Hospitals need proactive governance and boards that disagree

One of the key speakers at the American College of Healthcare Executives annual meeting in Chicago this week urged hospital boards to engage in constructive governance practices that did not necessarily preserve a convivial atmosphere.

James E. Orlikoff, a Chicago-based governance consultant, noted that the hospital governance practices of the past will no longer work in a world of declining reimbursements and stronger demands for more regulation and transparency.

"The quality of governance that was sufficient to get your organization where it is today will be insufficient to get it where it needs to be tomorrow," Orlikoff told the audience, joking that corporate governance debacles such as Enron have been very good for his practice.

Among Orlikoff's recommendations: have boards that disagree, and encourage debate rather than consensus. "You don't want (to encourage) unanimous votes," he said. "If the board votes 10-5, that's the way it votes, and everyone knows what the differences are."

Orlikoff also encouraged the appointment of board members from outside the hospital or healthcare system's community, noting that such members are far less likely to conform since their dissent may not damage potential business dealings with other board members.