Hidden treasures: Mining vs. managing health system boards

By Kulleni Gebreyes, M.D., chief health equity officer, Life Sciences and Health Care consulting leader, Deloitte Consulting LLP

We live in a time of great opportunity and uncertainty driven by rapid changes in social norms, economic realities, and technological advances. As a result, hospital and health system board members might need to navigate complex and ambiguous landscapes while maintaining a cohesive and clear strategy. At the same time, boards often seek to align mission and margin to provide everyone with the opportunity to achieve their full potential in health and well-being. 

I recently met with Michele Richardson, JD, at the Black Directors Health Equity Agenda’s (BDHEA) annual summit in Washington, D.C. BDHEA is a coalition of board directors that seeks to advance health equity and achieve long-term and sustainable reductions in health disparities.¹ Michele is a board member and founder of BDHEA. She is also the board chairperson at Advocate Health, one of the nation’s largest nonprofit health systems. (Advocate Health was formed in December 2022 when Atrium Health and Advocate Aurora Health merged.) At the summit, Michele was part of a panel of health care executives who explored the future of health equity. I was invited to moderate one of the sessions.

Michele and I met four or five years ago, and we quickly realized we have a lot in common. We share similar leadership styles and we both have a strong belief that equity and diversity make people and organizations stronger. We also share a love of fashion (right down to our style of watchbands), and we even have the same birthday. I connected with Michele shortly after the summit and we talked about the impact health system boards can have on the patients and the communities they serve if they lead with courage and celebrate diversity. Here is an excerpt from our conversation:

Kulleni: What do you think is the role of the modern board chair?

Michele: A board chair is, among other things, a bit like an orchestra conductor who is working to advance and productively harmonize the best from each of the instruments assembled. For example, a board chair might help members of the Finance Committee and the Safety and Health Outcomes Committee understand how their work is complementary and how it contributes to the organization’s larger vision. Board leadership shouldn’t shy away from the occasional discordant note in this orchestra. Productive dissent is healthy and can help highlight important diverse perspectives.

Kulleni: Consensus is often seen as being essential to a well-functioning board. You say that isn’t always the case. How do you navigate differences without creating rifts between members?

Michele: Board effectiveness isn’t about making everybody think and say the same things. I believe in creating an environment that fosters honest and candid discussions. It is about having courageous conversations that illuminate common threads but also highlight our differences. This allows the board to identify areas where a new way of thinking might be needed. One of our board’s principles is ‘listen first to understand, then to be understood.’ That’s where we start. When you get people listening to understand what you're saying, rather than trying to get their point across, they tend to view things differently.

Kulleni: I can imagine that some of these conversations are focused on highly sensitive issues. Which topics do you think tend to create tension and friction in the board room? How do you navigate around those tension points?

Michele: The biggest friction point usually comes down to resources. One of the key roles of a board is to consider capital allocation in an environment where needs are usually high, but resources are often severely limited. The board, assisted by management, might be asked to consider consider both immediate needs and long-term goals, and then make the best possible strategic decision. If, for example, they decide to invest in a new building to serve people who live in underserved areas, they might also need to weigh the long-term return on investment heavier than a normal ROI evaluation would suggest. When our two health systems merged, the new board led with our values. It concluded, among other things, that providing safe, high-quality care for our patients would remain our highest priority. We also agreed that in many of our communities, quality care required an ongoing commitment to equity. We committed to becoming a national leader for health equity to ensure the best of care for all of those we serve. Nevertheless, there are pain points when capital is limited. We often have to examine ROI in a non-traditional way so that our investments align with our for-all mission.

Kulleni: How do you foster an environment for candid discussions that leads to decisions that are aligned with mission and ROI?

Michele: The first step is to think about ways to get the most out of everyone at the table. In the old days, everyone just wanted consensus and agreement. Today, CEOs need to extract the maximum value from the time the board and CEO spend together. It would be easy to manage a board agenda so that nothing controversial is ever discussed. But the board and the CEO need to lean into being brave and address difficult issues that can impact the organization. Courage counts. There also needs to be a shift—from a model of managing a board to mining a board.

Kulleni: Mining instead of managing a board sounds like a transformational idea. What does it mean and why do you think it is important?

Michele: The first step in effectively mining a board requires doing research and gathering deep information about everyone sitting around the table. It requires an inquiry that goes well beyond listing an individual’s accomplishments. This includes determining a person’s unique professional and personal experiences that inform their perspective and shed light on areas where they might be most helpful to the management team. Everyone on my board has different experiences with health care, and all of those experiences have value.

