Healthcare Executive - November/December 2013 - 66

Governance Insights

Common Sense,
Fortitude and Discipline
Keys to creating a collaborative CEO-board
relationship.

When the relationship between a
CEO and board is dysfunctional,
everyone pays the price, including
patients. When it’s optimal,
patients, employees, physicians and
the community all benefit.
Clearly it is incumbent on the
board and CEO to take the lead in
establishing a sound partnership.
Unfortunately, we continue to witness headline-grabbing examples of
breakdowns in CEO-board leadership, too many of which are a result
of an ineffective working relationship. Consider a case such as the
board of a medical center that
received a whistle-blower letter,
alleging misconduct on the part of
the CEO. The allegations concerned his relationship with an
employee and asserted both professional and personal misconduct.
State authorities investigated but
said nothing illegal transpired. The
board, however, should be embarrassed because it was aware of the
situation and failed to take action.
Most CEO-board relationship
breakdowns are less sensational but
can also be costly to the organization. For example, a board might
not fully understand the intricacies
of establishing an accountable care
organization but decide to start one

Healthcare Executive
nOv/DEC 2013

anyway. Or a CEO might not fully
inform the board about the inadequacy of the legacy IT system and
its inability to meet the organization’s future needs.
Two questions follow: how does this
happen, and what is the prescription
for improvement?
How Does This Happen?
The simple answer to this question is
related to culture. Leadership relationship development, which is
largely qualitative in nature (not
something that can be easily scored),
is too often a low priority for many
busy healthcare leaders. Patrick
Lencioni, author of The Advantage:
Why Organizational Health Trumps
Everything Else in Business, says in his
book that we have to overcome three
biases that inhibit our ability to
address qualitative issues. They
include the following:
• Sophistication bias, which
“doesn’t require great intelligence
or sophistication, just uncommon levels of discipline, courage,
persistence and common sense”
• Adrenaline bias, i.e., “you have
to slow down in order to go fast”
• Quantification bias, which
indicates that “the benefits [of
the qualitative activity] … as

powerful as they are, are difficult to accurately quantify”
CEOs and boards are legitimately
pressed for time as never before. If
their adrenaline isn’t pumping,
there may be other problems the
organization is facing such as obsolescence or bankruptcy. And quantification does matter—certainly
when evaluating quality outcomes
and accepting financial risk for
acute care performance and population health management.
What Is the Prescription
for Improvement?
The answer to this question can be
vastly complicated, but it can also,
at least to get started, be elegantly
simple. Most board members are
natural leaders and highly successful in their day jobs. Many want to
know, as nonclinicians, how they
can be more effective board members and, in some cases, if they even
belong on the board. An appropriate response from the CEO is:
“This board needs people like you;
healthcare needs people like you.
We need you to bring the same
intuitive skills that made you successful in the business world and
apply them here. In other words,
listen hard, challenge us and hold
us accountable.”

Healthcare Executive - November/December 2013

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