Agenda: Board Self Assesment

Questions and Answers About Board Self-Assessment

What is a Board of Trustees Self-Assessment?

A board of trustees’ self-assessment is an organized quantitative and qualitative evaluation of the board's satisfaction with all aspects of its performance in fulfilling its governance responsibilities. It combines ratings of various positive statements about the hospital's governance environment, processes, focus and performance with trustee recommendations for change to improve leadership performance. Done correctly and consistently, a board self-assessment process (a combination of the assessment and the action plans created from it) enables the board to identify critical "leadership gaps", and achieve and maintain the level of governing excellence required for success in today's challenging health care environment.

Why Should Boards Regularly Do a Self-Assessment?

Boards of trustees that are accredited by the Joint Commission are required to conduct an annual board self-assessment. Joint Commission Standard LD.4.5 requires hospital leadership to:

Set measurable objectives for improving hospital performance;
Gather information to assess their effectiveness in improving hospital performance;
Use pre-established, objective process criteria to assess their effectiveness in improving hospital performance;
Draw conclusions based on their findings and develop and implement improvement in their activities; and
Evaluate their performance to support sustained improvement.

In addition to the Joint Commission's accreditation requirements, board self-assessment is an ideal way to regularly engage the board in an anonymous and confidential evaluation of its overall leadership performance, while at the same time providing trustees with an opportunity to rate their personal performance as a vital contributing member of the board of trustees. An excellent board self-assessment process will achieve several key outcomes:

Define the most critical governance success factors;
Secure confidential, broad-based trustee input on the critical fundamentals of successful governing leadership;
Create an opportunity to address major issues and ideas in a non-threatening, collaborative manner;
Clearly demonstrate where the board is both in and out of alignment on leadership fundamentals and issues;
Objectively assess the degree of common trustee understanding, expectations and direction for the board;
Assess the deficiencies that may impact the board's ability to fulfill its fiduciary responsibilities;
Identify opportunities for meaningful leadership improvement; and
Help administration better understand and respond to the board's leadership education and development needs.

How should the assessment be used to improve governing performance?

Conducting the board self-assessment is only the first step in improving leadership performance. An excellent board self-assessment process does not simply measure trustee viewpoints about governing performance. To be successful it must be a catalyst to engage trustees in a wide-ranging discussion of assessment findings that highlight performance gaps and areas where trustees lack consensus. Finally, it must facilitate the development of a governance improvement action plan with responsibilities, time frames and projected outcomes.

How often should the assessment be done?

Ideally, the board should assess its performance annually. Many boards conduct their self-assessment as part of an annual board retreat, setting aside time to discuss the assessment results and explore ways to improve leadership performance. Some boards are able to successfully design and conduct a self-assessment, compile and analyze the results and facilitate the development of a board improve action plan using internal resources. Others rely on outside consultants who offer tested and proven tools and techniques for board self-assessment.

About The Presenter

Larry W. Walker
The Walker Company

Larry W. Walker is president of the Walker Company, a Lake Oswego, Ore.-based health care management consulting firm with expertise in board self-assessment, strategic planning, board and staff retreats and market research. Walker has conducted board self-assessments for hospitals and health systems of all sizes, and frequently presents self-assessment information to hospital trustee organizations, including Texas Healthcare Trustees.

A long-time trustee leader, Walker is a five-year member of the American Hospital Association’s Chairman’s Circle, which recognizes contributions to AHA’s political advocacy activities and served for six years as chairman of the board for 107-bed Mt. Hood Medical Center. Previously a trustee of Portland’s Legacy Health System and two of its predecessor organizations, Healthlink and Metropolitan Hospitals, Walker consults with health care organizations ranging from small and rural hospitals to metropolitan health care systems, physicians, community groups and hospital associations.

Walker serves as special consultant to the AHA, working primarily on market research, strategic planning and various projects for AHA senior management.

Quick Analysis of Your Self-Assessment Process

YES / NO:

Do you do a self-assessment annually?
Does your board understand the purpose and value of self-assessment?
Is your board uniformly committed to self-assessment?
Does your self-assessment allow trustees to freely express their ideas for needed change?
Does your self-assessment result in specific ideas for ways to improve governance processes, structure and outcomes?
Do you use the results of your self-assessment to create governance improvement action plans?

Ten-Step Plan for Conducting a Board Self-Assessment

Step 1: Determine the unique objectives and projected outcomes of your assessment;
Step 2: Design draft evaluation criteria and a measurement methodology (for example, 5 = very satisfied, 1 = very dissatisfied; 5 = strongly agree, 1 = strongly disagree; 5 = excellent, 1 =poor);
Step 3: Print a draft questionnaire and test the criteria and methodology for relevance and completeness in meeting your assessment needs;
Step 4: Distribute your self-assessment questionnaire to all trustees with a stamped, self-addressed envelope, ensuring both anonymity and confidentiality. Alternatively, you can develop a Web-based self assessment, which can be administered online;
Step 5: Compile the results and produce a report with graphs depicting the areas measured in priority order, from highest to lowest average score; include verbatim comments, and a brief analysis of key themes and findings;
Step 6: Hold a special board meeting or retreat to review the assessment results and discuss their implications on all aspects of board activities and performance;
Step 7: Appoint a committee or task force to develop specific recommendations for improvement, prioritize the most important areas of governance focus, and determine thee resources required for success;
Step 8: Implement the recommendations: Assign responsibilities and determine outcomes;
Step 9: Document and regularly report on the progress of the approved governance improvement initiatives; and
Step 10: Continually reassess board performance.

Analyzing the Results of Your Self-Assessment

There are a variety of ways to compile and analyze the results of your board self-assessment, from simply tallying responses by hand to using customized self-assessment software applications. One effective process includes the following steps:

Compile the results into a database that enables 1) the creation of graphs that show mean (average) scores, in order from highest to lowest, for statements about the board's governance performance in several broad dimensions of leadership, such as improving community health, CEO and medical staff relationships, financial stewardship, etc.; and 2) development of individual "distribution graphs" that depict the frequency of rating response for each individual assessment point. These distribution graphs show the degree of consensus amount trustees on individual performance points, and help to provide the detail behind the mean scores.
Analyze trustees' suggestions for ways to improve board performance. Trustees should have an opportunity to comments on the reasons for their ratings, and/or express their ideas and recommendations for needed governance change.
Compile an executive summary of key themes and findings, based on both quantitative and qualitative responses.
Produce a report containing graphs of all statements rated by the board, including all mean graphs and relevant distribution graphs where trustee consensus appears to be lacking. Also include a summary of potential actions to respond to trustees' ratings and suggestions for governance improvement.

Downloadable documents:

Sample rating criteria (pdf)
Sample Questionnaire Page from a Self-Assessment (pdf)
Sample self-assessment report (pdf)
Sample root cause analysis, with explanation (pdf)
Sample board action plan, with explanation (pdf)

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