Engaging Governance in Workforce Strategy and Performance.

This column is a call to action for health care leaders to ensure that their governing boards make workforce an important part of their governance responsibility and oversight. Health care leaders need to take an active role in educating their governing board, identifying and monitoring appropriate workforce metrics, and engaging the board in developing and implementing a workforce plan. Workforce development is an important leadership competency and essential to today's health care organizations success.

Analysis of Race and Ethnicity Among United States Medical Board Leadership.

Background: The inequitable representation of women and members of racial and ethnic minority groups in leadership positions within academic medicine is an ongoing challenge with practical and realistic solutions. The purpose of this study was to assess the race and ethnicity of individuals in leadership positions among the 24 Member Boards of Directors (Boards) of the American Board of Medical Specialties (ABMS). Methods: We performed a cross-sectional analysis of the race and ethnicity patterns for individuals holding leadership positions among the 24 Boards of the ABMS as of March 1, 2022. Two independent coders with 100% concordance recorded race and ethnicity using online biographies and photographs. Percentages were compared to the Association of American Medical Colleges (AAMC) 2018 data reports. Results: Among 449 director positions, 415 (92.4%) were physicians. Within the physician subset, 12.3% (51/415) Asian, 8.2% (34/415) Black, and 3.4% (14/415) Hispanic individuals were identified. Women who are members of racial and ethnic minority groups have less representation than men of the same race. Of 24 Boards, 37.5% (9/24) had no Asian women, 50.0% (12/24) had no Black women, and 75.0% (18/24) had no Hispanic women. White physicians were overrepresented on 14 of 21 (66.7%) Boards compared to the proportion of active White physicians or White individuals in the United States general population. Conclusion: Disparities exist for members of racial and ethnic minority groups, particularly women from these groups. As a leader in academic medicine, the ABMS should ensure its Boards are diverse with respect to gender, race, and ethnicity. Diverse groups often contribute unique insights that support medical education, advance science, and improve clinical care.

Stock price crash risk and military connected board: Evidence from Thailand.

Based on the agency and stakeholder theories, effective boards, acting as an internal governance mechanism, reduce agency costs. This paper asks whether military connected boards represent a good governance tool by exploring how military connected boards affect stock price crash risk. Using instrumental variable analysis, we document that firms with military connected boards have lower risk of stock price crashes. Our findings are unlikely to have endogeneity concerns and shed light on the role of military connected boards as an effective internal governance tool. Consistent with the conservatism hypothesis and stakeholder theory, by being transparent about firm-specific bad news, military connected boards could effectively monitor managers to ensure they act on all stakeholders' interests.

Aligning Healthcare's Mission With Corporate Social Responsibility Action.

Amid many challenges, health systems and hospitals are striving to improve the health of their communities with varying degrees of commitment. While many have recognized the importance of the social determinants of health, most have not responded aggressively to the global climate crisis that is sickening and killing millions of people worldwide-and getting worse. As the largest healthcare provider in New York, Northwell Health is committed to keeping our communities well in the most socially responsible way. That means engaging with partners to enhance well-being, expand access to equitable care, and take environmental responsibility. Healthcare organizations have a special obligation to broaden their efforts to prevent further damage to the planet and limit the human toll of that damage. For this to happen, their governing boards must support tangible environmental, social, and governance (ESG) strategies and put in place the administrative structures for their C-suites that are necessary to ensure compliance. At Northwell Health, governance is the engine that drives accountability for ESG.

ESG Expands the View of Corporate Stewardship in Healthcare.

At Advocate Aurora Health, the board of directors established parameters for effectively executing the governance (G) function related to ESG activities while adopting a comprehensive approach to ESG that includes the corporate commitment to health equity. Establishing a board diversity, equity, and inclusion (DEI) committee with external experts served to integrate these efforts with the ESG strategy. This approach will continue to guide the board of directors of Advocate Health, formed in December 2022, by the combination of Advocate Aurora Health and Atrium Health. Our experience has demonstrated that empowering individual board committee members of not-for-profit healthcare organizations to embrace their unique responsibility for driving ESG requires collective efforts in the boardroom as well as a commitment to board refreshment and diversity.

A Seat at the Table: An Examination of Hospital Governing Board Diversity, 2011-2021.

GOAL: Board diversity is increasingly important for hospitals and healthcare systems, with national attention focused on eliminating health disparities and improving health equity. Yet, it remains a challenge despite concerted efforts by leading professional associations (e.g., American College of Healthcare Executives) to galvanize their constituents around the importance of the issue. METHODS: This study used survey data from The Governance Institute to explore the ethnoracial and gender diversity of hospital boards spanning 2011 through 2021. PRINCIPAL FINDINGS: The results showed modest gains in the mean number of female board members, although a small proportion of hospital boards still have no female representation. There was little change in the number of boards with ethnic minority representation until an uptick in 2021, likely in direct response to high-profile racial incidents and protests. PRACTICAL APPLICATIONS: Intentional and sustained efforts are necessary to increase diversity and create a culture of inclusion that fosters meaningful engagement of diverse board members.

The representation of women on Australian clinical practice guideline panels, 2010-2020.

