As healthcare reform spurs hospitals to consider new relationships with other providers and develop closer ties with their communities, board members become increasingly valuable assets. Trustees can give hospitals important access to their employees and to the business community. Their influence can also make them effective advocates for healthcare reform.
To be a true force for change, however, trustees must refocus on the vision that brought them to healthcare, says Bettsanne Holmes, chairperson of the Washington, DC-based Voluntary Trustees of Not-for-Profit Hospitals and a trustee at Maine Medical Center, Portland. "We agreed to join a board because we believed in the hospital's mission and wanted to do what we could to help," she says. But Holmes adds that in recent years trustees' immersion in issues such as whether a hospital had the money to deliver important services or whether a particular course of action could result in a lawsuit has often distracted them from their original vision.
New Roles
Holmes believes that the healthcare reform process has already been an important catalyst in reminding trustees why they chose to take on their role. As hospitals reexamine, define, and communicate their fundamental values, trustees are also challenged to look deeper into what they now do, can do, and should do for their communities.
Community Benefits and Tax Exemption One key role for trustees, Holmes says, is to educate citizens and public officials about what hospitals already do for their communities. "Locally, our tax-exempt status is at risk, we face reimbursement freezes, revenue caps, and every kind of imaginable tax," she notes. "In too many towns and cities and in the nation's capital, elected officials are unconvinced of the benefits hospitals provide to their communities."
Advocates for Healthy Communities
Holmes stresses, however, that telling the hospital's story is not enough. "As trustees, we must also ensure we are doing all we can to build healthier communities. We must go beyond our traditional role and become educators, motivators, counselors, and salespersons for healthier life-styles."
To do this effectively, Holmes says, trustees must help their hospitals build relationships and partnerships with other community groups, including schools, churches, civic organizations, and chambers of commerce. With their understanding of the enormous costs of caring for the smoker, the alcohol and drug abuser, and the overeater, trustees are well positioned to demonstrate the long-range savings a community can achieve with even incremental improvements in people's overall health.
Board Advocacy in Maine
Holmes's home state has become a leader in the area of trustee advocacy. Through the Maine Hospital Association (MHA) statewide Trustee Advisory Group (TAG), hospital board members play a vital role in political advocacy efforts in both the state capital and in Washington, DC.
TAG was initially established out of a growing concern that the state's hospital regulatory agency was seriously threatening the financial health of hospitals. In late 1987 trustees gathered at MHA to explore ways to help reform the regulatory system. In 1988 TAG was formally created and commissioned a statewide public opinion survey to gain a fuller understanding of public attitudes about hospitals. Among other findings, the survey confirmed that the public sees voluntary trustees as especially credible spokespersons for their institutions. Today, TAG includes nearly 900 trustees who serve on the boards of directors of Maine's community and specialty hospitals.
Statewide Advocacy
Over the past five years, trustees have contributed to the passage of a number of hospital-supported bills in the Maine State Legislature that led to a substantial turnaround in the financial health of Maine's hospitals. Trustees play a pivotal role in the passage of legislation through letter writing, face-to-face lobbying in the legislature and in local communities, and other activities. TAG members have also helped defeat state legislation believed detrimental to hospitals. They testify at legislative public hearings and help organize legislative breakfasts in local communities. All candidates for state legislative seats recently received a personal letter from the MHA trustee chairperson to offer the assistance of local hospitals and MHA as sources for information about key healthcare issues.
A long-term goal of TAG advocacy efforts is to pair each legislator with a specific trustee in his or her own community to build closer ties between hospitals and elected officials. Each year, trustees travel to the nation's capital to discuss issues of importance to hospitals with members of Maine's congressional delegation.
Trustee Education"TAG and the Maine Hospital Association share the belief that trustees can be effective advocates only if they are educated about the political process and kept fully informed on key issues," says James Harnar, MHA director of communications. Trustees are encouraged to attend MHA's legislative advocacy workshop.
TAG's aggressive communications program provides trustees with opportunities to learn about key issues facing Maine's hospitals and to share their experiences and expertise with others across the state. All trustees receive a quarterly newsletter and other mailings. Hospital board chairpersons and trustees serving as representatives to TAG receive MHA's weekly digest, a government relations newsletter, a monthly letter from MHA's president, and other publications and news clippings. All these publications include strong coverage of policy and advocacy-related issues.
TAG's Trustee Information Program (TIP) is designed to inform hospital boards about TAG activities and services. Presentations before individual hospital boards cover policy and advocacy-related subjects.
Importance of Collaboration
TAG's advocacy program is closely coordinated with MHA government relations activities, explains Harnar. "At the center of this effort is the belief that trustees are particularly credible and effective advocates for their hospitals because of their long-standing ties with their communities and the fact that they have no financial stake in their hospital and its operations."
TAG Steering Committees have a close liaison with the MHA Board of Directors. The TAG chairperson, along with other trustees, serves on the MHA board. In 1992 a trustee chaired the Maine Hospital Association for the first time in its 55-year history. Trustees also serve on councils, committees, and task forces.
In 1988 TAG established Maine Citizens for Quality Health Care, a statewide, nonpartisan grassroots organization dedicated to ensuring hospitals have the resources to preserve access to needed healthcare in communities throughout the state. The Maine Community Hospital political action committee (PAC) is cochaired by a trustee, and its steering committee includes five trustees who are responsible for building support for the PAC among trustees in their own regions of the state.
In 1992 TAG established an Advocacy Task Force to increase trustee involvement in the association's policy development and advocacy efforts. The implemented plan calls for the recruitment and training of a trustees legislative advocate on each MHA-member hospital board; presentations and discussions on key healthcare public policy issues at regular meetings of the TAG Steering Committee; and the coordination of all advocacy efforts through a new MHA Hospital Advocacy Committee made up of trustees and hospital management representatives.
Last year, heads of the boards of trustees at every Maine hospital signed a resolution from the MHA committing each board to fully consider the benefits of cooperation and to collaborate with other hospitals and providers in the communities they serve. The resolution describes quality enhancement issues; improvements in access to care and treatment; and the efficient and cooperative use and development of programs, services, and facilities. In addition, the trustees agreed to direct their chief executive officers to begin discussions with other institutions on cooperative activities and to remove barriers that impede cooperation.
Future Plans Trustees' involvement in association advocacy efforts have attracted considerable attention from other state hospital associations, which have sent representatives to Maine to learn from their experience.
"Although trustees have been a significant part of MHA's overall advocacy program for the past four years," says Harnar, "Maine has only scratched the surface of trustee involvement and leadership in this area. A great deal of time and energy has been devoted to development of much more aggressive plans to further involve trustees."
The association is optimistic that, as the plan is executed, trustees will have an even more positive and visible impact on policy development and advocacy.
Ms. Weiss is a Santa Monica, CA-based healthcare consultant.