Why Your Good NFP Board Needs To Be Great – And 10 Steps To Get There
As home and community care plays an increasingly central role in our
healthcare system, the role of CCAC (Community Care Access Centre) boards of
directors is also becoming more critical. CCACs (as well as non-profit community
groups involved in the provision of home and community care) need boards that
are effective, efficient and offer strategic value to their organizations.
Four years ago, Toronto Central CCAC (TC CCAC) was at a crossroads. We had a
new CEO, a new Board Chair, and a new strategic plan. And we were facing a
radically changing external environment: home and community care was growing in
prominence in Ontario’s health system, and new government policy agendas
required transformation in the sector.
However, there was a feeling by the senior team and a few board members that
the organization had a high-performing senior team but the board struggled to
add a similar level of value and contribute meaningfully. Board members had
varying perspectives on the role and functioning of the Board: several believed
they needed to know more about operations. We found the senior team was spending
a lot of time on board support without getting sufficient return on our
investment.
We knew our Board wanted to add value, but we had to help them figure out
how. During the past three years, we’ve made substantive progress. Today, we are
realizing the early benefits of a cultural shift in how board members see their
role – board work and senior team support has been streamlined, and discussions
have been elevated to a much more strategic level.
Here is our ten step plan for shifting from a ‘good’ board to a ‘great’
board:
- Communicate expectations from the beginning.
We’ve revamped our
orientation for new board members to include not only an introduction to the
organization, but also training in NFP (not-for-profit) governance and their
role in providing oversight and strategic counsel to the executive team (not in
reviewing operational decisions). We also discuss our governance culture,
decision-making, and approach to meetings.
- Determine what model of governance makes sense.
As our
organization grew in size and complexity, we determined that a community
representative board no longer suited our needs. We now do targeted recruitment
of skilled professionals based on an assessment of what our changing
organization needs at a governance level. This shift from a community
representative board to professional skills-based board has enabled us to
leverage greater strategic value.
- Right-size the number of meetings.
Between board and committee
meetings, we discovered we held 47 meetings in a single year(!). The Board Chair
and CEO attended each one. This was a significant investment of time and
effectively meant that someone still in the workforce could not take on the
position of Board Chair. We developed an annual workplan that identified when
input or decisions were required (budgets approved, strategic planning
discussions, financial reporting) and scheduled board meetings accordingly.
- Share leadership.
Because our Board Chair attended all committee
meetings, the role of the committee chairs was weakened. This was changed, so
the Board Chair only exceptionally attends committee meetings by request of the
Committee Chair. A new targeted orientation for committee chairs ensures they
are fully able to direct the activities and meetings of the committees.
- Reduce the time committed to procedural work.
We standardized the
formats of agendas, minutes, presentations and briefing notes for the board and
committees to make them easily read and understood. A consensus agenda was
adopted so limited valuable meeting time is spent reviewing agendas, minutes or
materials that are provided for information only. Briefing notes and
presentations are identified as being for consultation, decision, approval, or
information only and include key questions for consideration.
- Assess meeting materials for appropriateness.
Although our senior
team was concerned about time spent addressing operational questions from Board
members, when we looked at the material we were providing, it was very often
operations-related. We needed to take a step back to identify what we wanted
from the board, and engage in mutual discussion about what constituted
oversight. Once we increased focus on strategic information, conversations
started to shift accordingly.
- Use external experts as appropriate.
It can be tricky for
Executive Team members to try to make changes to governance work. It may appear
self-serving. We engaged a governance expert who provided an informed
third-party view on our governance effectiveness work. With the consultant, we
agreed upon a change plan focussed on: people, culture, structure, and
process.
- Understand that Board members not only want to add value, but they also
want to receive value.
We began to feature guest speakers as part of
board meetings: patients, caregivers, partners and funders. Topics range from
the front-line care experience to health system policy. This helps Board members
better understand our organization, and provides stimulating learning
opportunities, re-engaging many in the value of volunteering on the board.
- Evaluate your progress and improve continuously.
After every
meeting, board members complete a 5-minute survey to identify what’s working in
the meetings and what needs to be improved. The Governance Committee uses the
feedback to make improvements. Three meetings this year have been called “The
best meeting yet!” In addition, we have annual Board, Board Chair, and Committee
Chair evaluations. This year, we are introducing peer-to-peer evaluations of
individual Board members.
Board term limits should allow a balance of experience and new thinking,
and we now engage in early identification of potential leaders, starting from
the recruitment phase. Training and coaching are being put in place to develop
the leaders we will need for tomorrow.
A final point of reflection – we chose not to wait until there was a problem
to make improvements. Instead, we used the opportunity of leadership changes to
rethink our Board effectiveness. Governance needs to evolve within each
organization and with the emerging changes in health care. We are fortunate to
have many volunteer Board members across the health system; it is our
responsibility as senior leaders to ensure we are optimizing their value to us,
to patients, and to the system as a whole.
About the Author
Anne Wojtak, Chief Performance Officer, Senior Director, Performance
Improvement and Outcomes, Toronto Central Community Care Access Centre
Christopher Neuman, Chair, Governance Committee, Toronto Central
Community Care Access Centre
Brad Quinn, Principal, tng
