The scene is almost an archetype — a board of directors with extensive financial stakes in a company oversees its operations. However, among health and human services (HHS) organizations, the role of the board represents something entirely different. The governance structure plays a vital role in managing the safety of an organization’s persons served and represents the people it serves as well. Meanwhile, the individuals serving on the board often volunteer their time.
The ideals behind today’s boards are simple and humble, but this can lead to a disconnect between the needs of an organization’s front-line workers and management demands. Senior leadership may feel uncomfortable bringing issues to the board, and the disconnect breeds disengagement and struggles among board effectiveness. However, you can work to improve board engagement, excelling in its role and adhering to applicable criteria as a Certified Community Behavioral Health Clinic (CCBHC) through these steps:
1. Make the Board’s Actions Visible Throughout an Organization.
Visibility is the cornerstone of modern, successful organizations around the globe, and this holds true among HHS’ boards. An "open-door” policy, inviting staff members and those in senior leadership to be present for or participate in meetings, can boost the visibility of the board. Meeting schedules should be clearly posted, and meeting minutes should be available throughout your organization.
Obviously, protected health information (PHI) discussed during meetings should be redacted for privacy purposes, but case studies of specific events and pain points in an organization are essential to growth and development of the board and its representatives.
2. Ongoing Training Encourages Dialogue and Continuous Improvement.
Members of the board should be competent. They should undergo continued training on their responsibilities in the organization, and training should be frequent, flexible and available. Since board members often volunteer their time, training resources must not impose a financial burden. In other words, your organization should consider working with providers of free board training programs or courses.
Evidence-based practices must supersede the traditional responsibilities of boards. As explained by the Joint Commission, board committees should have an intricate understanding of quality, safety matters, including “risk management trends and patterns,” and the ability to draw insights from new issues. Today’s risks are not necessarily reflective of the issues boards may face in the future. Thus, training must evolve with time, comprising new standards and methodologies in board engagement.
3. Create and Follow Policies, Procedures and Bylaws Throughout Board Meetings.
Having a governance structure in place eliminates confusion and helps the board achieve realistic goals. During organizational change, inconsistencies or discrepancies among board bylaws, policies or procedures should be reviewed and adjusted accordingly. The CCBHC criteria advise centers to create transition plans during times of change. As the organization grows, bylaws may also need to change to reflect the needs of individuals served.
During meetings, opinions may cause disputes among members and workers participating in the meeting. Rather than allowing tempers to flare, your organization’s governance structure should allow for grievances to be filed and addressed in an appropriate manner. For example, if a team member feels the board’s actions were unjustified, a board evaluation, such as the self-evaluation tools published by the Health Resources and Services Administration (HRSA), may be used to highlight the issue.
4. Hold the Center to Compliance Laws and Regulations.
Depending on the type of organization, you may be subject to local, state, and federal laws and regulations. Governance members should hold your organization responsible for compliance, including using metrics and data to track accountability and adherence to evidence-based practices. Meanwhile, the finances of board members may also be subject to certain restrictions.
For example, the CCBHC criteria limit the ratio board members deriving more than 10 percent of their annual income from the health care industry to 50 percent of the total persons on the board. In other words, individuals working in your organization can only make up one-half, at the most, of your board members. The remaining members must come from families of persons served, individuals who have received services by your organization, preventing partiality and maintaining visibility simultaneously.
5. Plan Strategically for Both Known and Unknown Situations.
Nothing is certain. The board must be ready to respond to likely and unlikely scenarios with equal resolve at any time. A strategic plan in your governance structure should focus on both long-term and short-term goals while actively working to improve treatment outcomes. Examples of strategic plans include the following:
- Key metrics to track the successes, or failures, of treatments as new medications and therapies are developed for substance abuse, mental illness and other public needs.
- Transition plans in the event of a sudden, unexpected change in funding or state oversight.
- Means to continue providing services during times of crises for local, regional, state or federal agencies.
The key is to think about both worst-case and best-case scenarios, deriving the best pathway toward continued operation and access to your organization’s services throughout any event.
6. Work With Other People Outside Your Organization.
This is one of the hardest tips to embrace because it relies on working with organizations that might be considered “competition.” When organizations that serve the public, ranging from mental health services to housing case management, work together, the outcome for persons served tends to fair better. Board members should be encouraged to look for external partners that will help achieve your organization’s goals for helping people and making a positive impact on your community.
A few organizations that you might consider partnering with include:
- Religious organizations that help to provide a sense of home, fellowship and assistance with housing, food and health care.
- Nonprofit entities that work to prevent homelessness, disparate access to health care and promotion of self-advancement for those in need.
- Educational institutions, ranging from elementary school to colleges and career training programs, may offer counseling services or financial assistance to people looking to improve their career outlook or plans, an essential tool in preventing mental stress and anguish.
- Even businesses in your area may be interested in a partnership. They can help with job placement and encourage a sense of community, helping those in need become productive, healthy and happy members of society.
The ball is in your court now. Start by giving your board the tools and resources it needs to succeed, as explained in Part I, and provide appropriate training to all board members. Next, begin applying these tips to promote engagement and interaction among your board, community, persons served and staff members. This webinar can also help you identify some of the key ways to continue board engagement throughout your organization.
Board effectiveness, engagement and communication go back to one of the simplest concepts in any career or role, which is training. If your organization wants to make a positive impact in the world, the change starts from the those in a position of authority — board members. Start at the top, and let the power of board engagement become the lighthouse for your organization.