San Diego’s eight community hospitals are responsible for the physical well-being of most of the county’s 3 million residents. To ensure the hospitals’ well-being, their boards of directors — some elected, others appointed — bring to their duties a wide range of expertise and a broad array of interests.

Their perks include a small payment for meetings attended to free health care coverage. In general, each board member is charged with helping guide his or her respective health care system along as responsible, long-term community members.

“The boards are a broad representation of the community the hospitals serve,” says Judith Yates, vice president of the Health Care Association of San Diego and Imperial Counties. “Board members should know industry issues and community issues, not just their own hospital’s issues.”

That’s why each board has so many different faces. Made up of attorneys, engineers, real estate professionals, physicians and retired medical staff, most boards are responsible for hiring and reviewing the hospital’s chief executive officer. Boards also oversee finances and look at what the hospital is doing and where the board is in achieving strategic plans.

“A lot of it has to do with how the hospital was created,” Yates says of board responsibilities. “Historically a community would put together its resources. (The board) is part of the legal structure of the hospital. The group is there to advise the hospital on important decisions. Their main responsibility is to ensure hospital business is conducted appropriately.”

Board chairs are a dedicated bunch. They take their work seriously and make the workings and success of their hospital a top priority. Giving several hours of their week to board duties and keeping on top of issues, each chair brings different qualifications and expertise to the agenda.

Palomar Pomerado Hospital

Gastroenterologist Alan W. Larson chairs the Palomar Pomerado Hospital board. He says as a doctor he is aware of patient issues as well as staff issues. It is his job to bring the community and medical staff together. (photo/lambertphoto.com)

Gastroenterologist Alan W. Larson, chair of the Palomar Pomerado Hospital board, has been on the medical staff of Pomerado Hospital for 21 years and a board member for six years. He ran for the seat upon the urging of others to be an advocate for his community. “I am qualified as a physician who has been in the community for a long time,” Larson says. “As a doctor, I am aware of my patients’ issues. As hospital staff, I am aware of employee issues. I care about the community and the importance of the hospital as the key institute in the community promoting health and longevity.”

Members of the PPH board are publicly elected for four-year terms in the November general election. The board oversees and makes final decisions on the financial and strategic plans for the health system and serves an advisory role through committee participation. A board member chairs each board committee, which includes the administrative staff for each area. Committees include finance; strategic planning, human resources; community relations; governance and quality.

The board meets monthly, usually on the second Monday, in addition to monthly committee meetings and various special board meetings.

All board members have equal authority and are responsible to the public to provide strategic guidance and fiscal oversight to the hospital. Larson says he respects the community’s need to address grievances and aims to provide wellness opportunities to people in the district. As chair he is spokesman and sits on all hospital committees. “I work to bring the community and medical staff all together,” he says. “I see my role as a team coach.”

For the public health system, the board oversees and makes final voting decisions on new programs and services, strategic plans and all financial decisions like employee rewards programs and funding of new programs such as the Cal State San Marcos nursing partnership.

Although fund-raising is coordinated through a separate board in conjunction with the Palomar Pomerado Health Foundation, the hospital board identifies opportunities that support the health system.

Larson spends about 10 hours a week on his board duties. Along with free health care, he and other directors receive $100 for each official meeting they attend, to a maximum of $500 per month.

Among the hospital’s accomplishments, Larson says he is proud of its excellent staff and work environment that attracts caring employees.

The biggest challenge for PPH, as at any hospital, is the mismatch of funding. The expectation of the aging population for quality care, the funding of new technology and the looming unfunded government mandate for seismic safety upgrades of health care structures put increasing fiscal demands on the hospital and its board.

“We’re faced with a tremendous need for capital,” Larson says. Add to that the shortage of nurses in California and the hospital must create ways to both find and pay nurses. “It’s the job of the board to ensure we’re on sound financial footing and to encourage public support.”

Two of the board’s biggest responsibilities are hiring the hospital’s chief executive and conducting an annual review of that person’s performance.

“The (2003) hiring of CEO Michael Covert was a great achievement,” Larson says of the endeavor. “He is an outstanding leader and team builder. Covert also is turning things around financially and the board is seeing an increase in customer satisfaction scores.”

Scripps Health

Abby Silverman, a partner in the San Diego office of Baker & McKenzie, chairs the Scripps Health board. She says she took on board responsibility as a way to give back to the community. (photo/lambertphoto.com)

Unpaid volunteers serving a maximum of two three-year terms make up the board of trustees at Scripps Health. As terms expire, a board committee identifies new candidates in accordance with Scripps bylaws. Prospective directors must have expertise in fields such as accounting and finance, real estate, legal, managerial, marketing, information systems and medicine. Trustees must have experience in organizational and community activities or a particular interest or expertise beneficial to governing the $1.3 billion nonprofit corporation. The board also seeks diversity in age, gender and race.

Attorney Abby Silverman, a partner in the San Diego office of Baker & McKenzie, is chair of the Scripps Health board. She joined in January 2000 and became chair this January. She took on board responsibility as a way to give back.

“I have lived in La Jolla for a long time and been a community member since 1970,” says Silverman, who is internationally recognized in employment law and business litigation. “Interested in health care and very active in the community, I was invited on to the board. I perceived it as a challenge. The business of health care, getting health care services to people who need them. It’s intriguing. This is one of the thorniest problems that our society faces right now, within the U.S.

