Great Governance: A Practical Guide for Busy Board Leaders and Executives of Nonprofit Health Care Organizations

This fourteen-page Guide, approved by the Alliance Board in August 2011, is intended to answer the question: Among all of the 50 to 100 best practices permeating the literature, which will make the most difference in achieving great governance? It includes two appendices: one providing a list of resources for additional information and guidance to accomplish the key steps recommended under the seven great-governance benchmarks contained in the Guide, and the other providing two checklists derived from the key steps.

Advisors in the developing the Guide were: F. Kenneth Ackerman, Jr., Howard J. Berman, Douglas Brown, Richard Chait, John R. Combes, M.D., Sean Murphy, James E. Orlikoff, Lawrence Prybil, PH.D., James Rice, Ph.D., and Michael Roberto. Bruce McPherson, Alliance President, served as facilitator in the Guide’s development.

Why Governance?

This 6-page paper authored by Howard J. Berman, the Alliance's Board Chair, discusses the theory behind governance, why and how it matters, and governance differences in nonprofit and for-profit enterprises.

What Does it Take to Build a Strong Nonprofit Health Care Board?

This seven-page Alliance report is a reprint of an article of the same title published in the Spring 2007 issue of the health care journal Inquiry. This roundtable discussion is another in the series called Dialogue, a collaboration between the Alliance and Inquiry on important nonprofit health care issues. Panelists for this roundtable discussion were: Tony Armada, President and CEO, Henry Ford Hospital and Health Network, Detroit, MI; Howard Berman, retired CEO, Lifetime Healthcare Companies, Inc., Rochester, NY; John Hopkins, President and CEO of the Rocky Mountain Health Plans, headquartered in Grand Junction, CO; Bill Kreykes, Board Chair of Trinity Health, Novi, MI; and Don Wegmiller, Senior Consultant and Advisor, Clark Consulting-Healthcare Group, Minneapolis, MN. Bruce McPherson, Alliance President, moderatated this discussion.

New Study Urges Governance Transformation

In this January 2013 issue of the Great Governance newsletter published by the American Hospital Association (AHA), consultant Mary Totten summarizes a report of the AHA's Center for Health Care Governance entitled, "Governance Practices in an Era of Health Care Transformation." This report is consistent with the Alliance's Great Governance Guide. Ms. Totten's summary includes a sample competency-based matrix chart for use in determining the appropriate composition of key governance committees.

Compensation for Nonprofit Health Care Board Members: The Right Path or a Minefield?

This Alliance report is a reprint of an article of the same title published in the Winter 2012 issue of the health care journal Inquiry. This roundtable discussion is another in the series called Dialogue, a collaboration between the Alliance and Inquiry on important nonprofit health care issues. Panelists for this roundtable discussion were: Ken Ackerman, Chairman, Integrated Healthcare Strategies, Minneapolis, MN; Doug Clark, retired President and CEO, Excela Health (PA), residing in Greensburg, PA; Mike Cascone, retired President and CEO, Blue Cross Blue Shield of Florida, residing in Jacksonville, FL; and Bill Kreykes, former Board Chair, Trinity Health System (MI) and retired President and CEO, Lifespan Health System (RI), residing in Cape Cod, MA.

Report on Director Compensation in Key For-Profit Industry Segments and in Not-For-Profit Health Care

This fourteen-page Alliance Report report, prepared with the assistance of Consultant Ronald Wacker, based in Oakland, CA, was commissioned by the Not-For-Profit Leadership Council of the Blue Cross and Blue Shield Association. It summarizes the results of both primary and secondary research, presents basic conclusions and outlines other potential avenues for research in this area.

Survey Results on Nonprofit Health Care Board Compensation

This November 9, 2011 article reports that the Governance Institute found in its latest biennial survey that 15 % of nonprofit hospitals and systems compensate some or all of their board members, up from 10% in 2008. Of those compensating board chairs, two thirds were paying less than $5,000 annually. Health systems tended to compensate board chairs the most, with 25% paying them between $30,000 and $50,000 and 25% paying more than $50,000.

Maximizing Community Benefit: A Six-Point Program

This position paper, approved by the Alliance Board in April 2009, calls on all nonprofit health care organizations to adopt as quickly as possible, if they haven't already, six specific community benefit practices to maximize their community benefit. Included are recommendations on the board's role.

CEO Compensation Practices in Nonprofit Hospitals: A Matter for Public Concern and Action?

In August 2013 the Alliance issued this special report. The report summarizes the views expressed to Bruce McPherson, Alliance President, by two nationally recognized expert consultants at INTEGRATED Healthcare Strategies: Ken Ackerman, Chairman and David Bjork, Senior Vice President and Senior Advisor. They provide a useful slant on what is happening on this issue and why, and what might be done incrementally to alleviate some of the public concerns without tying the hands of nonprofit hospital boards in competing for talent.

The Governance Imperative for Nonprofit Hospitals

This article, appearing in the January 2010 issue of Trustee magazine and authored by Doug Brown, a member of the Alliance Board and Senior Vice President & General Counsel of UMass Memorial Health Care in Worcester, Mass., is entirely consistent with the Alliance's Six-Point Program and does an excellent job of linking community benefit and quality initiatives.

Independent Sector Guide on Good Nonprofit Governance and Ethical Practice

This Guide was issued in October 2007.

Governance in High-Performing Community Health Systems: A Report on Trustee and CEO Views

This report, issued in 2009, presents findings of a study by researchers at the University of Iowa, led by Lawrence Prybil, Ph.D. The study recommendations include a discussion of the board's role in establishing community benefit policy and a community benefit committee, ensuring the conduct of a community needs assessment, adopting a formal community benefit plan, ensuring that reporting and accountability mechanisms are in place, and reporting on the organization's community benefits to the community.

Governance Role in Community Benefit: Compliance or Leadership

This article, appearing in the Spring 2008 issue of Great Boards, discusses how eight nonprofit hospitals and health systems, representing a range of religious and secular, academic and community-based organizations, don't just collect community benefit data. They use it to both plan and oversee outreach programs, approaching community benefit as a matter of mission-based leadership rather than compliance.

IRS Recommendations on Good Governance Practices

This document released by the IRS in December 2009 updates its 2007 recommendations on nonprofit governance in such areas as mission, independence and qualifications of board members, number and selection of board members, board committees, code of ethics, fundraising and audits. It states that, while adopting a particular practice is not a requirement for exemption, an organization that adopts some or all of them is more likely to meet its exempt purposes and earn public support.

Beyond Charity Care: Mission Matters for Tax-Exempt Health Care

This report, authored by David Seay in 2007 for the Catholic Health Association, provides valuable discussions of community benefit, governance and accountability, volunteerism, philanthropy, staying the course, etc. which can be used in internal and external communications with a variety of audiences.