HAIPI - Healthcare & Academic Infrastructure Philanthropy & Investment Research Center of Excellence

HAIPI brings experience in philanthropy, online education, major donor development, capital markets, endowment and foundation management, infrastructure development, community hospital overall, hospital and academic infrastructure mergers and numerous other improvement across healthcare and academic organizations.

The Board’s Role in Quality Oversight In healthcare administration and hospital management, decisions can be life-altering and regulatory policies help shape care quality and delivery. Hospital Network board members and trustees play an important role in offering strategic counsel and oversight for hospitals and health systems. Delving into complex areas such as performance improvement, health care-associated infections and electronic health record management, board members need to make well-informed decisions and usually rely on the hospital executives to lead them in their decision making process. More than just approving budgets, hospital and health system board members establish the organization's goals, make strategic decisions and oversee performance, all while building relationships with key stakeholders. It's a delicate balance, requiring finesse and a deep understanding of the health care landscape. Most board members do not come equipped with the knowledge and the experience of managing and operating a healthcare facility and were not trained in the use of a stethoscope and do not have a medical or nursing degree. Only about 24% of surveyed board members have clinical backgrounds. Within the realm of health care governance, board members play a pivotal role in steering their hospitals and health systems toward a future marked by continuous quality and performance improvement. Quality initiatives need to be understood and championed. The community’s health needs, have to be explored and understood, and need to be strengthened. Hospital and health system boards need to be better positioned to address challenges and to embrace opportunities, ensuring every patient receives the highest standard of care while balancing the needs of the organization and of its staff. #hospitalmanagement

Nurses are missing from hospital boardrooms... Although nurses make up a significant proportion of the healthcare workforce, they are rarely represented on hospital boards. Now, some providers are pushing for more nurses to be included in boardrooms, arguing that they provide a crucial perspective on care quality and patient experience. Hospital and health system boards have largely been dominated by experts with backgrounds in banking, wealth management, and corporate investment rather than clinicians. In fact, a recent study found almost half of the board members of the 15 U.S. News & World Report top-ranked hospitals had finance backgrounds compared to less than 15% who had clinical experience. Among clinicians, nurses are even more underrepresented than physicians. Among the board members in the study, only 0.9% were nurses — even though nurses make up more than a third of all healthcare jobs. Similarly, the American Hospital Association found that only 5% of hospital and health system board members were nurses in 2022. According to experts, a lack of nurse representation in the boardroom may be due in part to biased selection processes, which often rely on referrals and lead to similar board compositions over time. "It is a function of the perceived hierarchy within medicine and also gender issues," said Stephen Shortell, a health policy and management professor emeritus at University of California, Berkeley. "The process for recruiting board members has historically relied on board members reaching out to their own networks, so it is self-perpetuating." According to Lori Boyd, an RN who has been on the board for Palo Pinto General Hospital for roughly a decade, boards without nurses are likely lacking a crucial perspective on care quality and the everyday patient experience. "We have an extremely deep understanding of what [board] decisions mean in terms of a positive or negative outcome for the patient," Boyd said. Amid rising labor costs and staffing constraints, there has been a greater push for boards to include nurses as members. Linda Aiken, a health policy professor at the University of Pennsylvania, noted that having more nurses on a board could increase nurse recruitment and retention. With nurses' input on the board, hospitals could also improve their bottom lines by improving discharge planning to reduce readmissions, Aiken said. Research has shown that there is a direct link between sufficient representation on a hospital board and workplace morale. In a study published in Nursing Outlook, Aiken and her colleagues found that over 70% of hospital bedside care nurses did not believe the top management would resolve problems identified in patient care. "That is a glaring chasm that explains why nurses have no loyalty to their employers," Aiken said. "There is a reluctance to see nurses as a resource, not just a cost."

At least 41 health systems announced changes to leadership ranks and administration teams in 2023. The changes come as hospitals continue to grapple with industry challenges, leading some organizations to cut jobs and implement other operational or C-suite adjustments. #hospitalnetworks #hospitalmanagement https://lnkd.in/en-3nw6X

