Leadership Toolkit for Redefining the H: Engaging Trustees and Communities 2014 AHA Committee on Research 2014 Committee on Performance Improvement January 2015 1

Engaging Trustees and Communities The 2104 Committee on Research and the 2014 Committee on Performance Improvement embarked on an effort to better understand where hospitals, trustees and communities are in their journeys of transformation. The committees spent the past year looking into: Trustee engagement — how it relates to redefining the “H” Community engagement — how hospitals can engage with community stakeholders to have conversations about the changing health care landscape This report includes community engagement and governance strategies for hospital leaders. 2

Redefining the “H” The AHA believes that changes in the health care field as significant as those likely to occur in the coming decade need to be planned for, not only within the hospital, but also with strong input and engagement from trustees and the community. 3

The Triple Aim As hospitals work to redefine the “H” and achieve the Triple Aim on behalf of patients and communities, they must actively engage trustees and communities now in the changes that will inevitably come. 4

Engaging Communities As transformation evolves, hospital leaders and boards must lead the way in forging community collaborations that: Appropriately allocate resources and define a shared responsibility for improving community health Bring insight, perspective and support from the community into the hospital board room as leaders consider paths for transformation Enter into strategic partnerships for improving community health and health outcomes 5

Community Conversations Events With the goal of educating communities on transformation, the AHA CPI hosted six community events across the country, listening and learning from community partners and seeking to foster further collaboration and engagement. Colorado Louisiana Maryland Pennsylvania Texas Vermont 6

Common Themes Collaboration Is Key – No one hospital or health system has to be all things to all patients. Transformation Will Be Local – Policy changes are needed but change must start locally Care Might Look Different – As the health care system transforms, communities may see changes in the number of inpatient beds, where care is provided, and the type of services offered. 7

Challenges Identified Through Community Conversation Events Align Community Priorities and Funding Behavioral Health Services Are Inadequate Primary Care Physicians Are in Shortage Social Determinants of Health Must Be Considered Stakeholders Need the Ability to Better Share Information and Data Different Types of Providers Will Face Unique Challenges (rural, urban, etc.) 8

Recommendations While each community event had its own unique characteristics, the recommendations below were drawn collectively from all of the Community Conversations. Engage in Broad-Based Dialogue Policy Changes Must Support Collaboration Frequent and Ongoing Communication Is needed Use the Community Health Needs Assessment as a Tool A Holistic Approach to Health Care Is Needed 9

“How-to” Toolkit Included within the report is a complete “how-to” toolkit that can be used as a model for others looking to host a Community Conversation event. 10

“How-to” Toolkit The toolkit includes: Timeline Audience Invitation Logistics Pre-event Survey/Materials Agenda Moderator’s Guide National Perspective Slide Deck Breakout Group Questions Common Themes to Date After the Conversation 11

Trustee Engagement The process of redefining the “H” will require leaders to adopt new structures to effectively govern increasingly complex organizations. To strengthen the health care system, boards must understand community needs and health status as well as: Become knowledgeable of changing business models Be representative of the community and possess needed skills and competencies Willingly and regularly engage with community stakeholders Consider a local board structure when feasible Address several possible business models to achieve and sustain goals. 12

Defining the Role of the Board Hospitals must have a governance and management structure that facilitates organization wide vision, oversight and decision making. Board Type Key Roles and Responsibilities System/Professional Board Finance, strategic direction, rigorous oversight of performance and risk Clinical Enterprise Board Management of care, management of clinical risk Local/Community Board Understanding of community needs and perceptions; communicating to system board; being responsible for local quality, patient safety and physician credentialing 13

Four Bold Steps for Trustees Develop Trustees for the Future. Boards must select new members who posses the skills to govern effectively in the current and future health care environment, which can even include looking beyond the immediate community to identify an individual with specific expertise in transformative change. Ensure the Right Governance Dialogue. Ensuring continual governance dialogue that is future focused, visionary, adaptive and innovative is vital. Three governance models that trustees must balance are: Fiduciary Strategic Generative 14

Four Bold Steps for Trustees 3. Commit to Continuous Trustee Education and Knowledge Building. To be true knowledge leaders, trustees must prepare themselves by continuously improving their knowledge in order to deliver the penetrating, insightful leadership that their communities want and deserve. 4. Develop the Courage to Make Difficult Decisions. Developing a high-performance board culture that does not shy away from difficult conversations is imperative. To ensure that the right discussions take place, boards must: Ask the right questions Disagree agreeably Challenge the status quo Be willing to leave the comfort zone 15

Tools for Trustees Current High- Performance Governance Practices Competency-Based Board Composition Creating the Right Boardroom Conversations Seven Steps to Designing an Effective Governance Education Process The report includes several tools and resources specific to trustees that offer strategic guidance and overviews of the following topics: 16

Putting it All Together As this report emphasizes, the future of health care is changing rapidly but, at best, uncertain. However, by strengthening leadership and governance practices and engaging with diverse community partners, hospitals are, more likely to be successful in achieving better health and health outcomes at an affordable cost. 17

Issues to Consider in a Rapidly Changing Environment Managing variation in the pace of change Adapting to new payment and delivery system models with little experience and knowledge about intended and unintended consequences Confronting the challenge of disruptive innovators that offer convenience and reduced complexity for the consumer Managing new and sometimes difficult partnerships where cultures clash and missions do not align Ensuring sustainability in an evolving business model Assembling and developing the right talent in the hospital and in the community Ensuring diversity of age, gender, race and ethnicity that reflects the community, at all levels of the organization from the board to management to frontline staff Developing a deep understanding of the community’s level of health and wellness, their burden of disease and their needs to achieve the health status they deserve 18

Additional Resources 19 AHA Hospitals in Pursuit of Excellence All reports can be found at www.hret.org/guides-reports/index.shtml Hospital-based Strategies for Creating a Culture of Health (2014) Navigating the Gap Between Volume and Value (2014) Building a Leadership Team for the Health Care Organization of the Future (2014) The Second Curve of Population health (2014) Your Hospital’s Path to the Second Curve: Integration and Transformation (2014) The Role of Small and Rural Hospitals and Care Systems in Effective Population Health Partnerships (2013) Metrics for the Second Curve of Health Care (2013) Second Curve Road Map for Health Care (2013) Engaging Health Care Users: A Framework for Healthy Individuals and Communities (2013) AHA Center for Healthcare Governance All reports can be found at www.americangovernance.com  “Trustee Tools for Transformation: Board Readiness Self-Assessment” (2013) The Value of Governance (2013) “Advent of ‘Care Systems” Means Governance Must Also Transform.”  Bader, Barry S.  AHA’s Great Boards Newsletter Spring 2013 issue (www.greatboards.org) Making the Transition from Volume to Value, Numerof, Rita E.  (2013) Governance Practices in an Era of Health Care Transformation (2012) AHA Center for Healthcare Governance Blue Ribbon Panel on Trustee Core Competencies.  Competency-Based Governance: A Foundation for Board and Organizational Effectiveness (2009) AHA Center for Healthcare Governance Blue Ribbon Panel on Healthcare Governance.  Building an Exceptional Board: Effective Practices for Health Care Governance (2007) 19