Demystifying the boardroom. Tips for timid trustees

The complexity of a modern hospital can mystify and intimidate trustees; they may have difficulty understanding how the hospital works and thus may feel unable to contribute to its success. Stripping away some of the mystery may enable them to more effectively fulfill their roles to "hold in trust" and "govern." Some strategies trustees can use to gain control include hiring a chief executive officer (CEO) who can communicate, remembering who works for whom, assuming that anyone who makes more than $80,000 a year expects to earn it, and stifling the urge to seek "fairness." To clarify the relationship between board and CEO, trustees should ask the following questions: Are all subsystems contributing to the system's overall goals, or are some serving their own ends? Does the system allow interaction among subsystems to promote synergy, or does it isolate the parts? How does the CEO plan to produce the required product or service and achieve profit goals within the organizational policies? How will the trustees know whether the intended product or service has been produced within the organizational policies at the desired profit? By following a code of conduct, trustees will become more effective. The seven elements of the code include observing behaviors and reporting observations, asking questions and insisting on clear answers, establishing relationships with constituencies, making decisions and being willing to explain those decisions, making sure solutions fit problems, realizing that management is a series of approximations, and seeing that adherence to the hospital's mission dominates the criteria used in free choices.