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Board Self-Assessments Discussion Guide

Board Self-Assessments Discussion Guide

Watch the Board Self-Assessments Webinar Here

Download the Session Slides Here

Prepared by
James A. Rice, Ph.D.
Brian E. Rice, MHA

Series Preface:

This discussion guide is part of an “ACHD Governance Toolkit” composed of a series of six recorded webinars organized by the Association of California Healthcare District (ACHD) to encourage and support healthcare district boards of directors to further enhance the performance of their governance models and practices. The six topics addressed are:

  1. Community Engagement
  2. Balancing Governance & Management
  3. Board Orientations
  4. Strategic Planning
  5. Board Self-Assessments
  6. Board Education Programming

The six programs consist of an approximately 15-minute video with a downloadable slide deck, and a short discussion guide to stimulate healthy conversations between the CEO and the board about practical ways they can collaborate for more effective and efficient board decision making in each topic. The programs are also intended to help encourage healthcare districts to consider the successful completion of ACHD Certification.

The ACHD Certified Healthcare District Program promotes good governance for healthcare districts by creating a core set of accountability and transparency standards. This core set of ACHD standards is known as Best Practices in Governance and districts that demonstrate compliance are designated by ACHD as a Certified Healthcare District for a period of three years. Find more information on our website.

Each of the six webinars can be optimized when the Board Chair and CEO collaborate to organize a five-step program of education for the coming year.
The five-step process for your board-CEO conversation to address these topics is suggested to be:

  1. The CEO and Board Chair reaffirm their shared commitment to the continuous enhancement of the board’s education and capacity development. Jointly express this commitment at the beginning of each year.
  2. Adopt a board policy of continuous board development that embraces:
    * Periodic CEO briefing materials on topics relevant to the strategic plans and challenges of the healthcare district.
    * A calendar of speakers in routine board meetings on hot topics to help the district’s vitality.
    * Organization of a “Symposium” on board best practices with other community organizations and associations for joint learning and community leader networking.
    * Participation in small groups of district board members at ACHD or other state conferences on strategic issues and trends.
    * Organization of customized educational readings or mentors for each board member based on their unique needs and requests.
  3. Organize a 30-minute educational session during a Spring and Fall board meeting to focus on one or more of the six Webinar topics. Ask one board member to team with a member of management and/or the staff to jointly present and help guide the discussion around the webinar and this Discussion Guide. This team approach helps build interest, ownership and shared responsibility among the board for its ongoing development.
  4. Encourage all board members to watch to the short video recording of the webinar before the scheduled discussion session. All should come to the discussion session ready to contribute in these ways:
    * Assess how well this topic is being addressed in your healthcare district;
    * Bring questions and ideas about how your district might better address this topic in the future; and
    * Bring some suggested resources that might help your healthcare district enhance its learning and planning for this topic.
  5. Conduct a collegial assessment of each program to see how its value to your district could best be optimized in the coming year. Share your ideas with the ACHD staff.

Thank you again for all you do for the people of your healthcare district, and for the enhanced performance of your healthcare district board work!
Contact ACHD staff at any time with questions, or contact us at

Let’s begin moving though this discussion guide.

Board Self-Assessments


Thank you for your interest in exploring how your healthcare district board might better understand and develop its capacity for enhanced board self-assessments.

This discussion guide is not a stand-alone document. The guide is to be used in conjunction with the corresponding recorded webinar and slide deck. We see Board Self-Assessments as essential to continuously strengthen the work and performance of your healthcare district governance.

We encourage your board and CEO to collaborate in conversations and shared strategic thinking and planning to support your board members, individually and collectively, to be more effective in establishing and nurturing new strategies and structures for board self-assessments.

This Discussion Guide is organized to answer these questions:

  1. What is a good “board self-assessment”?
  2. Why is it important?
  3. Common issues or challenges?
  4. What can boards do to be more successful?
  5. Where to secure resources for further educational insights on this topic?

