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Governance and Organizational Structure
This area deals with the development and analysis of the organizational structure and with delineating responsibility, authority, and accountability at all levels of the organization. Functions include the development and implementation of policies and procedures for the governance process.
December 2008
Saturday December 13, 2008
Posted by: Keith McGuinness at 8:00PM EST on December 13, 2008
Given the requirement that the CEO follow the direction of the Board, it seems that boards should invest considerable time and effort to ensure that a prospective CEO's management philosophy is consistent with the Board's expectations. Are there specific techniques used to identify potential irreconcilable differences between a board and a CEO candidate?
Posted by: Victor Stiebel at 3:24PM EST on December 13, 2008
Never having sat on a board I was fascinated by the readings and how a board is supposed to function. I have been in involved in senior management in several hospitals and in two had direct access to the CEO. I have never seen a member of the board 'in the trenches'. I did meet a Chairman once while taking care of a family member in the ED. I understand that choosing paint colors (as the readings joked) are not the place of the board members. On the other hand, shouldn't the members of the board be somewhat familiar with the way a hospital works, the people in it, etc.?
Victor Stiebel
Friday December 12, 2008
Posted by: Elaine Charest at 9:23AM EST on December 12, 2008
In our reading Peter Bastone (Practical Governance p. 57) from Mission Hospital Regional Medical Center in CA developed a CEO advisory from area businesses. It sounds like the primary purpose was to get people involved / interestdin the hospital and identify potential board members. I work for a private fraternal hospital whose by-laws restrict board membership to members of the fraternity (although the CEO, COS, Dir. of Nursging and Dir of Rehab serve as non-voting members). This tends to be a very isolated group. I was thinking developing such an advisory group would be a great asset to our organization in order to be better involved and connected to the community. Do you think it would be beneficial? Who would you invite and why?
Tuesday December 9, 2008
Posted by: Saqib Dara at 4:44PM EST on December 9, 2008
The presentation and reading materials are excellent. What I did not get a good sense of though is, how the various top level actors interact in larger healthcare networks. For example, the Mayo Clinic has facilities in at least four states. Do the principles of governance need to be modified in such settings? Another example is the VA health system. Thanks, Saqib Dara. Sunday December 7, 2008
Posted by: Marion Scott at 10:21AM EST on December 7, 2008
Two questions, with the first about medical staff representation on the board. Do your organizations have physician board members appointed by medical staff? If so, what impact, if any, does this have on the dynamics of the board meeting, the effectiveness of the board function, and the decision-making process? The second question relates to board meeting schedules. The reading material suggests the board should not meet more than six times a year. Is this practical? It would seem in today's climate and especially for boards of large hospitals or systems that monthly meetings of the full board would be more effective.
Saturday December 6, 2008
Posted by: Kathy McClelland at 5:21PM EST on December 6, 2008
I'm curious as to how organizations balance community stature and expertise versus diversity especially with the age of board members. The youth in our community to a large extend are more in tune with the electronic age and implications of potential areas of strategic direction. Does anyone feel that they have achieved this balance and if so how was it accomplished and in your opinion has it been successful? What new areas have been explored that otherwise would not have? The same question can be posed regarding socioeconomic status versus representation of the majority of the community served. Has anyone attempted a balance in this area and if so what has been the outcome?
Wednesday December 3, 2008
Posted by: Linda Lawton at 4:28PM EST on December 3, 2008
In reading about Joint Ventures they frequently mention that they ususally last for a limited period. I am thinking about a couple joint ventures I am familiar with that have been in place for quite some time. Does this possibly just refer to the fact that JV contracts are initially put into place for a designated # of years?
Posted by: Linda Lawton at 4:17PM EST on December 3, 2008
In the readings there was a comment that in an effort to address generation gaps every agenda should provide time for the board members to share what is going on in their lives. Does anyone seriously have this as an agenda topic and spend this time?
Posted by: Dan Wood at 11:49AM EST on December 3, 2008
Is the basic idea behind Sarbanes-Oxley to prevent Enron like companies or is it just to hold companies more accountable for the external reports they file? Having the CEO and the CFO both sign off on the annual reports is a very good idea to hold those who run the company liable for the information they provide. However, does this prevent companies from filing misleading reports?
Tuesday December 2, 2008
Posted by: Joseph Savage at 9:49PM EST on December 2, 2008
Mr Tyler states that one of the functions of the CEO in regards to the board is to recruit future members. Given the function of the board is to hire or fire the CEO, this appears to me to set up a conflict of interest. It is unlikely that a person recruited to the board at the recommendation of the CEO is likely to turn around and recommend firing the CEO even if it is richly deserved. Likewise, a smart CEO could, by serial recruitment, turn the board into puppet oversight, which is great for the CEO, not so hot for the organization. Are my concerns purely theoretical, and not found in real life? If not, what restrains this from happening?
Posted by: Barry Goettsch at 9:38PM EST on December 2, 2008
Does a conflict of interest exists in the following scenario? You have a Board member that is also managing the retirement plan for the organization. While other elements of the benefits package are researched and put up for bid annually to ensure the organization is getting the best possible products (i.e. health plan) the retirement plan stays with this particular Board member when there are a number of other options available in the community.
Posted by: Ibukun Ogunbekun at 2:53PM EST on December 2, 2008
Are there significant differences in the composition of the BOD of for-profit hospitals that influence performance relative to non-profit hospitals? What major weaknesses are seen in the BOD in instances where hospitals have failed?
Posted by: Andrew Anderson at 10:22AM EST on December 2, 2008
In the discussion it talks about the fine line between keeping The Board of Governors/Trustees informed and “never surprised”; but, not involved or over informed in the direct operational oversight. Where do you find the balance, and what are some of the steps you can take as a CEO, when The Board has moved from a governing role to a managing role?Monday December 1, 2008
Posted by: Stephen Gabelich at 4:36PM EST on December 1, 2008
An action resulting in an intermediate sanction is paying revenue-based compensation. My Question: Is this restriction limited to trustees, directors and executive management? Is there any professional in a health system that can participate in revenue-based compensation; such as exec. foundation fund raiser or physician?
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