by Allee
Mead
About five years ago, Gunnison Valley
Health (GVH) CEO Jason Amrich asked Board of Trustees
chair Mark Kaufman, MD, and other board members to attend
a Colorado Hospital Association meeting, where they
listened to a presentation about governance.
After that presentation, Kaufman recommended that the GVH
board create its own governance committee. “That was the
start of trying to understand how we could improve our
board development and functioning process,” Kaufman said.
“The governance committee also creates the expectation of
performance across the board,” Amrich said. He praised
the governance committee’s work on the board’s bylaws and
policies, calling that effort “the catalyst for our
board’s performance.”
Roles and expectations
A healthcare facility’s board “first and foremost defines
the mission and purpose of the organization,” Brock
Slabach, National
Rural Health Association (NRHA) Chief Operations
Officer, said. “Not only does it define it, but it also
holds the organization to that mission and purpose.”
Slabach also stressed the importance of a healthcare
board understanding its role within the organization.
“Governance is different and apart from operations,” he
said. “They’re not the operators; they’re governing the
organization in terms of a broader picture.”
Darrold Bertsch agreed: “It’s important for the board not
to get involved in the daily operations of the
organization. Board members have one employee, and that’s
the CEO.” A former healthcare executive, Bertsch serves
on the board of Coal Country
Community Health Center and Sakakawea Medical Center, a
Critical Access Hospital (CAH), in Mercer County, North
Dakota. The facilities are separate organizations with
separate boards of directors, but they share a CEO. The
two facilities “have integrated governance,” he said,
with two members serving on both boards.
Board members have one employee, and that’s the CEO.
To illustrate his point about boards’ roles, Bertsch gave
the scenario of a staff member being rude to a patient
and that patient complaining to a board member. The board
member should listen to the concern but not discuss the
complaint with the employee. Instead, the board member
should inform the CEO or encourage the patient to contact
the healthcare facility.
Along with understanding their roles on the board,
members need to understand the board’s larger
organization. “The most important thing is for the board
to be acutely aware of its organizational structure and
bylaws,” Slabach said. For example, a county hospital’s
board has to follow certain legal requirements.
“Boards must also understand and help community health
centers (CHCs) address increasing complexity in the U.S.
healthcare system…and be aware of policy and regulatory
changes that impact their organizations in order to
partner with CEOs on strategy,” said Emily Heard,
National Association of
Community Health Centers (NACHC) Vice President of
Health Center Governance.
Brock Slabach.
Boards also act as the fiduciary for the healthcare
facility. “They’re responsible to secure adequate
resources for the organization to fulfill its mission,”
Slabach said. “They make sure that they’re good stewards
of the money entrusted to the hospital or to the FQHC
[Federally Qualified Health Center] and then, more
importantly, setting up safeguards through processes like
audits and oversight that help to verify and to maintain
that integrity throughout the entire organization.”
Finally, Slabach added that board members should be
“reflectors” of the healthcare organization. Board
members are not spokespeople for the facility, but they
can still enhance the facility’s relationship to the
community it serves.
Recruiting new board members
Recruiting board members can be difficult for rural
healthcare facilities. Tanya Case is a board member for
DRH Health,
a rural health system in Duncan, Oklahoma, and also
serves on the American Hospital Association (AHA) Board
of Trustees
Committee on Governance. Hospital boards need
qualified individuals from different age groups and
professions, she said, but there is a limited pool of
people who are able and willing to serve on a board,
especially those working and raising a family.
Tanya Case.
“Our lives are busier,” Case said. “When you’re asking
someone who already leads an organization or holds a
demanding position to spend several hours at an evening
board meeting after a full day of work, that’s a tough
ask.” Case said hospitals may need to rethink the
traditional evening meeting model and instead hold board
meetings during business hours, while encouraging local
employers to support employees who take on these
important community leadership roles.
