As home and community care plays an increasingly central role in our healthcare system, the role of CCAC (Community Care Access Centre) boards of directors is also becoming more critical. CCACs (as well as non-profit community groups involved in the provision of home and community care) need boards that are effective, efficient and offer strategic value to their organizations.

Four years ago, Toronto Central CCAC (TC CCAC) was at a crossroads. We had a new CEO, a new Board Chair, and a new strategic plan. And we were facing a radically changing external environment: home and community care was growing in prominence in Ontario’s health system, and new government policy agendas required transformation in the sector.

However, there was a feeling by the senior team and a few board members that the organization had a high-performing senior team but the board struggled to add a similar level of value and contribute meaningfully. Board members had varying perspectives on the role and functioning of the Board: several believed they needed to know more about operations. We found the senior team was spending a lot of time on board support without getting sufficient return on our investment.

We knew our Board wanted to add value, but we had to help them figure out how. During the past three years, we’ve made substantive progress. Today, we are realizing the early benefits of a cultural shift in how board members see their role – board work and senior team support has been streamlined, and discussions have been elevated to a much more strategic level.

Here is our ten step plan for shifting from a ‘good’ board to a ‘great’ board:

1. Communicate expectations from the beginning.
   We’ve revamped our orientation for new board members to include not only an introduction to the organization, but also training in NFP (not-for-profit) governance and their role in providing oversight and strategic counsel to the executive team (not in reviewing operational decisions). We also discuss our governance culture, decision-making, and approach to meetings.
    
2. Determine what model of governance makes sense.
   As our organization grew in size and complexity, we determined that a community representative board no longer suited our needs. We now do targeted recruitment of skilled professionals based on an assessment of what our changing organization needs at a governance level. This shift from a community representative board to professional skills-based board has enabled us to leverage greater strategic value.
    
3. Right-size the number of meetings.
   Between board and committee meetings, we discovered we held 47 meetings in a single year(!). The Board Chair and CEO attended each one. This was a significant investment of time and effectively meant that someone still in the workforce could not take on the position of Board Chair. We developed an annual workplan that identified when input or decisions were required (budgets approved, strategic planning discussions, financial reporting) and scheduled board meetings accordingly.
    
4. Share leadership.
   Because our Board Chair attended all committee meetings, the role of the committee chairs was weakened. This was changed, so the Board Chair only exceptionally attends committee meetings by request of the Committee Chair. A new targeted orientation for committee chairs ensures they are fully able to direct the activities and meetings of the committees.
    
5. Reduce the time committed to procedural work.
   We standardized the formats of agendas, minutes, presentations and briefing notes for the board and committees to make them easily read and understood. A consensus agenda was adopted so limited valuable meeting time is spent reviewing agendas, minutes or materials that are provided for information only. Briefing notes and presentations are identified as being for consultation, decision, approval, or information only and include key questions for consideration.
    
6. Assess meeting materials for appropriateness.
   Although our senior team was concerned about time spent addressing operational questions from Board members, when we looked at the material we were providing, it was very often operations-related. We needed to take a step back to identify what we wanted from the board, and engage in mutual discussion about what constituted oversight. Once we increased focus on strategic information, conversations started to shift accordingly.
    
7. Use external experts as appropriate.
   It can be tricky for Executive Team members to try to make changes to governance work. It may appear self-serving. We engaged a governance expert who provided an informed third-party view on our governance effectiveness work. With the consultant, we agreed upon a change plan focussed on: people, culture, structure, and process.
    
8. Understand that Board members not only want to add value, but they also want to receive value.
   We began to feature guest speakers as part of board meetings: patients, caregivers, partners and funders. Topics range from the front-line care experience to health system policy. This helps Board members better understand our organization, and provides stimulating learning opportunities, re-engaging many in the value of volunteering on the board.
    
9. Evaluate your progress and improve continuously.
   After every meeting, board members complete a 5-minute survey to identify what’s working in the meetings and what needs to be improved. The Governance Committee uses the feedback to make improvements. Three meetings this year have been called “The best meeting yet!” In addition, we have annual Board, Board Chair, and Committee Chair evaluations. This year, we are introducing peer-to-peer evaluations of individual Board members.
    
10. 
    Board term limits should allow a balance of experience and new thinking, and we now engage in early identification of potential leaders, starting from the recruitment phase. Training and coaching are being put in place to develop the leaders we will need for tomorrow.

A final point of reflection – we chose not to wait until there was a problem to make improvements. Instead, we used the opportunity of leadership changes to rethink our Board effectiveness. Governance needs to evolve within each organization and with the emerging changes in health care. We are fortunate to have many volunteer Board members across the health system; it is our responsibility as senior leaders to ensure we are optimizing their value to us, to patients, and to the system as a whole. 

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