Organizations have habits as do boards and leadership groups. Like individuals, some of these habits are good (timely financial audits); some are bad (no performance evaluation for the board or board members); some are inexcusable (no real-time decision support to reduce medical errors).
This is not a trivial or rare problem. Recent reports indicate that "during a 10 year period, 50% of the U.S. population will receive unnecessary medical care. During this time medical care will kill 7.8 million people. This is more than all the casualties from all the wars fought by the U.S. in its entire history."* Nor is this a recently discovered problem. The Institute of Medicine reported similar figures in 1999. Seventeen years and counting? That is clearly a very entrenched, very bad organizational habit. Healthcare boards at all levels have considerable responsibility in the continuation of these indefensible results.
The thing about habits is that they are easy. Some are easy from the get-go (sugary drinks pacify infants); some start noxious but become easy and therefore habitual (smoking). Once a habit becomes part of your life it takes a great deal of energy and thought and commitment to change. If we get into rewarding ourselves for getting through a hard day with a cocktail or two, it is not a simple matter to substitute a five mile run for that cocktail.
Before a board takes its' own appraisal seriously they have to understand that their own bad habits makes suspect their leadership for continuous improvement in their organization and their members. "Do as I say, not as I do" has never worked anywhere and is just insulting to other busy professionals. You gotta walk the walk, not just talk the talk.
It doesn't matter where you start correcting a bad habit, or what intervention-du-jour is currently in vogue. LEAN is as good as Six-Sigma as is Process Improvement to correct organizational and board bad habits. You might get even better return on investment and a lot less local carping with a quality local consultant willing to develop and extend your own leadership team. What matters is making the commitment to change the habit of ignoring the evidence and taking the easy way. Just like quitting smoking, losing weight or substituting a run for the cocktail: it is the commitment that comes first and sustains the trial and error and the persistence required to succeed.
*Dr. W. Gifford-Jones, "Medical care main cause of death". Toronto Sun, Monday April 4th 2016.