Within each of these five sections, we pose a series of questions to guide your conversations about how best to plan for and conduct board self-assessments as a means to better accomplish the mission of your healthcare district.

1. What is a good “board self-assessment”?

We have found that an effective and valuable Board Self-Assessment (BSA) is a survey, usually conducted every year or every two years, to evaluate the degree to which the board (and often management) believes the board’s work is functioning at a high level of performance.

The survey incorporates questions about key dimensions for good governance of healthcare districts, and invites each board member (and periodically the senior management team) to assess the degree to which they believe the board and its committees are accomplishing their fiduciary duties.

ACHD offers a very good assessment tool for free to all ACHD members that generates a useful and easy to read summary of the performance review. Results can then be used to shape an annual board education and development plan for the coming 12-24 months. Please reach out directly to ACHD if your board is interested in taking advantage of this member benefit.

To further your thinking and actions in this area, please try to ask and answer these questions:

  • How might you adjust your board policy framework to ensure an annual or semi-annual self-assessment is a part of your board’s culture?
  • How does your survey help identify insights into how the board thinks they are performing in meeting their governance duties collectively and as individual participants?
  • What are the advantages of periodically asking management to participate in the board assessment process to help advance overall governance performance?

2. Why is it important?

Conducting, and then using the results of a BSA to continuously improve your board work is important because:

  • Continuous review and improvement is a best practice;
  • Medicare requires good governance as a means to ensure a culture of good performance via better quality, use of resources, and good access to needed to care;
  • Boards help ensure compliance with public payer rules;
  • Performance review helps build confidence among providers, staff, the community, media and donors; and
  • Board member time, talent and pride are more likely optimized when good self-reflection yields better governance.

How would you address these questions to improve the use of your board self-assessment?

  • How might you best ensure follow-up discussions of your board review occurs at regular board meetings?
  • How can you encourage your self-assessments to guide a commitment of the board and each committee to do at last one activity better in the coming year?
  • How can your assessment shape the scope and nature of your board educational programming in the coming year?

3. Common issues or challenges?

Our work with many governance bodies across the country have identified several common challenges to utilizing a consistent BSA process, such as:

  • Lack of board and CEO recognition of the value of the BSA to be used to continuously enhanced board work.
  • Lack of commitment to use the assessment results to guide future board work performance enhancement via board education and development.
  • Unwillingness to invest in ongoing board development to improve the board’s effectiveness and performance growth.
  • Lack of experience with use of web based, confidential survey tools.
  • Discomfort of board members to identify less than perfect performance.

What do you see as the key challenges to deploying a BSA and utilizing the results to enhance the board’s effectiveness?

4. What can boards do to be more successful?

Leveraging the talents of your board members and management team is critical to having a high functioning governance model. We encourage you, if not already in place, to establish a board commitment to continuously improve the performance of the board on behalf of the people served by the healthcare district. This commitment can include:

  • Designing an assessment process to balance the board-only survey with one that invites senior managers’ input;
  • Consider periodically using interviews via outside consultants;
  • Commit to using results to design annual board education program (see accompanying PowerPoint presentation in webinar #5, slide 9 for example framework); and
  • Consider comparative discussions with other organizations on their approach and tools.

Please discuss how you can best answer these related questions:

  • How can the results of your recent BSA be readily accessible and utilized for continuous governance improvement?
  • What are other experiences you have in governance that could further inform your efforts with the healthcare district’s governance performance?
  • Pick one of the challenges in section 3 above. How should your board and executive team best remove, reduce or work-around that obstacle to an enhanced board assessment process?

5. Where to secure resources for further educational insights on this topic?

We encourage you to have a conversation about where you can turn for ideas and resources to enhance board self-assessments that enable effective and efficient governance. Our suggested sources are shown here:

What do you find as even better resources to use in your board self-assessment efforts?

Thank You

Thank you again for all you are doing to enhance your board self-assessment process.

Please reach out to ACHD staff for comments or suggestions to improve this board development discussion guide and webinar.

And thank you for all you do for the people you exist to serve in your healthcare district!

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