Kulleni: Let’s put that idea into action: Michele, tell me about yourself and your lived experiences.

Michele: I moved to the Atlanta area several years ago from a community on the South Side of Chicago where the average life expectancy is 30 years lower than on the North Side of town.² Maternal mortality rates there, and in Georgia, rival any underserved country in the world.³ In Georgia, where I live now, there are 159 counties and 78 of them do not have an OB-GYN.⁴ If I go to an emergency room today, my professional background and socioeconomic status won’t necessarily shield me or my family members from receiving sub-standard care based on invalid assumptions, made by medical personnel, based on my race and my gender.⁵ My lived experience is that some people are treated differently because of how they look. Everyone should be treated with respect.

Kulleni: How does your identity and lived experience enrich the value that you bring to the boardroom? What riches does that unearth for the organizations and communities you serve?

Michele: I believe in creating a culture that treats everyone with dignity. I serve on boards that focus on bringing value to the community. At Advocate Health, we begin every meeting with something we call Connect to Purpose. We benefit from hearing the voice of our patients through our team members who work in underserved and other communities every day. We recently heard from one of our Atrium physicians who works closely with underserved young women through our Centering Pregnancy model in Charlotte, North Carolina.⁶ Hearing these women’s stories had a significant impact on the board. We have also heard from team members who are helping formerly incarcerated people get on their feet financially, progressing to full-time productive work within our health system. It has been a win-win program. Hearing from those we serve helps the board members see our strategy in action.

Kulleni: What hidden treasures have you found in the diversity and lived experiences of your board members?

Michele: Study after study has confirmed that diverse viewpoints and diverse boards lead to better outcomes and may also help improve the bottom line.⁷ We understand the value of diverse viewpoints within our system. A diverse board makes it possible to identify costly challenges and develop strategies to address them. It won’t happen overnight, and it requires early investment and commitment. When you have a board with three or four women, for example, members naturally ask more questions about gender diversity and impact. When board members represent different communities, you start to look deeper into how decisions might impact the people who live in those communities. Increasing the diversity on a board might lead to questions that some members might not have thought about before. Health system boards are more diverse than they were 20 years ago, but diverse members still represent a small percentage of an overall board. Across health care, we certainly have an opportunity to increase representation.

Kulleni: You have inspired me to share my story and lived experiences with you. I was born in Ethiopia and spent my early childhood there. It wasn't until I moved to the US that I saw television images of Ethiopian children who were starving. Many of them were my age. I hadn’t done anything to have a different life than them. But I looked at the young girls and felt like I am her and she is me. There are circumstances beyond our control, and it is important to bring humility into every space that we're in. My identity and life experiences are the foundation of my commitment to creating a better world in which everyone has the opportunity to achieve their full potential in health and well-being.

Michele: The idea of “I am she and she is me” really resonates. It creates space for us to acknowledge our commonalities, respect our differences and elevate our humanity. We can then treat one another with respect and dignity.

Conclusion

The strategy of mining a board—as opposed to managing it—can reveal some of the hidden treasures that lie within the peaks, valleys, and depths of our identities and lived experiences. Leadership can become transformative when each board member's unique background is seen as an asset in the decision-making processes. This can lead to more informed and more effective governance. This approach not only fosters a culture of respect and dignity but also can help boards to navigate resource constraints. By valuing and harnessing the unique backgrounds and viewpoints of each board member, health systems might be better prepared to meet community needs, address disparities, and drive meaningful change toward equitable health outcomes.

The executive’s participation in this article is solely for educational purposes based on their knowledge of the subject and the views expressed by them are solely their own. This article should not be deemed or construed to be for the purpose of soliciting business for any of the companies mentioned, nor does Deloitte advocate or endorse the services or products provided by these companies.

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Endnotes

1_{Black Directors Health Equity Agenda}

2_{Chicago’s lifespan gap: Streeterville residents live to 90. Englewood residents die at 60, Chicago Tribune, June 6, 2019}

3_{Fighting the maternal mortality crisis, Emory University/Rollins School of Public Health, Spring 2023}

4_{78 Georgia counties have no OB-GYN, Georgia Alliance of Community Hospitals}

5_{Implicit bias and racial disparities in health care, American Bar Association}

6_{Birthing care & support, Advocate Health Care}

7_{How and why to increase board diversity, American Hospital Association Trustee Services; Diversity improves performance and outcomes, National Medical Association/Elsevier Inc., 2019}

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