Effective governance can be critical to a hospice’s performance and growth, and a number of providers have been working to optimize the engagement of their boards of directors or trustees.
To develop an engaged board that adds value to an organization, hospices are taking governance activity beyond the standard, periodic meetings and fundraising events. This has required increased communication and involvement in strategic planning.
“In a fully engaged board people are focused on a long-term vision for the impact the board and the organization can have in the community. It’s more forward facing than looking backwards,” Bill Musick, CEO of Integriti3D, told Hospice News. “A lot of board meetings are really focused on a retrospective look at financials, previous meeting minutes, and so on — and not so much on that vision for the future.”
California-based consulting firm Integriti3D in 2019 launched its Hospice Governance Academy, a program designed to help providers improve board operations.
This means taking governing body members out of the board room and into the community, according to Musick.
Board members can help a hospice build relationships and facilitate communication with potential collaborators, referral partners, and philanthropic donors, Musick said. During the early days of the pandemic, for example, hospice boards were able to assist their organizations with identifying personal protective equipment and other scarce resources.
As the impact of COVID began transforming the way hospices operate, at least in the near term, a few began taking a closer look their boards to ensure they were maximizing their value.
Among these were North Hawaii Hospice. Prior to 2020 much of their board’s work focused on fundraising and customery financial oversight. But as they retooled to communicate with members remotely, the organization began looking beyond those functions.
“The pandemic gave us an opportunity to do work at the governance level and to develop board members, so we really started taking a big hard look at the role of the board,” North Hawaii’s Executive Director Katherine Werner Brooks. “Now, after we’ve gone through the work that we’ve done, I would say that the board is more focused on the strategic direction of the organization as a whole.”
As part of this process, the hospice’s board performed a self-assessment in 2020 to identify areas in which they could enhance their efforts, according to North Hawaii’s board chair Susan Hunt. This led to the development of more in-depth, written policies and procedures for governance.
Hunt and other board members recognized a need to focus on issues like succession planning for both executives and the governing body. They also sought to establish more clearly defined responsibilities when it comes to financial management. This included advising on decisions related to the hospice’s endowment investment fund as well as development of new fundraising strategies when the pandemic temporarily shut down in-person events.
“There’s been some really interesting plans put into place with regards to how we changed our focus and kind of revamped the board through people that we’ve recruited who have more experience with governance and health care administration,” Hunt said. “But we also have to be very cognizant of the fact that one of our great successes was that we had people who really were connected to the community and were able to go out and make the ask. It’s very important for us to maintain that balance.”
Even with committed members with health care experience on the board, a certain amount of education is necessary to help governance understand the nuances of hospice care delivery, regulation, and reimbursement, according to Werner Brooks. To assist with these efforts, North Hawaii consulted with Musick and Integriti3D.
Board members needed to understand the details that could affect a provider’s financial health, including things like emerging payment models, the growth of palliative care services, and service intensity add-ons. This including knowledge of the “U-shaped” approach to reimbursement in which per diems are higher during the patient’s early days in hospice as well as in the final days of life, Werner Brooks told Hospice News.
Back on the U.S. mainland, New Jersey-based Samaritan Life Enhancing Care also began to re-examine the role of their board under the leadership of Phillip W. Heath, who has served as chair for the past four years. In October, Heath will step down from the board to become the organization’s CEO.
Among Heath’s priorities was establishing more open lines of communication among board members and with executive leadership in between their regular meetings. This included social events to build camaraderie and solidify the board as a team, though for a time most of those went virtual due to the pandemic.
“I made a point to meet with our board members one-on-one to ensure that they understood our strategic plan and the goals of the organization are, and to ask any questions,” Heath told Hospice News. “If there is any area that a board member is uncomfortable or unclear with, we will spend time educating them around around that.”
Heath also ensured that at the board’s meetings, he and the other officers didn’t necessarily do all the talking, encouraging a range of members to speak and present their perspectives on issues critical to the organization.
Another strategy was to make the board more public-facing, in attendance at Samaritan events and networking opportunities in the community.
“We let members know, you’re a vital part the board, and we make a personal effort to pick up the phone and say that this might be a great opportunity for you to engage in our community,” Heath said. “We need an engaged board in our community, engaging our volunteers, engaging our staff, making sure that we begin to expand our services and look to those areas where the most vulnerable people are.”