Recently, I interviewed Dr. David Morris, a physician in Ireland and CEO of Verity Barrington, along with Geoffrey Roche, director of workforce development for Siemens Healthineers. Our conversation focused on successes in health care in both Ireland and America, and the lessons we can share to improve the system. A critical part of our discussion revolved around the role of health care boards. Geoffrey posed a pivotal question: “Where are the boards? Where are they to care about these issues?!” This led to inquiries about how to hold boards accountable for shaping organizational culture and the future of health care. Geoffrey speaks to the role of boards here…

Health system boards bear significant responsibility for the strategic direction and governance of their organizations. Traditionally, their primary duties included ensuring high-quality care, sound financial management, and regulatory compliance. However, as health care faces increasingly complex challenges—such as workforce shortages, shifting demographics, and changing patient needs—boards must expand their focus to encompass organizational culture, workforce development, and career pathways. These aspects are essential for the long-term sustainability and success of health care organizations.

Organizational culture: the backbone of health care excellence

Organizational culture shapes values, behaviors, and expectations that guide interactions and decision-making, impacting employee satisfaction, retention, patient outcomes, and community trust. Boards play a critical role in fostering a positive and inclusive culture, which directly contributes to institutional success.

A strong culture depends on clear communication, transparency, and respect for employees at all levels, combined with a commitment to patient-centered care. Boards must actively define and uphold this culture, setting expectations for leadership to model desired behaviors and maintaining high standards of care and collaboration.

Prioritizing organizational culture is not merely a “soft” issue; it is a financial imperative. Organizations with healthy cultures outperform those with toxic environments, experiencing lower turnover, higher employee engagement, and better patient outcomes. The tone set by governance influences attitudes and behaviors throughout the organization, ultimately affecting patient care.

Workforce development and career pathways: the key to long-term success

The strength of health care systems is intrinsically linked to their workforce. Given the acute staffing shortages, especially in nursing, boards must recognize workforce development as a strategic priority. A well-trained and motivated workforce is essential for meeting patient demands and maintaining quality care.

Boards should collaborate with executive teams to create comprehensive strategies that include professional development, continuous learning, and clear career pathways. Investing in training and education for all employees enhances skill sets and improves retention, fostering an environment where career growth is supported.

Moreover, boards must align development efforts with the future needs of their organizations and communities. This proactive approach requires identifying emerging trends—such as advancements in technology and shifts in patient demographics—and adapting strategies accordingly. By fostering career pathways that reflect these changes, boards can help organizations remain agile and responsive.

DEIB: reflecting the communities we serve

A diverse workforce is essential for effective health care. Boards have both a moral and strategic obligation to prioritize diversity, equity, inclusion, and belonging (DEIB) within their organizations, including in their own composition. Diverse boards contribute varied perspectives, leading to improved decision-making and better understanding of the needs of different patient populations.

Achieving DEIB in health care governance requires intentionality. Boards must actively recruit, retain, and support members from diverse backgrounds to ensure representation across race, gender, ethnicity, and professional experience. A diverse board is better equipped to address health disparities and advocate for equitable care. By emphasizing DEIB at the governance level, boards promote inclusivity and equity throughout their organizations.

This commitment must extend to workforce development and career pathways, ensuring all employees have access to growth opportunities. Boards should collaborate with leadership to implement programs that address systemic inequities, reduce bias in hiring and promotion, and foster a sense of belonging among staff.

The case for more nurses on health system boards

One critical gap is the underrepresentation of nurses on boards. As the largest segment of the health care workforce, nurses have invaluable insights into patient care and operational challenges affecting quality and safety. Their presence on boards brings essential perspectives often missing in strategic discussions.

Nurses possess firsthand knowledge of the intersection between workforce culture and patient care. Advocating for their inclusion in governance enhances the organization’s ability to make informed, patient-centered decisions. Boards must actively recruit qualified nurses, enriching board diversity and strengthening governance.

Conclusion

Health system boards have a duty that extends beyond financial health and compliance; they must engage in fostering a positive organizational culture, championing workforce development, and creating inclusive career pathways. DEIB initiatives are not optional—they are essential for building resilient and compassionate systems that serve their communities effectively.

By focusing on these critical areas and ensuring representation from key stakeholders like nurses, boards can significantly influence the future of health care. The time for boards to embrace this responsibility is now, and the benefits will resonate for generations.

Kim Downey is a physician advocate and physical therapist. Geoffrey Roche is a health care consultant.