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Explore the critical role of health care boards in shaping organizational culture, workforce development, and diversity, equity, inclusion, and belonging (DEIB). Physician advocate and physical therapist Kim Downey and health care consultant Geoffrey Roche discuss how boards can drive systemic change, address workforce shortages, and prioritize career pathways to ensure long-term success in health care.
Kim Downey is a physician advocate and physical therapist. Geoffrey Roche is a health care consultant.
They discuss the KevinMD article, “The duty of health system boards to prioritize organizational culture, workforce development, and career pathways.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Kim Downey. She is a physician advocate. We also welcome Jeffrey Roche. He is a health care consultant. The KevinMD article we are talking about is “The duty of health system boards to prioritize organizational culture, workforce development, and career pathways.” Kim and Jeff, welcome to the show.
Kim Downey: Thanks, Kevin.
Kevin Pho: Kim, how did you find Jeff, and what about his story resonated with you to bring him on KevinMD.com?
Kim Downey: We connected on LinkedIn a while back this summer to have Jeffrey on with Dr. David Morris on my Stand Up for Doctors YouTube channel, and during our conversation Jeffrey posed this pivotal question, which is, “Where are the boards? Where are they to care about these issues?” And that was like a mic-drop moment for me because of all the conversations I have been having in this space for a couple of years, nobody had ever mentioned the boards. After our conversation, I thought, “This was so awesome, and I wanted to talk about it more, and I wanted this conversation to have a bigger audience.” So I said, “I have an idea—do you guys want to write an article?” David, at the moment, did not have the bandwidth, but Jeffrey was like, “Sure,” and so we did it, and here we are. But I do want to pay tribute to Dr. David Morris and his wife, Olivia Morris, whom you have already had on, for their insights and contributions to this topic.
Kevin Pho: All right. So, Jeffrey, tell us a little bit about your story, and then you could lead into your article for those who did not get a chance to read it.
Jeffrey Roche: Yeah, so obviously, Kevin, thank you, and, Kim, so appreciative of you both and all the work that you do in this critical space. My story, obviously, is that I am the son of a nurse. I entered hospital administration back in 2008, served in hospital administration at a health care system in northeast Pennsylvania from 2008 to 2017, moved on from there after we were acquired as a system, and then I moved into academia and did similar work in the academic world. I was always involved in leadership, workforce development, partnerships, and such. While I was in health care, I worked for a great CEO—a medical professional who happened to be a nurse—and I learned a lot from her during that time around boards, because we had a very interesting board. Ultimately, I tell people our board is what led to us being acquired and ultimately led to a lot of things afterward that were not right for the community. And now I have the privilege of leading workforce development in North America, with a focus on the U.S. and Canada, for Siemens Healthineers, and I do a lot of other ecosystem work in the health care and education sector as well.
Kevin Pho: All right. So, Jeffrey, tell us the role of the health care boards, whether it is for an academic facility or a hospital. For those who are not familiar with health care boards, tell us about who they are comprised of and what their roles are.
Jeffrey Roche: Yeah, so obviously in the U.S. health care system, we have either for-profit or not-for-profit boards. In a for-profit situation, you have shareholders on the board, so if you think of organizations like Tenet or HCA, those are going to have shareholders. The not-for-profit sector, which is the larger share of our health care system, usually has boards of directors or boards of trustees. These boards generally govern themselves, are meant to be representative of the community, and generally do not necessarily have a significant amount of health care experience. In most cases, the chief of staff or the president of the medical staff (a physician) serves on the board, but other than that, there are usually very few people with clinical experience. These boards are responsible for hiring and firing the president and CEO of the system, and they are also responsible for all aspects of what they call fiduciary responsibility. That responsibility spans finance, strategic positioning, and more. I argue—and this is what Kim and I argued in our article—that it actually goes a little further than that. You do not have health care finance or health care strategy if you do not have people. So culture, recruitment, retention, career pathways—thinking about your workforce and caring for them as your workforce—is super important. Kim and I argue that boards should take ownership and hold the president and CEO and the executive team responsible and accountable. When we talk about burnout, I am sure you are familiar with the story of the nurse in Ohio named Tristan. She worked for a health care system in Ohio, and her burnout was so bad that it ultimately led to the end of her life. Her parents found a letter to the editor she wrote before her passing, and they later had it published. It is a very emotional letter. When you read it, you see a health care system that ignored what she was facing—leaders that ignored exactly what she and others were experiencing. I remember posting that letter on LinkedIn when I first saw it, saying, “When will boards wake up to the reality of these situations, and when will they tell the executive team, ‘You need to own these things, or else we will hold you accountable?’” This is truly life-or-death decision-making. As someone who has worked with boards in the health care system, I think there is a lot of work we must do to make them more representative and more effective in this arena.
