Public Health and Hospitals: Lessons Learned From Partnerships in a Changing Health Care Environment.

Recent changes in policymaking, such as the passage of the Patient Protection and Affordable Care Act, have ushered in a new era in community health partnerships. To investigate characteristics of effective collaboration between hospitals, their parent systems, and the public health community, with the support of major hospital, medical, and public health associations, we compiled a list of 157 successful partnerships. This set was subsequently narrowed to 12 successful and diverse partnerships. After conducting site visits in each of the partnerships' communities and interviews with key partnership participants, we extracted lessons about their success. The lessons we have learned from our investigation have the potential to assist others as they develop partnerships.

Better Community Health.

Hospitals need to find and work with multiple partners to improve community health. Here's the case for doing so.

Partners for public health.

Hospitals and public health departments share the same goals.

Board oversight of community benefit: an ethical imperative.

Board oversight of community benefit responsibility in tax-exempt organizations in the nonprofit health care sector is attracting considerable attention. Scrutiny by the IRS and other official bodies has led to stricter measures of compliance with the community benefit standard. But stricter compliance does not sufficiently engage the underlying ethical imperative for boards to provide effective oversight--an imperative that recent research suggests has not been sufficiently honored. This analysis considers why there is a distinctively ethical imperative for board oversight, the organizational nature of the imperative involved, and practical ways to fulfill its obligations. We adopt an organizational ethics paradigm to illuminate the constituent components of the ethical imperative and to clarify emerging benchmarks as flexible guidelines. As these emerging benchmarks enhance board oversight of community benefit they also can shed light on what it means to be a virtuous organization.

The right stuff.

The interviews with board members at 10 high-performing community health systems revealed many other factors that, in the opinions of some, have contributed to their system's strong operating performance; for example, prudent investments in facilities and services, new technology and strategic mistakes by competitors. On the whole, however, the trustees perceived the six factors outlined above as being most influential in their organizations' successful performance in recent years. The table on Page 21 provides a summary of the trustees' views. Numerous factors contribute in varying degrees to organizational performance. Board leaders and CEOs should assess their organization and, as objectively as possible, identify those which are truly pivotal in determining its operating performance. Allocating proper attention and resources to them and monitoring the results on an on-going basis are among the main responsibilities of governing boards in today's challenging health care environment.

Governance education for nurses: Preparing nurses for the future.

The complexities of today's health care environment require organizational governing boards to have deeper understanding of health needs, influences, and outcomes with diverse board leadership. Nurses understand the complexities and demands of health care, but few nurses are engaged on boards of directors and many nurses feel unprepared for the governance leadership role. The nurse of the future requires governance knowledge and competencies to influence organizational policies that will improve health care outcomes and advance health promotion. Governance education is a necessary component of preparing the nurse of the future to influence health care transformation. Until nurses can confidently embrace governance leadership as a part of their professional identity, convincing and expecting non-nurse board leaders to appoint nurses to boards will continue to be a challenge. This paper describes a strategy for incorporating governance competencies into nursing curricula across all education levels by leveraging the American Hospital Association Governance Core Competencies (2009) and the Massachusetts Nurse of the Future Core Competencies©-RN (Massachusetts Department of Higher Education Nursing Initiative, 2016).

What's your board's culture?

You have a board culture whether you know it or not. Every board creates a governance culture--a pattern of beliefs, traditions and practices-that prevails at meetings. Some work well; others get in the way.

Size, composition, and culture of high-performing hospital boards.

At the national, state, and community levels of American society, there is a growing cry for more accountability and better performance by the governing boards of business firms, institutions of higher learning, and health care organizations. A recently completed study has examined selected aspects of governance in a set of high-performing nonprofit hospitals versus hospitals that are similar in several respects but whose performance is midrange. This article discusses the findings with respect to the boards' size, composition, and culture.

The Wellmark and University of Iowa partnership: an innovative model for collaboration between Blue Cross-Blue Shield plans and colleges.

Wellmark Blue Cross-Blue Shield and the University of Iowa College of Public Health share a strong commitment to improving the health of communities they serve in Iowa and South Dakota. Beginning in 2002, these organizations forged an innovative partnership through which they annually select several collaborative projects that are congruent with their respective missions and address clearly defined needs. The outcomes of their joint efforts toward the partnership's goals are formally assessed on an annual basis. This cooperative arrangement has proven to be workable and beneficial, and may have applications in other settings.

Characteristics of effective boards.

High-performing boards in all business sectors share many common traits: ongoing development; efficient, prioritized agendas; and solid structure and processes. Most important of all, however, is strong support from the top.

Employing the Precautionary Principle to Evaluate the Use of E-Cigarettes.

Electronic cigarettes (e-cigarettes) have emerged onto the public market as an alternative to tobacco cigarettes; however, science is inconclusive as e-cigarettes have not been thoroughly investigated, including their short- and long-term risks and benefits (1, 2). The question arises of whether e-cigarettes will become the future tobacco crisis. This paper connects the precautionary principle to the use of e-cigarettes in an effort to guide decision-makers in the prevention of adverse health outcomes and societal costs.

Transforming the accreditation of health care management education.

Recognizing the considerable changes occurring over recent years in health care, the Accrediting Commission on Education for Health Services Administration (ACEHSA) sought to remake itself to become a more vital participant in the field. This article reports the rationale, objectives, and process pursued by ACEHSA as it underwent this transformation and adopted a new name: Commission on Accreditation of Healthcare Management Education (CAHME). This paper features the planning document adopted to lead CAHME through the future. It also highlights actions taken to date and subsequent steps planned.

Governance practices and performance in US academic medical centers.

Recognition of the complex nature of modern health care delivery has led to interest in investigating the ways in which various factors, including governance structures and practices, influence health care quality. In this study, the chief executive officers (CEOs) of US academic medical centers were surveyed to elicit their perceptions of board structures, activities, and attitudes reflecting 6 widely identified governance best practices; the relationship between use of these practices and organizational performance, based on the University HealthSystem Consortium's Quality & Accountability rankings, was assessed. High-performing hospitals showed greater use of all 6 practices, but the strongest evidence supported a focus on board member education and development, the rigorous use of performance measures to guide quality improvement, and systematic board self-assessment processes. All hospitals, even those with the highest quality ratings, had major gaps in their use of best practices for CEO and board assessments. These findings can serve as the basis for developing sound board improvement plans.