About 1 in 7 hospital board members works in healthcare

The governing boards of hospitals help set the course for their organizations, and most board members work outside of healthcare, a new study finds.

Researchers examined the composition of the boards of top hospitals and found 14.6% of board members - or about 1 in 7 members - were health professionals, according to a study published Feb. 8 in the Journal of General Internal Medicine.

More than half of all hospital board members (56%) work in finance or business, which is almost four times higher than the number of board members who are health professionals.

The researchers examined the board of hospitals with high rankings in U.S. News & World Reports. They started with the top 20 hospitals and found public information on the boards of 15 hospitals. The analysis was conducted in July 2022.

Most of the board members working in healthcare are doctors (13.3%), the researchers found. Meanwhile, 0.9% of board members, or just about 1 in 100, are nurses.

Almost half of hospital board members (44%) work in the financial activities sector.

The vast majority of those in financial activities (80.2%) led financial corporations, including private equity firms, wealth management firms and banks. Others in the financial activities sector work in real estate (14.7%) and insurance (5.2%).

An additional 12.6% work in professional and business services.

All nonprofit hospitals and health systems are required by law to be governed by a board of directors, the authors note. Nonprofit hospitals account for about two-thirds of the nation’s hospitals.

The authors of the study said the ideal composition of board memberships isn’t clear. But the researchers wrote that the findings could “reinforce voiced concerns about the salience of financial success as a dominant priority for major hospitals, and raise questions about the relative importance given to the interest of clinicians, patients, and communities.”

Few nurses are sitting on the boards of hospitals, and that needs to change, Jennifer Mensik Kennedy, president of the American Nurses Association, said in a January interview with Chief Healthcare Executive.

“That’s where it really needs to start,” she said. “We can’t always rely on the chief nurse executive to be that voice.”

Mensik Kennedy said health systems would have better relationships with nurses, and better odds of retaining nurses, by having the voices of nurses in leadership settings. Many healthcare leaders say they are struggling to keep nurses. Some nurses are leaving bedside roles in hospitals because they don’t feel valued, nursing leaders say. Industry analysts expect to see more labor strife, and possibly more strikes, with nursing unions this year.

Some healthcare leaders have also said they need to get more diversity on hospital boards as they aim to attract a more diverse workforce and tackle health equity.

Jennifer Mieres, chief diversity and inclusion officer at Northwell Health, told Chief Healthcare Executive in a February 2022 interview that the system is aiming for more diversity in the C-suite and on the system’s board of directors.

The system is expanding the criteria of board membership “beyond the financial contribution you’re able to bring to the table,” Mieres said.

The American Hospital Association has recommended that hospital boards should have enough members to carry out tasks, but they shouldn’t be so large that they become unwieldy or hinder decision-making. The association recommends that boards include members with experience in healthcare delivery.

In a 2009 guide to good governance among hospital boards, the hospital association also pointed to the growing need for diversity on boards, so that they reflect the communities they are aiming to serve.

The researchers noted they did not examine the racial or gender diversity of the boards, but they said that is an area that merits additional study.

A 2019 American Hospital Association study of board membership shows 30% of voting members are women. The vast majority of board members (87%) were white in that 2019 report, while 6% are Black, 3% are Hispanic, and 2% are Asian/Pacific Islander. And 42% of hospitals had boards made up solely of white members.

The authors noted other limitations in the new study, including the examination of a limited set of hospitals. However, they also pointed out they looked at systems that employ a total of 240,000 people and account for a combined $200 billion in spending.