Priorities on the Board: Board member backgrounds and hospital social responsibility

A report published in the Journal of General Internal Medicine last month investigated the professional background of board members at hospitals with top rankings in U.S. News & World Report The report revealed that a plurality of board members (44%) come from the financial sector, including private equity, wealth management firms, banks, and insurance. The report’s authors, Dr. Suhas Gondi at Brigham and Women’s Hospital, and colleagues also note that less than 15% of board members were healthcare professionals. 

Hospital board members do have a fiduciary responsibility to the organization, but their professional experience and knowledge will shape how they pursue their priorities. For example, hospitals lacking physician representation on their boards are associated with lower measures of quality of care. Simultaneously, having board members with medical occupational backgrounds in both for-profit and nonprofit hospitals correlates to higher community benefit spending, primarily uncompensated care. This is hugely impactful; our data at the Lown Institute shows that in 2019, nonprofit hospitals nationally had an $18.4 billion deficit between their community investments and the estimated value of their tax breaks. 

Professional training and experience of board members can shape how they prioritize their resource allocation. And when it comes down to profits or vulnerable patients, it has been shown time and time again that profits usually win. To change the choices a hospital board makes, it may be necessary to change the composition of the board.

Many physicians truly internalize their oath to do no harm; they continue to view the patient as the most important stakeholder in the healthcare business. Other clinical staff like nurses, who spend the majority of their time working directly with patients, have valuable unique insights and skills to bring to a hospital board. Including nurses on hospital boards could also have the beneficial side effect of demonstrating to the nursing workforce that their voices and insights are valued. 

The “People’s Hospital” – a past vision that deserves resurrection

In addition to healthcare professionals, another type of stakeholder is often missing from the decision-making – community members.

In July 1970, the activist group the Young Lords occupied Lincoln Hospital in the South Bronx in protest of the unsafe, overcrowded conditions (the hospital was locally known as the “butcher shop”). These young activists seized the building for 12 hours, making concrete demands that rippled out and became one of the first patient’s bill of rights. Their vision was a “People’s Hospital,” one that provided quality, accessible care with respect and dignity to all members of the community, including staff. Accountability to the community has paid off for Lincoln Medical Center; the hospital is one of the top-ranked hospitals for equity and inclusion on the Lown Hospitals Index.

That’s a vision we’re still working towards today. Consider Massachusetts General Brigham, one of the largest hospital systems in the country. On Thursday, residents and fellows announced their intent to unionize, with demands very similar to those of the Young Lords. Perhaps with more board-level representation, healthcare workers and community members can together change the priorities of our hospitals and healthcare system for the better.