Transformation and the governance agenda: keeping your board on track.

based system to systems of care that promote and encourage population health. To make matters even more complex, hospitals and systems will need to evaluate each of these issues within the context of their existing strengths and weaknesses, financial performance, ability to control and reduce costs, existing programs and integration initiatives, access to capital, current quality and safety performance and, of course, their local market. Simply put, when a local health care market begins to change rapidly in these areas, the urgency and pace of change accelerates, often placing organizations in a reactionary mode that makes everything move faster. Hospital and health system executives and clinical leaders have no shortage of work and pressing issues to keep them awake at night. However, the current scope and pace of change heightens the need for all health care leaders to remain informed and to learn continuously. In many cases, the learning curve will be steep and time-consuming as organizations increasingly find themselves operating and governing two businesses: the existing disease-focused, fee-for-service model (which encourages utilization of care and services) and a model focused on wellness and disease prevention (which ultimately rewards health as opposed to treatment and procedures). Among all of these priorities and activities that are routinely part of the transformation dialogue, one issue is conspicuously absent: governance. It’s no secret that board time is an important and limited asset. Yet, while many CEOs around the country value governance, one has to wonder what its priority will be in relation to other compelling, game-changing issues that are on the minds of health care executives and clinical leaders and that will surely occupy the board agenda.