OBJECTIVES: To assess the composition by gender of Australian clinical practice guideline development panels; to explore guideline development-related factors that influence the composition of panels. DESIGN, SETTING, PARTICIPANTS: Survey of clinical guidelines published in Australia during 2010-2020 that observed the 2016 NHMRC Standards for Guidelines, identified (June 2021) in the NHMRC Clinical Practice Guideline Portal or by searching the Guideline International Network guidelines library, the Trip medical database, and PubMed. The gender of contributors to guideline development was inferred from gendered titles (guideline documents) or pronouns (online biographies). MAIN OUTCOME MEASURES: The overall proportion of guideline panel members - the guideline contributors who formally considered evidence and formulated recommendations (ie, guideline panel chairs and members) - who were women. RESULTS: Of 406 eligible guidelines, 335 listed the names of people who contributed to their development (82%). Of 7472 named contributors (including 511 guideline panel chairs [6.8%] and 5039 guideline panel members [67.4%]), 3514 were men (47.0%), 3345 were women (44.8%), and gender could not be determined for 612 (8.2%). A total of 215 guideline panel chairs were women (42.1%), 280 were men (54.8%); 2566 guideline panel members were men (50.9%), 2071 were women (41.1%). The proportion of female guideline panel members was smaller than 40% for 179 guidelines (53%) and larger than 60% for 71 guidelines (21%). The median guideline proportion of female panel members was smaller than 50% for all but two years (2017, 2018). CONCLUSIONS: The representation of women in health leadership roles in Australia does not reflect their level of participation in the health care workforce. In particular, clinical guideline development bodies should develop transparent policies for increasing the participation of women in guideline development panels.

Perceived performance of health facility governing committees in overseeing healthcare services delivery in primary health care facilities in Tanzania.

Health Facility Governing Committees (HFGCs) play a vital role in overseeing health services delivery in the primary health care system. However, despite their existence in Tanzania hiccups remain reported on the quality of health services delivered in primary health care facilities. The latter poses a question on the performance of HFGCs in overseeing the services delivery at the primary health facilities. This study sought to assess the perceived performance of the HFGCs and the associated factors in overseeing the healthcare services delivery at the primary health facilities in Tanzania. A cross-sectional study was conducted in five regions of Tanzania: Mwanza, Dar Es Salaam, Kilimanjaro, Pwani, and Arusha. A self-administered questionnaire containing structured questions was used to gather information from randomly selected 574 HFGC members. Data were analyzed descriptively and the binary logistic regression model was used to determine factors associated with the perceived performance. Half (50.52%) of the HFGCs members perceived themselves to have good performance. Furthermore, only 51.05% of all the participants had received any form of health management and governance training whereby about two-thirds had received training for only 1 day. The main factors associated with the perceived low performance of the HFGCs members were age, level of education and duration served in the HFGC. A low level of education was associated with the poor perceived performance of the HFGC (AOR 0.36 [CI: 0.23-0.55]). Similarly with increasing age, the odds of good-perceived performance lowered (AOR 0.26 [CI: 0.13, 0.55]). Serving as a HFGC member for less than 1 year was associated with poor perceived performance (AOR 0.40 [CI: 0.17, 0.95]). From these findings, it is recommended that the criteria for recruitment of HFGC members should be revisited. Furthermore, a qualitative study to explore contextual factors influencing the perforce of HFGCs is recommended.

Representation: raising awareness of opportunities and skill development with undergraduate dental students.

Representatives for dentists are required for many governing committees, local and national, that contribute to many aspects of the profession related to politics, the workplace, education, or community-building. Developing skills as a representative can begin as an undergraduate in student representation systems as part of UK university governance structures. At one UK dental institution, there was a plan to explore the learning and skill development of current student representatives, review the training, identify any areas where there were gaps or where they should be strengthened, and consider whether a new training programme could be developed. Training gaps in the representation process and preference for peer mentoring in training were identified as students acknowledged learning 'on the job' through observation of experienced peers. Current representation training also fell short of highlighting the relevance to their future dental profession. Staff and students co-designed a bespoke programme of training to help students develop their representation skills, as well as align them to the development of professional skills which were determined to be relevant for their future dental career.

Board dynamics and relational tensions in the English NHS foundation trusts.

PURPOSE: This study explores interactional dynamics and relational tensions within English NHS Foundation Trust board meetings that are influenced by governance structure and the board composition. DESIGN/METHODOLOGY/APPROACH: This paper draws upon an ethnonarrative approach to enable the understanding of the nuances of boardroom interactions. Data was collected through participant observation of board of directors' and board of governors' meetings and narrative interviews from directors and governors of two NHS Foundation Trusts. Data was analyzed through thematic narrative analysis to enable the identification and understanding of the patterns and the hidden tensions in boards. FINDINGS: Findings reveal that board interactions are influenced strongly by the nexus of structural, contextual and human elements of governance. Three main findings are highlighted: a lack of clarity of the governors' and chairpersons' roles which create ambiguities within board processes; the large size of the board of governors disrupts meaningful discussions in board meetings; the unacceptability and avoidance of governors' accountability by the directors creates a struggle for supremacy and legitimacy in boards. RESEARCH LIMITATIONS/IMPLICATIONS: Future research can explore both the positive and negative outcomes of board behaviors, which are influenced by the perceived built-in tensions in governance structures. In addition, access to other spaces of governance, such as, subcommittee meetings and private board meetings can further enrich our understanding of board dynamics. ORIGINALITY/VALUE: This study attempts to uncover the neglected modes of interactions within boards through a combination of two disparate perspectives: board structures/composition and interactions through an ethnonarrative approach.

Measuring Board Impact on Hospital Finance and Quality.

Boards are a powerful resource in overseeing our health system. This resource is limited in the amount of available time; therefore, boards should be as productive as possible. Boards should focus their energy on tangible, measurable results. Using natural language processing tools and quantitative outcome measures allows us to measure the impact of board focus. This analysis finds no significant relationship between a higher focus on finance or quality as measured by the board minutes and organizational performance in finance or quality. Boards focus much more on finance than quality or any other focus area with no substantive difference in outcomes. The study indicates that, at least in Ontario, boards may need to revise their approach and allocation of time to these topics.