Getting board members on board with education

State requirements for trustees changing

Several states are re-energizing hospital board member education efforts with moves to certify and mandate educational requirements. Minnesota has started a voluntary certification program, and New Jersey has passed laws to require education.

"I think we're going to see, especially if the new law from New Jersey goes over well, more of a push to have some kind of certification [for hospital trustees]," says Peggy Westby, vice president of the Minnesota Hospital Association (MHA).

Though the MHA's trustee council had been working on getting a certification program going for three years, the program launched in January, and Westby says 80 trustees are already going through the process. The association has two annual events each year for board members — a winter conference and a summer one, which they've been doing for about 22 years.

MHA's trustee council spent a lot of time narrowing down what educational components would be a part of the program, beyond the general governance practices. Components include:

• principles of governance — knowing their mission and vision, the basic role of a trustee, conflict of interest concepts, and ethics;

• strategic planning and positioning — setting goals, comprehending trends, developing policies for the overall operations, and working with physicians;

• the role of the board member in quality improvement and patient safety, which Westby says they are really pushing and include something on this at "every single conference we have"

• fiduciary responsibilities;

• board development and self-assessment.

In order to be certified in Minnesota, board members must get 36 credits and send to MHA where they got the credits, the program description, and the program content. Twelve units must be taken in principles of effective governance and the others in prescribed categories, which MHA includes in its program descriptions for participants to easily identify and track.

Westby says the winter conference used to have about 80 participants, but this year enrolled 210 people. The summer conference usually had about 135 enrollees and this year saw 190 participants so trustees are taking advantage of the new certification option.

"They're probably the most dedicated people I've seen," she says, "because in Minnesota the board members are all voluntary, they don't get paid. They do it for many different reasons." Hospitals in the state are usually in smaller areas and are the largest employers in those areas so trustees, she says, see it as a way to give back to their communities.

Conferences are always held on the weekends, starting on Friday and ending on Sunday so people with full-time jobs can attend. And the MHA often includes North Dakota and South Dakota trustees in their educational events.

One area of confusion for Minnesota members, Westby says, is the concept of the states' new adverse events law, for which the state must "literally publicize all of our mistakes." Trustees "sometimes don't see the value of telling everyone your mistakes, but they're getting to that point where they see that transparency is only a good thing," she says.

Mandating education

While the program in Minnesota offers voluntary certification, New Jersey is now mandating board members receive education. The legislation came in response to recommendations from the New Jersey Governor's Commission on Rationalizing Health Care, known statewide as the Reinhardt Report.

The New Jersey Hospital Association (NJHA) had no objection and testified for the law to be passed. Currently, all hospital trustees from general hospitals must receive seven hours of education. Sally Roslow, vice president of development and trustee relations at the NJHA, says the education is crucial in giving board members "a common foundation" to work from.

The NJHA, like the MHA, offers two annual conferences, in the fall during the evening and in the summer during the day but with the new laws in place will probably expand on that. She says in her tenure at the association, the focus on governance is no longer ancillary but has become pivotal.

Educational components mirror those in Minnesota:

• ethical and fiduciary responsibilities of a member of a hospital governing body;

• role of the governing body in improving the quality of health care and mechanisms for achieving that;

• hospital financial management and understanding reimbursement and financial payment systems;

• hospital leadership and governance;

• legal and regulatory compliance issues.

As to quality, Roslow, says "you can't have quality if the board doesn't endorse that. They're the last line." Trustees are more a part of that than ever before, she says.

"Now they're getting quality reports. They're looking at compliance. They're talking to compliance officers," she says.

While boards work on compliance and quality issues on a strategic level, not on a day-to-day level, it is important for them to be the stewards of those things, Roslow says. They might not be creating the checklists, but they can suggest the hospital have discussions about creating one.

Roslow says the NJHA has been receiving lots of calls from other states "looking to create similar programs. For us it wasn't a difficult process," she says. But they started because, she says, it was the right thing to do.