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This publication discusses observations and trends about system development and identifies models of governance that are emerging as new organizations form and determine what it really means to become a system. It also reviews issues and obstacles that can arise as models of governance change and suggests steps boards can take to address them on the path toward more effective system governance.

Incentive compensation plans are intended to focus executives’ attention on their organizations’ most vital priorities and initiatives. As health care organizations revise their business strategies to address the ongoing transformation of care delivery and payment, health care boards also need to reassess the structure and measures of performance in their executive incentive compensation plans.

Serving on the boards of a hospital system and its health plan offers a unique governance perspective. My journey as a student of governance began 10 years ago when I attended a course on board best practices. As president of the Health Plan Alliance in Irving, Texas, I thought this would be a good way to enhance my communication with my own board, which is made up of C-level health plan executives.

Great health care boards primarily focus on enabling their organizations to create innovative solutions that address community needs for improved health and well-being. They also address regulatory, competitive, resource and other challenges that sometimes may seem daunting, but these do not divert them from their primary purpose.

Executives, trustees and physicians should be the leading advocates of philanthropy.

The emerging health care environment has changed the game for health care organizations and for physician leadership. The turbulence of that environment is going to require what could be called “agile organizations” adept at matching leadership and decision-making styles and setting and executing strategies appropriate to the nature and depth of environmental change.

The traditional acute-care hospital is becoming just one of the entities within a larger system that probably includes primary and specialty care clinics, ambulatory care sites, behavioral health care and post-acute care. In addition, the systems may be employing physicians, developing robust philanthropic organizations, developing entrepreneurial businesses, conducting research and offering medical education.

The complexity around physician compensation demands defined, layered board oversight.

The U.S. health care system is quickly moving toward a care delivery model that encompasses entire populations, not just the patients who present themselves for care. This is because many at-risk individuals in the community seldom, if ever, seek treatment or health screenings—and they have a disproportionate impact on total health care spending.

Much has been written about the resources that hospitals should provide their board members to develop their governance expertise. Generally, a good orientation to the board’s work, educational sessions at board meetings, an annual retreat, periodic attendance at outside educational programs and frequent performance evaluation are some of the basics for any board.

Imagine a health care consumer who dictates his or her own health goals, tracks progress with a wearable medical device or two and who consults provider and social media contacts for advice about interventions, side effects and choices affecting his or her health that could be rewarded financially via insurance policy incentives.

When someone walks into your hospital, his first impression is created by the physical architecture. But his lasting impression — and what he is most likely to talk about when he returns home — will be determined by what we call the “invisible architecture” of core values, organizational culture and behavioral expectations.

Recruiting board members is a challenge for every hospital and health system, but the task is particularly difficult in small communities. At Benefits Health System, Great Falls, Mont., our pool of candidates is largely limited to the city’s 60,000 residents, despite the fact that we are the tertiary referral center for a population of 250,000 across nearly 40,000 square miles of rural Montana.

For boards to participate in shaping their new organization, they must be currently performing at an extremely high level. The following is a list of four practices that hospital and health system boards must be engaged in today, in order to be successful in the future.

This Mind Map, developed in association with innovation partner HDR, depicts a variety of business objectives in healthcare today that are top of mind for healthcare strategists.

Succeeding in the care coordination environment means leaving behind the hospital business model.

A successful governance education process requires commitment, collaboration and consensus. Below is an outline of how a board of trustees may design a process that will ensure optimum development of leadership knowledge and effectiveness...

This 2014 National Health Care Governance Survey includes many questions from previous surveys that allow insightful comparisons of governance evolution over time. It also probes new areas to enable a better understanding about how hospital and health system boards are preparing for and responding to the transforming health care environment.

Information technology can be the catalyst in transforming the health care delivery system.