Healthcare Issues & Trends

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Boundary Spanners

Posted on February 15, 2017 by James A. Rice, Ph.D., FACHE

New challenges for trustees in the journey to population health and accountable care

It is difficult to have a board meeting now without at least one question like…. “How are we progressing to deliver health gain as well as health care in the communities we serve?”

Answering this question by Board and C-Suite leaders, however, is not easy.

It requires broader and deeper engagement between board members and their counterparts in organizations and institutions influencing the “social determinants of health”[1] like housing, poverty, schools, food, and safety. Board members must not only be wise about the affairs of the hospital or health system, but be informed and linked to many other community based organizations. They must now not only be good stewards of their institution’s resources, but also be “boundary spanners” that work across organizations to: define community health needs; develop a blueprint for collective community action; and champion the mobilization of scarce resources to remove the root causes of poor health, communicable and chronic diseases, as well as injuries and accidents[2]

Boundary spanners value new forms of “strategic listening”[3] and what we see in Canada as “collaborative governance”[4] that elevates improvements in overall community health above the increase of admissions or surgeries. It is this tension in planning and budgeting for “collective action for health”[5] that hospital leadership wrestles with in mapping their journey into the challenging domain of high performance and population health gain. 

As “trustees” of community assets entrusted for use by clinical colleagues to both enhance health care and health gain, boards require a clear sense of their role and responsibilities; and drive to implement decision-making processes that wisely engage diverse stakeholders in collective action for enhanced community vitality.

To explore smart practices for board decision making in this new age of stewardship and community health gains, you may find it useful to get back to the basics and a set of 50 good board work practices for health systems boards

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Community Health Centers at Risk

Posted on November 10, 2016 by James A. Rice, Ph.D., FACHE

Community Health Centers have a long and respected history of protecting, promoting and restoring health for the most vulnerable of our communities. But they are threatened by the potential loss of federal funding. See:   A recent meeting of our  Governance Academy with leaders from the Minnesota Association of Community Health Centers is one small initiative to help address this risk.  Developing effective Boards must help strengthen the vitality of these community health centers, and also foster more effective collaborative governance with local health departments and community hospitals.  Finding common ground should be in the shared development of Community Health Needs Assessments (CHNAs) such as outlined in our recent webinar with Carrot Health.  CLICK HERE to watch the presentation. 

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Voting and Visions

Posted on November 8, 2016 by Gallagher Integrated

On Election Day, we know painfully well that Politics is often referred to as the art of the possible. But politicians, just like Board Chairpersons, need a vision to guide their policies and bridge-building among diverse stakeholders.

The key visionary concept this year must be bridge-building. How can we reach out to others that have different views and experiences than ours to find common ground for the most good for the most people?

For those of us dedicated to smarter, stronger and more sustainable health systems, we can find provocative ideas for bridge building in the recent work of the Robert Wood Johnson Foundation’s “The Culture of Health

San Diego’s bold partnerships in their Live Well San Diego should also be followed by board leaders to explore fresh ways to embrace and master the Social Determinants of Health, see: 

All of these initiatives, however, will call for us all to break through old ways of thinking, and be prepared to make more investments in community health and poverty reduction than in our medical equipment arms race. Look at the many ways that the Foster McGaw Award winners are building bridges to their communities, see:

Vote for community leaders who are boundary spanners, reaching across party, racial, ethnic, age and income lines to do “Collaborative Governance” that yields board work that is SMART…Stakeholder engaged. Mission driven. Accountable to those we serve. Resource mobilized. Transparency expected. To see our White Paper on Collaborative Governance, see:

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A NEW Infographic on Governance and Health Study Group

Posted on September 9, 2016 by Gallagher Integrated


 Between July 11 and July 22, 2016 15 participants from 35 countries participated in the "Governance and Health Study Group", a 2-week facilitated, online group hosted on the Global Health eLearning Center. The group's purpose was to provide a space for individuals to discuss the challenges and share experiences in applying the practices of GOOD GOVERNANCE in HEALTH SETTINGS. Click here to see the results in this new infographic:


 INFOGRAPHIC To learn more, participate in a study group, or take a free eLearning course, visit   


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Hospital Boards Need to Worry and Watch regarding New Jersey Property Tax Threat

Posted on August 30, 2016 by James A. Rice, Ph.D., FACHE

Can you afford to pay millions in property tax next year?

Eager to tap into a new source of cash to lower New Jersey's notoriously high property taxes, local officials have filed tax appeals challenging the tax-exempt status of 35 nonprofit hospitals.  [1]

The litigation continues to pile up in response to last year's precedent-setting  tax court ruling and settlement which required Morristown Medical Center  to pay Morristown $15.5 million in lieu of property taxes. The judge found the hospital operated in many ways like a for-profit entity and should share the cost of public safety and other municipal services.

Two of the 35 cases have been settled already, resulting in additional revenue for the city of Elizabeth and Edison Township.

In March — after 15 municipalities filed tax appeals — Gov. Chris Christie called on local officials to support a two-year freeze on new litigation while a commission devised a solution that would preserve the tax-exempt status of the 58 nonprofit in the state but require hospital make contributions in lieu of taxes.

Christie needs the Legislature to pass a bill creating the commission, however. Assemblyman Herb Conaway (D-Burlington), chairman of the Assembly Health Committee, introduced the bill, but Assembly Speaker Vincent Prieto has opposed it, saying the matter could not wait two years to be resolved.


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