What You Can Do to Improve Board Effectiveness

Depending on the size of your organization, the board of directors oversees the general success, or failure, of every person served and community impacted. However, the stereotypes of board effectiveness are lost amid the media. Television and movies show the board hidden behind the scenes, rarely peeking from behind the closed curtain. Yet, to be truly effective, board members must communicate with people throughout an organization and work together to promote positive outcomes.

If your organization struggles with board management or providing adequate, evidence-based services that are needed in your community, it may be time to re-evaluate your governance structure. In fact, depending on the type of services provided, your organization may be subject to criteria set forth to be a Certified Community Behavioral Health Clinic (CCBHC), including specifics for board actions. So, you need to know how today’s boards differ from those of the past and why communication and education are essential to board effectiveness and success.

The modern board of directors differs from past boards

Throughout history, being a member of the board of directors for a health and human services (HHS) organization meant attending quarterly meetings and casting votes. But, being a member of the board of directors (BOD) in modernity is more than just casting votes; it is about providing invaluable feedback and insight into what may and may not benefit the organization and communities served, explains The Joint Commission.

Traditional boards also have a striking difference in compensation for services rendered. Previous members may have received payment for their time, and some may have solely served on the governance structure in an organization. Modern board members often volunteer in this capacity, keeping governance separated from health care politics that cause unwarranted or blurring of an organization’s ability to provide superior service and care. Being a board member means caring enough about an organization to spend unpaid time working to improve it.

Executives have moved to instill the board as a key aspect of all organizational decisions and outcomes, holding those with authority responsible for results, or failures, seen among individuals served. The type of people appointed to modern boards has evolved from disjointed, disconnected executives to focus on people involved in direct care and senior leadership roles in an organization, blending decision-making and management with providing services.

Modern boards oversee quality and safety, not just finances and bylaws. In fact, the Joint Commission advises board meetings to include a safety and quality report before the end of each meeting. However, some may prefer to receive reports at the start of a meeting, giving participants an opportunity to voice concerns and opinions on ways to improve an organization’s safety and health standards.

So, what does it take for a modern board to manage these responsibilities and be effective?

What does a board need to be effective?

The effectiveness of the board of directors rests on a simple concept, engagement. However, board engagement can be further refined by ensuring every board convened uses the following factors in decision-making:

• Feedback concerning real-life experiences and pain points within an organization. This is about involving senior leadership and newcomers to an organization with the board. Unfortunately, the traditional stereotype of the board may make some people in leadership roles feel uncomfortable expressing case studies or unique views that contradict trends among board members. So, keeping the flow of information honest and ongoing is key to helping the board stay engaged.
• Representation of those served, including representation of different demographics and groups. As listed in the CCBHC criteria, reports the Substance Abuse and Mental Health Services Administration (SAMHSA), board members should reflect the populations served. This includes ensuring diversity among demographics that is proportionate with demographics served, which may include mental illnesses, sexual orientation, gender, ethnicity, age, and other groups.
• Real-world understanding of what the organization provides, including having received or been involved in providing services previously as well. In fact, 51 percent of members should be comprised of families or persons who have received services by an organization.  For example, members may have personal experience in caring for co-occurring disorders, substance abuse, or multi-cultural care or have received services themselves.
• The board must have the ability to self-evaluate board effectiveness. Since members of an organization’s governing body have the authority to dispel or embrace new policies, they need a means of evaluating their effectiveness. This may include using self-evaluation tools, such as the examples given by the Health Resources and Services Administration (HRSA).  Additional ways of managing the board’s effectiveness may include the use of metrics and data-based tools to gain insight into the governance structure’s activities.
• Continuous quality improvement plans to meet demand for services. Nothing in HHS providers stays the same unless proven by studies and evidence-based practices. Since the knowledge behind how to best govern a facility changes frequently and significantly, members should strive toward continuous quality improvement plans that adapt to meet increasing service demands. In addition, ongoing training encourages organizational growth and success.
• Approval from state oversight agencies. If a board is unable to meet CCBHC criteria, the organization must receive approval from the appropriate state oversight agency. For example, large scale organizations with boards comprised of state employees may apply for exception to certain criteria. However, the board must demonstrate a plan to ensure applicability, representation, and accountability to meet the needs of an organization’s persons served and receive feedback for such services. Should a state determine the board’s makeup or processes are ineffective for representation or governance under the criteria, new processes, and feedback models must be created and provided to the state.

Now what?

Help your organization’s board of directors meet applicable local, state, and federal requirements for governance, monitoring, and evaluation by providing the proper HHS training needed, ranging from learning from case studies to learning more about an organization’s services and state governance requirements. Boards going through organizational change or creation can lead by example when the proper tools and resources are presented clearly and concisely.

The role of the board is of utmost importance, and board members may take advantage of training programs. Ultimately, better, more cohesive training will prompt improvement in the effectiveness and communication of the board, giving your organization a better level of management and ability to provide for populations in need. In the interim, Part II of this series will explore how applying CCBHC criteria to boards can be effectively leveraged to enhance your organization’s governance.