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Board Work and Boundary Spanning

Board Work and Boundary Spanning

Board Work and Boundary Spanning:

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”1like 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 scare 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 and medical groups.


1: Healthy cities tackle the social determinants of inequities in health

2: Association for Community Health Improvement website

3: Population Health and the Rise of Consumerism

4: Improving Community Health Through Hospital Partnerships: Insights and Lessons Learned

5: Improving Community Health Through Hospital - Public Health Collaboration


James A. Rice


Jim Rice, PhD, FACHE is the Managing Director & Practice Leader with the Governance & Leadership service line of Integrated Healthcare Strategies, a part of the Gallagher Human Resources & Compensation Consulting practice. He focuses his consulting work on strategic governance structures and systems for high performing, tax-exempt health sector organizations and integrated care systems; visioning for health sector and not-for-profit organizations; and leadership development for physicians and medical groups.

Dr. Rice holds masters ...

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