Kevin Pho: Kim, of course, it is well known that you talk to so many people across the health care spectrum about wellness and burnout, and you are certainly doing your best—you are doing so much to help combat that. Now, before talking to Jeffrey, what did you hear about the role of hospital boards or academic institution boards in terms of influencing burnout, either positively or negatively?
Kim Downey: I did not hear anything, and that was the thing: nobody was talking about boards. Doctors do not mention boards. Let me take a little pivot to share that, when you just said that, what I am thinking about is that in our last conversation, you asked me, “When you talk to doctors about AI, what are they saying?” But when I talk to doctors, they are not talking about AI. Doctors are talking about human things, their human struggles. They are not talking about boards, and they are not talking about AI in our private conversations.
Kevin Pho: And, Kim, whether as a patient or as a physical therapist, there was no visible influence or interaction that you had with the boards of the various health care institutions or hospitals you dealt with, correct?
Kim Downey: Correct. And I was thinking that when we get off of this call, I might send our letter to the editor to our local hospital.
Kevin Pho: So, Jeff, what kind of influence do these boards have? What can they really do if we are talking about burnout specifically and how they need to take more responsibility? In practical terms, what changes or moves can hospital or medical institution boards make?
Jeffrey Roche: Well, think of it from the vantage point that boards make the ultimate decision on hiring and firing the CEO, but they also have influence over the rest of the executive team. Generally, the executive team and leaders of the health care system, including physician leaders, serve on the board subcommittees. So if you think about the medical executive structure or the medical staff, as you heard me say, the president or chief of staff of the medical staff generally is on the board. One of the things I also argue is that there should be a nurse on the board. Every health system should have a nurse on the board, because nursing is the largest workforce in a health care system. I am not arguing that it has to be a current nurse, but if there is a current doctor on the board, why cannot there be a current nurse? I think that is a fair question.
Now, in terms of what they can do—look, they set policies, standards, and strategies for the health care system. They are the ones looking out five, ten, or twenty years. I do not think you can look out five, ten, or twenty years without dealing with the current climate. So I believe, fiduciary-wise, I am not suggesting boards should micromanage, but I do believe it is fair for a board member—actually, I serve on a number of boards, though not a health system board—to be asking questions about culture, about burnout, about data. In fact, if I were on a health system board, I would be asking to meet with the staff. I would want to hear from them directly. When I worked at my regional community health care system, we had board members—one was a president and CEO of a local bank—who would meet with staff, and if he did not, his wife would, because she was well known in the community. Then he would bring issues to our CEO, and she would address them. She never saw it as micromanaging; she saw him as her governing partner. That is what a board should be—a governing partner to the president and CEO. But to be effective, a board must be in touch with the workforce, because ultimately they also have responsibility for them. It is a human-centric model. Health care systems are among the largest workforces in a community. Generally, boards are made up of community leaders. I do not know how you could sleep at night being a CEO of a bank or a grocery store or some other business, while sitting on a health system board, and not know if there is burnout, stress, or really bad culture. To me, that is just unthinkable.
Kevin Pho: Jeffrey, is that typically not happening from what you hear or see on LinkedIn in terms of a typical hospital board? Do they not have a nurse, do they not have that connection with the staff? What is typical out there?
Jeffrey Roche: Less than three percent of our nation’s boards have a nurse on them. That alone tells you a lot. Another thing that I know Kim, David, and I talked about is how boards are often not representative of the communities they serve. Most health system boards are still dominated by older white males; they do not have the diversity that would help them truly represent their communities. One could argue—and I have—that if we had boards that were more inclusive of the communities they serve, we might move the needle on health equity. They would be asking more challenging questions on the quality committee or patient safety committee. The same goes for gender diversity. Women dominate the health care workforce, yet they are not fully represented on the board. That is something we must address. I know we are at a time when people do not want to talk much about DEI, but in health care, you cannot avoid it. It is truly about advancing health equity and creating a culture where everyone feels recognized, appreciated, and valued. We have a lot of work to do with boards.
Kevin Pho: How do boards typically include new members? How are they usually brought on?