Tackling workforce challenges for hospital networks The fact that shortages of technicians are the top workforce concern this year — narrowly edging out RN shortages (which is still an area of extremely high concern) — is intriguing. This shift represents a realization that unlicensed and assistive staff are the backbone of the healthcare workforce.  Without enough of those team members, higher-licensed staff, such as RNs, physicians, and pharmacists, are unable to work at the tops of their licenses, harming efficiency and driving burnout. Many organizations have not invested heavily in resources aimed at retaining or developing technicians. Instead of simply focusing on labor costs, leaders should take a holistic approach to workforce shortages. While the costs can be high, the opportunity cost of not fixing the problem by changing the work environment and providing more support is higher. This means leaders should consider all of the responsibilities allocated to staff and evaluate whether they have the right team structure in place and the right technology available to support those staff. Rethink staffing models, Invest in retention and development, Advocate for policy changes and Leverage technology By taking a comprehensive approach to addressing workforce shortages, healthcare leaders can ensure that their organizations are well equipped to provide high-quality care to patients while also supporting staff well-being and development. #hospitalnetworks #hospitalchallenges #hospitalgovernance #hospitalceos

Workforce shortages top list of CEO concerns Workforce shortages topped the list of hospital CEOs' biggest concerns for the third year in a row, according to a survey by the American College of Healthcare Executives (ACHE). For the survey, 241 hospital CEOs ranked 11 issues affecting their hospitals in order of how pressing they are, and to identify specific areas of concern within those issues. The top issues — and their respective average rankings — for hospital CEOs in 2023 were Workforce challenges, 2.3, Financial challenges, 2.6, Behavioral health/addiction issues, 5.3, Access to care, 5.6 Governmental mandates, 5.7, Patient safety and quality, 5.9, Patient satisfaction, 6.4, Technology, 7.3, Physician-hospital relations, 7.6 Population health management, 8.7 and Reorganization, 9.3. For the past three years, hospital CEOs named workforce issues as their top concern. While the issue "workforce challenges," which includes personnel shortages, was added to the survey in 2022, personnel shortages topped the list in 2021's survey  edition, with an average rank of 1.6. Previously, financial challenges held the top spot for nearly 20 years. Within workforce challenges, a shortage of technicians was identified as the biggest concern (87%), followed by a shortage of RNs (86%). Within the second biggest concern, financial challenges, increasing costs for staff and supplies was identified as the top concern among 94% of respondents, up from 89% last year. And within behavioral health/addiction issues, lack of appropriate facilities and programs in the community was identified as the top concern by 83% of respondents, up from 78% last year.  #hospitals #hospitalnetwork #hospitalgovernance #nonprofitoperations #healthcare

Governance has grown more political as the membrane separating public colleges, universities and healthcare networks from government has become thinner. A focus on philanthropy, public private partnerships and investment management and not simply on governance has become a major part of the trustee and board dialogue, and the organizations board members’ ability to make substantial donations, and to deliver financial results and partnerships, and to otherwise build up both the financial and the infrastructure capacity of the organization has become a major part of the dialogue and of the discourse, during the appointment and the elections of the organizational board members and trustees, as it should. Compliance officers need to think like the chair of the board of trustees, as the primary objective of organizational governance should be safeguarding stakeholders, while allocating authority and responsibilities to the board and senior management. #complianceofficer #complianceofficer #nonprofitcompliance #healthcare #academicexcellence

Boards that govern institutions of higher education, including private universities, state universities, and community colleges as well as the boards that govern healthcare and hospital networks, operate as a board of directors, and they vary by formal name, size, powers, and membership. From a legal standpoint, many higher education institutions and hospital networks are corporations; they have separate legal personhood and are the legal owners of their endowment and other property. These board members (trustees, regents, etc.) are fiduciaries for the corporation although in some cases, the institution might not have separate legal personhood and the trustees transact in their own name with other parties, such as students, faculty, or donors. The trustees often utilize a common, enduring title, which enables the trust to operate continuously even as individual trustees change. Major gift cultivation and fundraising often falls on the shoulders of the governing boards but often non-governing boards may also be appointed to handle these duties separately from the governing board duties. Significant changes in the structure, management, and governance of both public and private universities and colleges and in the management of hospital and healthcare networks have been taking hold since the mid-1970s. The days of having an honorific, ceremonial board that meets in a very perfunctory fashion, routinely rubber-stamps every proposed action by the administration – those days have ended. The two watershed moments at the root of these changes were the Enron scandal and the Great Recession. Along with other high-profile instances of fraudulent financial reporting by corporations during the early 2000s, the Enron debacle created much greater public recognition of the importance of governance. As a result, boards today are more inquisitive, more proactive, and likely to be much more engaged than before, but most board are still not proactive enough. #governance #oversight #trustees #universities #endowments #hospitalnetworks #healthcare

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