CHCs have another consideration while recruiting board
members, since 51% of CHC board members must be patients
of the health center. Heard from NACHC said, “CHCs can
leverage the well-established relationships the clinical
staff have with patients to identify individuals who
could be an effective patient board member,” adding that
some health centers train their staff to identify future
board members and make recommendations about possible
candidates to the CEO and the board. Other recruitment
strategies include contacting the CHC’s Patient Advisory
Committee if one exists, handing out or hanging up
flyers, or posting an interest form on the health
center’s website or social media.
Board orientation
After recruiting comes training new board members. One
key aspect of orientation is teaching board members how
CAHs’ and CHCs’ finances are different from other
organizations and businesses. “A banker’s business is
totally different than a Critical Access Hospital,”
Bertsch from North Dakota said. Board members need to
learn about cost-based reimbursement for a CAH and
regulatory requirements for CAHs and CHCs.
Bertsch also recommended that board members tour the
healthcare facility so they can better understand the
organization and people they’re serving.
Toniann Richard is the CEO of HCC Network in west central
Missouri. “The compliance side of an FQHC board can be a
little overwhelming and could be daunting for somebody
just looking at it,” she said. She explained it’s
important to walk new board members through the
expectations and explain the support that board members
have in this work.
Alexis Foster, National Rural Health
Resource Center Lead Program Specialist, co-created a
training for healthcare facility boards. “We really
wanted to be able to provide them with general
information, because sometimes this is their first time
being on a board,” Foster said. “They really just want to
understand what’s expected of them.”
The training walks board members through roles and
responsibilities as well as required documents board
members need to sign. The training provides different
scenarios that a board might face and explains what to do
and not to do. “It truly allows them to practice working
through different discussions and situations,” Foster
said.
The training also explores “building those successful
relationships with staff, staying engaged as board
members, forming a strong bond with that CEO,” she said.
Ongoing education
Since each board is different, “there is not one approach
to supporting board development,” Bethany Adams, National
Rural Health Resource Center Program Advisor, explained.
She added the Center has “a multi-technical assistance
approach.”
When the National Rural Health Resource Center assists a
struggling hospital with developing turnaround
strategies, Adams said her organization starts with the
hospital’s board. The Center performs a financial
operational assessment and holds “conversations with the
board, providing them the information in a meaningful way
that helps them to understand the impact of their
decisions,” Adams said. She added that the Center has
helped seven hospitals prevent closure.
Adams said the Center’s training also compiles best
practices and helps board members consider quality
improvement as well as financial success. The Center
offers in-person workshops and virtual learning
collaboratives. Adams said participants also benefit from
networking through these programs.
The Center meets with a healthcare facility’s board and
answers any questions that board members have. “We build
a working relationship with them right from the get-go,”
Adams said. “We help boards learn how to think
strategically forward and remain focused on
transformational strategies that position the
organization for the future.”
Most of the Center’s work is supported through the
Federal Office of Rural Health Policy (FORHP).
Organizations do not pay a fee to access this
programming. Through these programs, participants
complete leadership team agreements, which help them hold
themselves and their teams accountable.
Case’s health system in Oklahoma works with a healthcare
performance improvement company that offers board
governance training, but she said other hospitals could
access resources from AHA. She added the AHA Committee on
Governance can answer people’s questions or direct them
to someone who can help. “You learn so much just by being
around other people on other boards,” she said.
You always have more to learn as a board, even if your
board’s been around a long time.
“You always have more to learn as a board, even if your
board’s been around a long time,” Case said. “I think
that board governance is something that is always
evolving, especially in today’s rapidly complex,
ever-changing healthcare environment.”
Learning together with boards from other healthcare
facilities can help keep costs down and provide valuable
insights from peers. At a previous job, Bertsch helped
organize a regional board training in North Dakota,
funded by the state’s Flex program. Board members and
CEOs from neighboring healthcare facilities gathered and
learned about different topics. The state department of
health presented on CAH regulatory requirements, a public
accounting firm talked about reimbursement, an attorney
spoke about fiduciary responsibilities, and the Center
for Rural Health (North Dakota’s State Office of Rural
Health) spoke about its work and best practices for board
members.
Strengthening relationships
Amrich said the board’s governance framework and the
trust between the CEO and board helped GVH weather recent
challenges, such as transitioning to a new electronic
health record.