Jeffrey Roche: Typically, there is a governing process, and usually—especially on the not-for-profit side, which is where I am more familiar—board members are selected from a pool of people they already know. It is not generally an open, public process. Some boards will open it up by sending a letter to the local newspaper, welcoming individuals to submit applications, and then the board’s governing committee might vet them, talk to them, etc. The president and CEO is usually asked to think about good candidates for the board, interviews them, prepares them, and so on. I would argue that, for example, in my former system—our CEO was a woman, a nurse—she worked intentionally to diversify the board. It was during her tenure, after over 100 years, that a woman finally joined the board. Think about that: 101 years, and it was the first time a woman got on the board. It was also the first time a higher-ed administrator joined the board—specifically, a provost from a local community college. And the third thing she did was specifically bring in a leader of color. She said, “We cannot keep doing the same thing.” Her board chair was on board with that. So you can see the president and CEO wields significant influence. But if that CEO is ignoring culture and these issues, and the board chair is not really engaged, then you see how we end up in the situation we are in. The board basically replenishes itself from the same circles of influence. Think about this from another perspective: if I lived in the same region as Kim, she would be a perfect health system board member—her health system should be calling her right now and asking her to serve. She would bring that crucial human-centric perspective, along with her clinical background. We need people who actually understand health care on these boards. We also need people who understand why people matter.
Kevin Pho: So Kim, after having this conversation with Jeffrey and David and learning how influential hospital boards are, how does this knowledge inform your conversations when you talk to other health care professionals about burnout or on your own podcast, now that you know about the influence of hospital and nonprofit boards?
Kim Downey: Well, I am going to make sure we keep people at the center, which is the name of this episode, by the way, and it all boils down to that: you have to keep people at the center. If we would just do that, a lot of the other issues would fall into place.
Kevin Pho: We are talking to Kim Downey and Jeffrey Roche. Kim is a physician advocate, and Jeffrey is a health care consultant. We are talking about “The duty of health system boards to prioritize organizational culture, workforce development, and career pathways.” Now I am going to ask each of you to share some take-home messages with the KevinMD audience. Kim, why don’t you go first?
Kim Downey: Sure. I want to talk about the human connection. I got to meet Jeffrey in person and give him a hug at the burnout symposium last month. David and Olivia Morris went from being LinkedIn connections to spending two weeks in Ireland, where I spent two days with them and their family. It was so nice. It is all about human connection and supporting each other. Let me share a few more messages from that episode featuring David and Jeffrey. David said, “What we really need is people to start coming forward with solutions, driving with action, changing the culture, actively being on the ground and doing it.” Jeffrey added, “What I have always been reminded of is the power of relationships. There is nothing like a human-centered relationship, and I think that in many ways we have missed that in health care. It has become bigger, and we really need to get back to that human-centered connection.” Then, when Jeffrey was speaking about health equity, David responded, “Each one of those people is a person with a story that needs to be cared for, that needs to walk out the door feeling like they have had care, they have been able to heal or get something done that makes them better. It is not a widget factory, and we need to bring health care away from that.” What I want to add is that we need to include doctors: they are also people with a story who need care. Doctors need to walk out the door feeling supported and able to make the difference they went to school for at least a decade of their lives to make.
You have mentioned more than once, Kevin, that some of these issues have been discussed for years on your podcast. I feel like the ripples and waves are primed for a tsunami—hopefully the positive kind—for changes in health care. We need action, and I want to be part of it. I am starting a group to discuss patient empathy and clinician well-being. Regardless of insurance or other obstacles, we can make a huge positive difference right now if health care leaders put the well-being of their staff first. That must be the top priority, and other things will fall into place. We need a lot of support to make these changes, so please reach out to help make a difference. You can find me on LinkedIn.
Kevin Pho: Jeffrey, we will end with you—your take-home messages.
Jeffrey Roche: I always say health care takes a village and a community. To Kim’s point, we really have to rally together and engage every facet of the health care ecosystem. If you are serving in a leadership role at your health care system or you are on a health system board right now, look around and really think about whether your board is representative of your community. Are the voices of your employees being heard by your board? Is your executive team listening to those voices, paying attention to the human connection? Lives are literally at stake every moment in our U.S. health care system, and we must demonstrate respect, compassion, and empathy for the incredible doctors, nurses, clinicians, and all staff—both nonclinical and clinical—in our health care system. Boards have an important responsibility here. Again, Kevin, I applaud you and Kim for being not only pioneers but also incredible voices in this quest, and I am happy to be here along with you.
Kevin Pho: Kim and Jeffrey, thank you so much for sharing your perspectives and wisdom, and thanks again for coming on the show.
Kim Downey: Thank you, Kevin.
Jeffrey Roche: Thank you.
