Moving your board from good to great.

confront the rapid, transformational changes under way in health care. They must keep their organizations focused on their mission to meet community health needs, encourage collaboration and generative thinking with internal and external partners, and engage in governance practices that foster disciplined oversight and decision-making processes. A benchmarked, practiced and disciplined board process combined with regular self-assessment and robust reflection on process and outcomes are key determinants for great board performance and sustainable organizational success. In The Board Book, author William Bowen, former president of the Mellon Foundation and Princeton University, writes, “Governance ... is a team sport, par excellence, and individual members must understand that boards have a collective oversight responsibility. ... Nonprofit boards, in turn, have much to learn from disciplines characteristic of corporate boards — especially the routine use of benchmark data and the constant monitoring of discrepancies between planned outcomes and actual results.” Bowen concludes: “Appropriate governing arrangements can enable the CEO-board partnership to operate smoothly, and ... facilitate both the exercise of courage and effective forms of collective decision-making. ... Being explicit about conventions reduces awkwardness and increases the odds that responsibilities will be discharged appropriately. ... Experience has helped me overcome an ingrained distaste for spending time thinking about matters of process when substantive issues are more interesting ... and I have come to believe that the upfront investments of time and energy needed to put good mechanisms in place can pay large dividends.” Past Is not Prologue Many health care governance processes have been fashioned on a long-standing tradition of strong CEO direction and minimal collaboration between the chief executive and trustees. While this approach may have worked in a more stable past, it is illequipped to deal with the transformational changes now being accelerated by health care reform. Effective leadership requires boards and CEOs to work together as a highperforming team. The process involves tapping into the collective intelligence and energy of the board, the executive team and key stakeholders to make better decisions faster and to generate new and better solutions to achieve the ambitious performance, quality and cost goals that characterize successful organizations. “As the new CEO of Shore, it was clear to me that the tools, processes and skills the entire organization had developed, including our board, were appropriate in the environment we came from, but not for the health care environment we were facing,” says Ron Johnson, president and CEO of Shore Medical Center, Somers Point, N.J. “I believed that flexibility and Moving Your Board from Good to Great