Rice Discusses Collaborative Governance and Boundary Spanning

Continuing our series on excerpts of interviews with iProtean experts, we feature our old friend and new iProtean expert, Jim Rice, Ph.D., FACHE., on governing in an era of population health.


We’re moving into an era of population health management that will have profound implications, both challenges and opportunities, for boards of directors. I think it’s going to be important to examine some of the elements of what population health management is all about, and some of the requirements for success that are going to drive the work and the decision processes of boards for the next three to five years at least.


Population health management will reward us with psychological, political and financial incentives to pay attention to the health and well being of large populations—not just those patients who turn to our physician clinics and to our hospitals, but the population itself. The board will have to be concerned about what happens to the people’s health before they present themselves to their health care or hospital campus, and then what happens to these individuals when they are discharged from the hospital. To manage that whole continuum of care means that the boards of directors will have to oversee some entirely new collaborative arrangements with these organizations. And it’s going to move them into the arena of social determinants of health.


When you examine what we know across the globe about the social and societal factors that influence the health and well-being of large populations, we know that it’s about poverty and education, food security and water. And also we know, of course, those factors that create illness or injuries that have to be managed. All of these different risk factors are going to be on the plates of boards of directors to consider how best to manage those risks, how to mitigate those risks, how to remove or reduce those risks. And that’s going to mean they have to work with completely new kinds of organizations along this continuum of care. They will have to not only work with physicians, durable medical equipment companies, skilled nursing facilities, home health agencies, but they’ll also have to work with schools, with police, with first responders, and with employers—because the underlying driver of the ability to access health services and to modify behaviors relates to poverty.


So, boards will have to be engaged in discussions with completely new kinds of organizations that help strengthen the fabric of the society and the community and the regions in which they’re working. These organizations are often organizations that they are not used to working with.


When we look at the challenge of working with new organizations and governing across these organizations, organizations we may not control or own, we’re going to have to develop some new competencies and skills. One of the clusters of these competencies is the art and science of boundary spanning. It means that board members have to have one of their feet in their own organization, but also working with other organizations. They’re going to be spanning the organizational boundaries to get at more health gain, not just health care.


Now, we know that old joke about people that have one foot on the dock and one foot in the boat, so that’s one of the risks of boundary spanning. If we’re not very careful with our balance, we’re going to find that we’ll take some stumbles and run into some problems in our efforts to govern inter-organizational relationships.



We will feature Dr. Rice in several courses in 2016. Stay tuned!



iProtean subscribers, the advanced Governance course, Committee Effectiveness, is in your library. This course features Barry Bader and Pam Knecht, who cover committee structure and task forces, ideal committee size and composition, independent members, the committee charter, information and reports, and committee evaluation.


And watch for our upcoming course, Population Health and Alternative Payment Models, featuring Marian Jennings and Dan Grauman.


For a complete list of iProtean courses, click here.



For more information about iProtean, click here.