Effective Board Meetings


As governance expert Jamie Orlikoff often says, “The single most precious commodity a board possesses is it’s time together.” This is because a board only exists, only has decision making authority, when it is officially meeting. Given the time limitation and busy schedules that so many have, it is crucial that hospital and system boards use their meeting time wisely and efficiently, which is done primarily via two key components: meeting logistics and effective communication during meetings.

An organization’s meetings often provide insight into its leadership style and internal culture. Well-prepared and well-run meetings are a sign that the organization knows where it is going and what must be done. A good meeting not only accomplishes the task at hand but also fosters healthy communication and greater commitment to decisions made. Characteristics of effective board meetings include:

  • Send out the agenda and background materials at least five to seven working days in advance. Traditionally, sending the agenda and materials two weeks in advance is a governance best practice.
  • Schedule only as much time as is needed.
  • Start on time.
  • Keep the mission top of mind, whether by including it on the agenda or having a patient/quality story included in the meetings.
  • Focus on the strategy, mission and vision, not day-to-day operations.
  • Deal with the most important items first to avoid decision fatigue.
  • Provide clear, concise reports and executive summaries and don’t repeat or recite reports in the board meeting. Make use of consent agendas.
  • Encourage participation but moving through the agenda in a timely manner.
  • Engage all board members for their questions, ideas, opinions and feedback.
  • Build consensus and unification behind decisions.
  • End on time.

The board chair ultimately presides over board meetings, however, every board member has a role in supporting the board chair to ensure these gatherings are efficient and effective. The two most important things trustees can do is arrive prepared and be engaged. It’s crucial for board members to do their homework by reviewing materials prior to the meeting and have questions ready and discussion items ready so that time is not wasted repeating information that has already been provided. Of course, there may be questions about materials in the board packet that warrants further exploration and discourse, but that should be identified in advance as you review information beforehand. Board members should be highly engaged throughout the meeting, actively listening, asking questions, hearing from their colleagues and/or hospital staff and respectfully voicing his or her own opinion on relevant matters.

Trustees not only have to work through critical operational issues but also strategy, business philosophies and, at times, hot button issues that arise in health care. Studies show businesses experience increased financial and strategic success when boards are diverse in their perspectives and backgrounds. This diversity can lead to disagreements and debates, which is perfectly healthy if handled accordingly. Constructive conflict can be an asset as long as it is approached in good faith and collaboratively. All board members should be given an opportunity to speak their mind or asks hard questions, but trustees need to do so in a highly professional manner.

When debating or discussing important issues at board meetings, trustees should:

  • Trust other board members.
  • Argue meaningfully.
  • Think about their community/patients first.
  • Work to advance the mission of the organization.
  • Keep the main thing, the main thing.
  • Be a hospital advocate.
  • Have an open mind, you may think you have your decision made but be open and willing to hear what others have to say.
  • Use data, when available. This is especially helpful if emotions are increasing when discussing controversial issues.
  • Be respectful in all discussions.

Conversely, board member should not:

  • Keep doubts or hesitancies to themselves.
  • Accept complacency.
  • Make their mind up before they have the facts.
  • Nitpick board work.
  • Promote special interests.
  • Sacrifice the greater good for an easy answer.
  • Continually to try revisit decisions that have already been made.
  • Check-out or not listen to and following along during discussions.

So how do you know if your board meetings are effective? There are a few different ways to approach this. The hospital administration may have an electronic survey ready to go and send to the board after the board meeting. Hospitals can also utilize written surveys can be made available at the end of a board meeting in order for an easier and faster response – this is typically conducted while everyone is in the room. Finally, make meeting evaluations part of the annual board assessment.

And there are a few key things to highlight when conducting this type of survey:

  • It should occur immediately after/at the end of each board meeting to help ensure you get a response and when feelings and ideas are fresh on peoples’ minds.
  • Keep it short and sweet as not to fatigue the respondents (especially if your board has monthly meetings). Limit the survey to roughly 3-5 questions – it should only take about five minutes to complete. It can be helpful to have an open-ended question that allows for additional feedback that you may not receive in the questions that were included.
  • If board meetings were identified as an area of improvement from the annual board self-assessment, then questions from the smaller board meeting survey should align with those.

Keep in mind, every board meeting is an opportunity to build greater board cohesion and commitment, and not just deal with isolated issues. The hospital leadership and board chair play a significant role in the topics discussed and the manner in which the board meeting is run but it is up to the entire board to be good citizens of the board through their preparation, contributions and engagement.