Speaking Up: The Trustees Role in Advocacy


Some trustees will be more comfortable than others when it comes to being a health care/hospital advocate. In the current environment, rampant with misinformation, it is important to build relationships with community leaders in order for our organization to be a trusted source of information. Board members typically has strong ties to the local community making them a powerful resource.

The Special Attributes of Trustees

Trustees can be very effective in describing the hospital’s concerns. Few can better describe the plight of the underserved poor affected by inadequate payments, the need to maintain the solvency of the Medicare trust fund or the repercussions of shortages of nursing staff. As community leaders, trustees have a high degree of credibility, especially because hospital board members are typically not paid for their oversight of the hospital. The board must recognize and be committed to its responsibility to take an active role in building community support. Trustees should be knowledgeable about the hospital and aware of specific areas and issues which attract public attention. Additional characteristics that make trustee strong advocates may include the following:

  • Trustees’ spheres of influence often include friends, neighbors, business associates, civic leaders and politicians;
  • Trustees have a broad community perspective. They serve both as the community’s link to the hospital and as the hospital’s link to the community;
  • Many trustees and their families have lived in the same community for generations; and trustees, in their volunteer service to the hospital, have the ability to build and maintain trust.

Whether meeting with elected officials or community leaders, before any conversations take place the trustees and hospital should identify what their goals are in conducting this outreach and make sure there is a consistent, concise message being shared.

Opportunities for Advocacy with Elected Officials

The most important time to bold relationships with elected officials is in between legislative sessions. This is time that legislators are more frequently in their communities and are not dealing with the intense time commitment that comes with a legislative session. One of the most effective ways to build relationships outside of a legislative session is hosting a hospital tour for your elected official. This gives the official the opportunity to see firsthand what the hospital does and to interact with constituents. It also may provide an opportunity for publicity. Remember the purpose of the visit and be careful not to send mixed messages. For example, if the visit is intended to discuss the need for more Medicaid and trauma funding, don’t serve an elaborate lunch in a handsomely appointed dining room.

There are also opportunities during session for trustees to educate legislators on proposed legislation.
Prior to a bill being filed hospital administration and trustees, working with state and national hospital associations and legislative champions, can help craft beneficial legislation. Many bills are rewritten or amended during the committee process, and a significant percentage are permanently tabled or left pending. In coordination with the hospital CEO or government relations officer, board members may be asked to inform committee members about hospitals’ concerns, submit written comments or even present testimony.

All Politics is Local

It takes local support to get elected, and no one stays in office very long without remembering the constituents back home. Over the past two decades, the political environment has become more divisive. However, partisanship has little place in an industry devoted to saving lives. Officials should not be judged by their party affiliation but by their personal beliefs and actions to support their local constituents. Similarly, ideology should not overshadow medical knowledge and expertise, empirical data and medical ethics.

Meet the Needs of Public Officials

Public officials are complex, diverse individuals with a common need for accurate information, good advice and support. Politicians have many concerns, and each has differing priorities. Health care may be far down on their list unless trustees help make sure it is high on the lawmaker’s agenda. Board responsibilities include:

Coordination – Trustees should work with hospital administration. Hospitals are most effective when they speak with a single voice. State and national hospital associations coordinate advocacy initiatives among all hospitals, and becoming involved gives an individual hospital a more powerful, effective voice.

Information – Elected officials should be educated about the hospital and the issues that are important. Be truthful, accurate and rational. Today’s lawmakers want facts and figures. While it is important to demonstrate the impact of an issue on people, don’t become overly dramatic or present a strictly emotional argument. Most lawmakers want to see individuals taking personal responsibility for their health care, and to see a return-on investment of government dollars.

Contact – Stay in touch. Trustees should not call or write lawmakers only when unfavorable legislation is pending. Constituents should communicate their support for sound health policies as well. Relationships based on mutual respect should be built. As previously discussed, in Texas, the best opportunity to create connections with your elected officials is in between legislative sessions. The Texas Legislature meets biennially providing many great opportunities for hospital leaders to develop and maintain these relationships.

Support – Thank an official when he/she supports the hospital’s position. This lets the elected official know you are paying attention to how he/ she votes. If a legislator is supportive and helpful in Washington or in the statehouse, trustees should help make sure that person stays in office when the next election occurs.

Remember! It is important for the hospital and governing board to have a plan for who, when, where and how to involve trustees.
Advocating for your hospital or any specific health care issues should not be done in a vacuum and should be closely coordinated with the hospital CEO and/or governance relations team. This ensures accurate and consistent messaging and talking points.

Making the Connection

Politicians, like all people, respond to personal contact. Telephone calls, personal letters, emails help raise awareness but one-on-one visits make the biggest impact. The time and effort invested into creating a personal relationship with elected officials pays big dividends. Trustees should become constituents whose names and faces are known to their elected officials and, as appropriate, make a special effort to educate them about health care. They may be important allies in the future.

When conducting initial outreach legislators’ aides are a key to building these relationships. They are a valuable resource when it comes to tracking legislation, determining a legislator’s stand on particular issues and getting information about regulatory issues. Trustees should make it a point to get to know members of their legislators’ staffs in Austin and Washington, D.C., and at home in the district.

When meeting with staff or legislators keep in mind there is always too much going on. No one can keep up with every issue, every bill, every hearing. Consequently, expertise and input are critical to help legislators make the right decisions on health care issues. As a result of the volume of legislation, advocates cannot win on every issue, no matter how worthy the cause. Advocates should focus attention on what is most important for health care.

Elections are costly and often lawmakers at the state and national level constantly are thinking about the next election. With the escalating costs of campaigns, politicians raise money every chance they get. Making financial contributions to a candidate is part of the relationship-building process. Working with your state or national hospital association, you can multiply the effect of your donation.

Permissible Political Activities

Some general political activities have been deemed permissible through prior IRS rulings but they are very limited and heavily scrutinized. For example, nonprofit entities may encourage voter registration and get-out-the-vote efforts. Other activities – such as candidate education programs, candidate forums and hosting candidates to speak at events – have been allowed as long as the nonprofit entity treated all candidates the same. Nonprofit hospitals should secure the advice of their legal counsel before engaging in these types of activities.

In general, public entities – like hospital districts – may not spend tax dollars to influence legislation, nor may they contribute to political campaigns. However, public entities can engage in educational activities, and they may participate in permissible political activities, such as voter registration and get-out-the-vote efforts. Public hospitals should secure the advice of their legal counsel before engaging in these types of activities.

Getting Started

Speaking with elected officials and community leaders can see very intimidating at times but keep in mind, as hospital leaders you are the expert. If you are meeting these leaders as a representative of the hospital, be sure at some point you connect the official or community leader with the CEO of the hospital or system who is another valuable subject matter expert that they can rely on as a trusted source of information. And advocacy takes practice; some people are naturally gifted public speakers while others may be a little more hesitant but the more you have these conversations, the easier they become.

Trustees are uniquely positioned as hospital leaders and community stewards making them credible sources for elected officials and other community leaders and regulators. In coordination with the hospital CEO and government relations staff, trustees could have a pivotal role in advocating for their hospital and/or significant health care issues. Take time to find out who represents you and who has oversight of your organization and make a plan with the hospital leadership on the best way to ensure elected and regulatory leaders are aware and informed about important health care issues.