Healthcare governance is in transition, and according to the American Hospital Association's 2019 National Health Care Governance Survey Report, there are some positive and negative trends when it comes to health leadership.
First, the bad news: Nearly a third of the 1,300 CEOs surveyed said their boards do not implement terms limits of any kind. More than three-quarters said their organizations don't replace board members during their terms, or else they've kept reappointing eligible members during the past three years in lieu of bringing in fresh blood.
The policies in place at most healthcare organizations result in low levels of board turnover, the AHA found.
Formal assessments were another area that could stand to be improved, the survey found. A full 31 percent of respondents said formal assessments for boards, board members and chairpersons weren't conducted at all.
Because of all that, it's increasingly common for board members to be older. In 2018, about 12 percent of them were 71 or older, a three percent increase from 2005. The percentage of board members 59 or younger has gone down in that time, from 29 percent in 2005 to 22 percent last year.
Perhaps one of the more surprising findings was the widespread lack of CEO succession plans. Overall, 24 percent of hospital system boards, 50 percent of free-standing hospital boards and 59 percent of subsidiary boards lacked succession plans.
Not all of the news was bad, however. Lack of racial and ethnic diversity on hospital boards is still an issue, but less so than it used to be. According to the survey, 58 percent of boards had at least one non-white member, a 5 percent increase from 2014 -- which of course means that 42 percent of hospital boards were still all white.
A majority of hospital boards have restructured to improve their governance, another positive development. And close to half of all boards include members from outside the facilities' target communities, contributing to a heightened geographic diversity.
Women, meanwhile, are slowly making inroads when it comes to increasing gender diversity. In 2018, men made up 72 percent of system board members and 70 percent of free-standing board members. Those numbers were 76 and 72 percent, respectively, in 2014.
Boston, Massachusetts can serve as a microcosm of sorts to highlight a persistent lack of gender and ethnic diversity among hospital leadership. A 2018 survey by the Boston Globe found 80 percent of clinical department heads for the city's six major teaching hospitals are men, and almost 90 percent are white.