and I at MEDI Leadership would love to hear yours. Does your governance team consider leadership development part of its duty?
Fill out this 7-item survey and let’s see where industry stands.

John Anderson
About the author

John Anderson, MD, FACS has over 25 years’ experience in healthcare leadership and governance roles in several of the country’s leading healthcare systems.

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