The Importance of Clearly Defined Roles
The highest-performing healthcare organizations recognize the importance of maintaining a clear distinction between the responsibilities of governance and management, particularly those of the governing board and executive leadership. While several members of executive leadership teams may work closely with the board, either through reporting or as subject matter experts, it is important to remember the sole employee of the board is the CEO. Both the board and management must understand their respective roles and responsibilities, as finding the right balance is essential to the success of the organization.
When a board loses sight of its overarching responsibilities and becomes too involved in the day-to-day operations of the organization, it risks diverting valuable time and attention away from its primary objectives- upholding the hospital’s mission and fulfilling its governance and oversight responsibilities.
Maintaining the Boundaries between Governance and Management
There are several ways governing boards and executive leadership can foster a strong and boundary-conscious relationship that supports the hospital’s success.
- Knowledge of Duties and Education – Board members and management must understand their exact responsibilities and expectations. They must be educated on the scope and limitations of their roles, recognizing when to exercise their authority and when to defer to the responsibilities of the other. Clear roles and responsibilities should be provided during board orientation.
- Respect and Trust – The governing board should trust management to carry out operational responsibilities within the boundaries of the board’s established expectations. Likewise, management should trust the governing board will guide them in their mission without overstepping.
- Communication – Regular and transparent communication among the governing board, board chair and CEO helps cultivate a healthy working relationship.
- Annual board self-assessments and a formal CEO evaluation process – This allows both the board and CEO to self-reflect on performance and how each can be supported by the other.
Governance and Management: A Practical Guide
| Shared Area | Governance Provides direction and oversight | Management Executes strategy and manages day-to-day operations |
| Mission, Vision, and Values | Establishes and safeguards the mission, vision and values. | Integrates the mission, vision, and values into daily operations. |
| Strategic planning | Approves strategic direction and organizational priorities. | Recommends and executes the strategic plan. |
| Budget and finance | Approves budget and oversees financial performance. | Prepares budget and provides regular performance reporting. Deploys resources (budget, staff, etc.) appropriately to achieve goals. |
| Quality and patient safety | Establishes and approves governing policies. | Drafts, recommends and implements policies. |
| Policy | Selects, evaluates and supports the CEO. | Recommends and executes talent strategy and builds the leadership team. |
| Medical staff | Monitors organizational quality, safety and performance. | Ensures effectiveness of quality and safety initiatives. |
| Risk and compliance | Oversees organizational risk and regulatory compliance. | Policy implementation and risk management. |
Note: Specific responsibilities may vary depending on organizational structure, governing documents and applicable regulations.