Surviving the Crisis - Lessons Learned from Healthcare Boards

Dottie Schindlinger

Surviving the Crisis - Lessons Learned from Healthcare Boards

Listen to Episode 27 on Apple Podcasts

Guest: Jamie Orlikoff, Chairperson of the Board for the St. Charles Health System in Bend, Oregon and President of Orlikoff & Associates, Inc., who specializes in healthcare governance and leadership, strategy and organizational development.

Hosts: Dottie Schindlinger, Executive Director of the Diligent Institute, and Meghan Day, Senior Director of Board Member Experience for Diligent Corporation

In this episode:

  1. Priority #1 in an emergency is a functioning board. Make sure you can achieve quorum. Have processes in place for optimizing time and making decisions. 
  2. The right culture is crucial. Such a culture prioritizes teamwork and constructive dissent and starts with how a director is onboarded.
  3. Boards are in a unique position to support executives and employees. Crafting board-approved policies and speaking out to media and government officials are two ways they can help.  

Episode Summary: 

During the COVID-19 crisis, when we most need a strong and robust healthcare system, healthcare leaders have faced unprecedented challenges. From canceling lucrative elective procedures at already cash-strapped facilities, to obtaining and allocating vital resources, to navigating evolving conditions—and standing up to skeptics—while battling a deadly virus, hospital and health system leaders have faced one tough decision after another.

What best practices can all industries glean from the “lessons learned” by healthcare boards, both now and into the future?

In this episode, podcast co-hosts Dottie Schindlinger, Executive Director of the Diligent Institute, and Meghan Day, Diligent Corporation Senior Director of Board Member Experience, get insights from Jamie Orlikoff, a governance expert who’s been working with hospital and health system boards since 1985.  

Jamie Orlikoff, chairperson of the board for the St. Charles Health System in Bend, Oregon, also advises the American Hospital Association and Health Forum and Center for Healthcare Governance. He is President of Orlikoff & Associates, which specializes in healthcare governance and leadership, strategy, quality, and organizational development. An author of 15 books and over 100 articles, he is one of Modern Healthcare’s 100 Most Influential People in Healthcare.

Priority #1 in an emergency is a functioning board.

What should the very first responsibility of a board be in a crisis? Make sure it can function, Orlikoff says, pointing out that many directors are over 60 and thus in a higher-risk group. Will you be able to meet minimum quorum requirements? Have you designated emergency executive committees to make quick decisions in an emergency situation? 

Only meet when absolutely necessary, he advises, and optimize your time when you do. More complex decisions will benefit from discussion and analysis of multiple alternatives, but routine decisions can be a simple “yes or no” vote. Orlikoff also advises that boards schedule the most important things at the beginning of the agenda—when directors are at their freshest—rather than at the end after rote procedural tasks. 

“Little things like that can be really revolutionary in improving the quality of the board’s decision-making,” he said.

Say you have a choice between perfect information or a really good process for making a decision – which will lead the board to a better decision? The answer, very counter-intuitively, is process.

– Jamie Orlikoff, Chairperson of the Board, St. Charles Health System 

The right culture is crucial.

Orlikoff says that when confronting incredibly difficult and unprecedented decisions, like how and when to allocate limited resources, a board must have a strong culture in place as well as the right processes. Such a culture prioritizes diverse perspectives, rigorous debate, constructive dissent, and a shared acknowledgement of the board as a team.

“When suddenly you and another individual are seeing a situation from a very different perspective,” Orlikoff said, “that’s when that social glue makes a difference and can help you come to a decision and avoid hitting gridlock.”

Creating this culture starts with the onboarding process—specifically, going beyond giving new members “a big thick binder” and telling them, “just come to the meeting and you’ll figure things out.” Rather, Orlikoff emphasizes, “communicate to the new director where the board is now and where you want it to be,” and encourage the director to actively participate in these efforts.

“The boards that have that have the social glue, that have taken the time to build those kind of dynamic interpersonal relationships, are going to fare much better in this crisis than the board that don’t.”

– Jamie Orlikoff, Chairperson of the Board, St. Charles Health System

Boards are in a unique position to support executives and employees. 

Emergencies often put executives and front-line employees in situations of stress, uncertainty and even legal liability. Boards in their leadership and oversight role can lend a valuable voice and “stamp of approval.” Are directors willing to pick up the phone and call political leaders, go out to the media, or take the heat for controversial decisions? 

Orlikoff says he has been seeing boards stepping up to the plate in all of these capacities and more during the COVID-19 crisis. One example is board-approved policies in care and resource allocation decisions “so that you don’t have someone in a situation that is by themselves at two in the morning making a life and death decision with no support.” 

Boards may need to take a more aggressive role in the community than they have done in the past.”

– Jamie Orlikoff, Chairperson of the Board, St. Charles Health System

Also in this episode…

Orlikoff examines how we may need to rethink the concept of capacity (just in time vs. just in case), supply chains, and the pursuit of efficiency at all costs. Schindlinger and Day talk about the Diligent Institute’s new report. How have directors have been leading during the COVID-19 crisis?

It all leads into the “future of work.” Will technology-enabled virtual communications permanently take the place of “old style” formal meetings? And will stakeholder governance become the new normal? 

Resources in this episode:

Listen to Episode 27 on Apple Podcasts