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Improving Board Accountability
By Brenda Sauer, President, National Association of Healthcare Access Management

Board accountability initiatives can have a powerful impact. They can bring board members into closer alignment, improve performance and advance an organization’s strategic objectives. While it is not easy to change attitudes and behaviors, an accountability program can make a dramatic change in volunteer leadership culture.

Laying the Foundation

Founded four decades ago, the National Association of Healthcare Access Management (NAHAM) is a leading educational, networking and advocacy organization for patient access professionals who manage the "front line" patient registration, financial and support processes. NAHAM currently has more than 6,000 certified patient access professionals and approximately 1,500 members.

Recently, our executive committee concluded there was a need to revitalize our 17-member board, provide leaders with a better picture of their roles and responsibilities and instill a greater sense of accountability. Some volunteer leaders were too influenced by their own personal agendas or regional interests. Other directors found that their full-time jobs consumed most of their time and attention, leaving little for the business of the board.

While these kinds of problems are common in volunteer associations, we wanted to create an action-oriented culture that would lead to better performance. We also felt that the status quo was unfair to our dedicated volunteers, who were putting in long hours to pick up the slack.

After agreeing on the need to improve board accountability, one of our first steps was to create job descriptions outlining the roles and responsibilities of the president, vice president, secretary, treasurer, regional delegates, committee chairs and committee members. Our goal was to provide a clear and consistent description of their leadership roles and provide the foundation for an accountability program.

This year, our board approved these steps and adopted a new two-page code of conduct document that board members must sign each year they serve on the board, in conjunction with the signed conflict of interest policy. The document serves as a constant and contractual reminder of their responsibilities.

Implementing Accountability Practices

After putting that foundation in place, the board then turned to implementing new accountability procedures and practices for individuals, committees and the board as a whole.

First, we set aside time for an evaluation process at the end of our board meeting in November – something new for our leadership. Starting with myself as president, each board member submitted a self-evaluation report on what he or she contributed to the board over the past year. Then, we discussed the performance of the board as a whole and if there were ways we could improve our performance in the future.

We continued that focus on accountability by following a similar procedure at our board's quarterly conference call in February, and we will do the same at our face-to-face meeting in May at NAHAM's 40th Annual Conference & Exposition. After all, it takes a sustained and consistent effort to change old habits.

In addition, our board approved a mentoring program to reduce the learning curve for new board members and provide greater continuity during leadership transitions. Each current member is now responsible for educating a newcomer who is beginning a term on the board. After assuming the position, the new board member will send a report to the current president on the mentoring process – another step in building a culture of accountability. This will lead to greater productivity throughout our organization, while being helpful to new leaders. In fact, I wish that practice had been in place eight years ago when I became a committee chair for the first time and did not fully understand my role or responsibilities.

Driving Better Performance

In recent months, we have seen remarkable progress in the functioning of our committees and board as a whole. Our volunteer leaders increased their ability to fulfill their job descriptions and advance the organization’s objectives. And, evaluating board performance as a whole created a greater sense of teamwork that will also pay off in the future.

Based on our experience, here are several steps for other associations seeking to improve board accountability:
  • Be sure to set the stage first. Discuss the current situation and the benefits that will come from making a change. It's important to get buy-in from the executive committee and then start building a consensus from the entire board.
  • Be patient and persistent. Remember that change does not happen overnight. It takes time to create and instill new practices and procedures.
  • Depersonalize negative feedback. It is better to talk about fulfilling board roles and responsibilities rather than personal issues.
  • Have board members self-report on their activities and effectiveness. This is a useful process for increasing accountability, since no one wants to stand up and say, "I was too busy to do anything last quarter."
  • Set a personal example. An association president or other officer should be willing to serve as a role model. That could mean asking for personal feedback on a question like, "How well am I doing as your president?" Then, you have to be willing to accept both positive and constructive feedback and use those comments to improve your own performance.
In conclusion, adopting formal accountability policies and practices has been a very positive step for NAHAM's board, and we can already see a difference in how we address key issues. I hope that these suggestions will help your board operate more effectively as you advance your organization's mission and strategic goals.

Brenda Sauer, RN, MA CHAM, is the director - Patient Access at New York Presbyterian Hospital - Weill Cornell Medical Center in New York. She serves as president of the National Association of Healthcare Access Management (NAHAM).

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