Darrold Bertsch.
Bertsch also stressed the importance of a healthy
relationship between the CEO and the board. “I’ve been
fortunate in my career [as a former CEO] that I’ve always
had supportive board members and, more importantly, a
supportive board chair, because a lot of the
communication takes place between the CEO and the board
chair,” he said.
As a CEO, Richard in Missouri discussed the importance of
transparency with her board, “making sure that I’m
providing them with enough information that they can be
informed and comfortable with that governance role and
not feel the need to step into an operational space.”
At HCC Network, Richard said most board members “max out
their role” in terms of how many years they can serve.
HCC Network board members can serve a total of nine
years. “In my almost 20 years in this role, I think
there’s been three instances where somebody has had to
resign from the board during a term or not renew their
next term” due to personal reasons like moving or
becoming a caregiver, Richard said.
Our board is really great at opening doors for us.
“Our board is really great at opening doors for us” in
the community, Richard said. She discussed the healthcare
that HCC Network provides in the local jail. One HCC
Network board member is the county captain of the
sheriff’s department. He helped inform HCC Network on
providing care for incarcerated individuals. “Just
yesterday [HCC Network] got a phone call from the sheriff
saying that this program is running better than it ever
has,” Richard said.
Improving meetings and overall performance
The environment in the boardroom can determine the
board’s success. Bertsch in North Dakota recommended that
no one person should dominate discussions during board
meetings. “A good board chair will solicit input from a
variety of folks, and board members need to feel
comfortable that they can ask whatever question that they
want,” he said.
Case in Oklahoma stressed that board members should be
able to disagree with one another while deliberating, but
then board members need to unify once a decision has been
made.
In Colorado, GVH board members can come to board meetings
an hour early to visit a section of the hospital. This
board rounding allows board members to meet frontline
staff and see the work they do.
In addition, Amrich said the board labels agenda items so
members “can get into that right frame of mind for the
type of conversation they will be having.” The labels can
identify topics like oversight or indicate whether the
board is just discussing an item or needs to make a
decision about it. Board meetings include a meeting
review, in which members discuss what went well, what
could be improved, and if members stayed in their
“governance lane.”
Slabach from NRHA recommended that boards evaluate their
own performance: “How do they feel about the job that
they’re doing and what are the gaps that they may need to
attend to in order to be better at some of those
functions?”
In 2023, working with a software company, the GVH Board
of Trustees in Colorado completed a self-assessment. The
assessment allowed the board to compare itself to other
boards across the country. The GVH board then developed
action plans to address areas needing improvements.
The board completed another assessment in 2025 and showed
improvement in the eight domains measured. Board members
reported overall satisfaction with their governing
performance, with 60% rating it as “outstanding” (up from
29% in 2023) and 33% as performing well.
“The fact that we can improve from an already pretty
high-performing board and then go even above and beyond,
to me, is a pretty awesome success story,” Amrich said.
But boards shouldn’t stop at just evaluating their own
performance. Bertsch recommended that board members
complete an annual evaluation of the CEO: what’s going
well, what opportunities there are for improvement, and
if the CEO is involved in the larger community. “As a
CEO, I would occasionally attend city council meetings,
county commission meetings…to give them updates so that
they know what’s happening in our healthcare industry
locally and on a national level,” he said.
Case suggested having board members review one another’s
performance but added, “It’s a very mature board that can
do that.”
Resources for Board Members
- American Hospital Association
- National Rural Health Association
- National Rural Health Resource Center
- National Association of Community Health Centers
The importance of boards
Case from Oklahoma serves on local boards for museums and
orchestras but said these boards “are very different from
hospital boards in that they do not take the same amount
of time.”
“Being a hospital board member is hard work,” Case said.
“It is extremely time-consuming, and it is different than
other community boards that most people are used to
serving on…It’s not something that you just show up to a
meeting and give your input and leave.”
“It’s really a selfless undertaking,” Heard from NACHC
said. “People are really dedicated to their communities
and making sure that people and patients in their
communities are receiving quality care.”