“The biggest business challenge is delivering what we consider a first-class product evenly, fairly and at a price that we can stay in business.”

Silverman says during her time on board the hospital has been able to obtain some high-quality executive talent.

Trustees have overall responsibility for policy decisions and setting the direction for Scripps Health. They ensure there is qualified management in place to carry out the organization’s obligation and mission to meet the health care needs of the San Diego community.

“The biggest achievement that we’ve accomplished is, given our many constituents, a level of communication that has us all (doctors, nurses, medical staff) swinging in the same direction,” Silverman says. “Another huge achievement is the empowerment of our executive leadership. We have a terrific team and it’s made a real difference.”

Scripps’ board sets the overall direction, hires the CEO, approves the budget and establishes policy for operations and strategic growth. Trustees oversee management, finance, workforce and quality of care issues, as well as physician relations and ensuring the organization serves the community’s health care needs.

During Silverman’s first year on the board, CEO Chris Van Gorder was hired. The trustees meet in full session every other month. In addition, all trustees participate among the board’s nine committees, which meet regularly, and two annual board retreats. They may be asked to attend special board sessions as needed. As board chair, Silverman says she spends about eight hours a week on hospital matters.

“There are many people in the community and in my firm who spend a great deal of time in the community,” she says. “It’s rewarding and it’s necessary for a vibrant community.”

Silverman is on the complex litigation and employment law panels of the American Arbitration Association; a member of the Association of Business Trial Lawyers; the USD School of Law Board of Governors; and the National Institute for Trial Advocacy.

Tri-City Medical Center

Ronald Mitchell, director of health services and managing partner with the accounting firm of Grice, Lund & Tarkington, relies on his business experience to chair the Tri-City Medical Center board. (photo/lambertphoto.com)

Intrigued 10 years ago by the position and the business perspective he could offer, Ron Mitchell ran for — and won — a seat on the Tri-City Medical Center board that serves Oceanside and much of coastal North County. “In my profession I deal with health care and finances and I’ve always been interested in politics,” says Mitchell, director of health services and managing partner with the accounting firm of Grice, Lund & Tarkington. “I bring a business perspective to the board. There are only two of us who have owned a business.”

Tri-City’s directors are elected to four-year terms in the November general election. They are charged with representing the health care needs of the community and sharing the hospital’s needs and concerns with external constituencies. They also serve as a communication link between the hospital, government officials and others important to the provision of health services. Members are expected to remain current on changing trends and issues affecting hospitals.

Mitchell, a Vista resident who serves as the hospital board’s chairman, is most proud that he was part of the board that helped set up community advisory groups for Tri-City. “It was the first time the hospital gathered information from outside its walls,” he says. “It spurred good programs.”

Meeting monthly, board members work to adopt a long-term capital expenditure plan with estimates, projected sources, uses and costs of future funds for buildings and equipment. Other meetings include participation in the board committees, which include finance, operations and planning; human resources, governance and legislative, joint conference and mission and community outreach.

Tri-City’s board is charged with hiring the medical center’s chief executive. Mitchell was there six years ago when CEO Arthur Gonzalez was selected. “It’s very time-consuming,” Mitchell says. “But it’s the most important job of the board. We invest a lot of time and money to find the right person.”

Annual reviews of the CEO’s performance also fall to the board. The CEO gets input from the hospital foundation, employees and physicians. It’s a blended review, Mitchell explains, with feedback combined so no one comment lands on one person.

The biggest board challenge is raising funds. “We have one of the largest uninsured populations in the country,” Mitchell says. “When those people come into the hospital they are not denied care. But who pays for that? It’s a major issue. Hospitals in (places like) North Dakota don’t have this issue. It’s a huge financial burden.”

Mitchell spends between 10 to 12 hours a month on his board duties.

Board members are not paid, but do receive free health care. Mitchell says the experience has provided the opportunity to work closely with the CEO of a large business. He also has learned how to run televised board meetings where emotions can run high.

Paradise Valley Hospital

At Paradise Valley Hospital in National City the board is selected by a committee responsible for identifying new members in accordance with hospital bylaws. Candidates are selected based on their experience and whether they will be beneficial to or needed on the board. Vacancies are filled by those who most match the qualities of the person leaving. The two-year appointments have no term limits. The board meets every other month and members must be actively involved to be reappointed. There is no monetary compensation for board members.

“Most people usually stay on for about three terms because the issues can be so complex,” explains Robert Carmen, executive vice president and COO of Adventist Health, which runs five hospitals in California, Oregon and Hawaii. “Board members are responsible for the day-to-day operation of the hospital through the CEO. The CEO then reports to the board, which makes sure the staff is credentialed and that medical services are being offered.”

Carmen is part of the corporate structure of Adventist Health and chairs all of its hospital boards. He works from the Adventist office in Roseville, visits Paradise Valley at least once a month and speaks on the phone weekly with the hospital’s CEO, Terrence Hansen.

“I’m most proud that (the hospital) has been a part of National City for 100 years this September,” Carmen says. It has been hard work keeping things afloat. Although at one time National City was an affluent community, Carmen says, now those on MediCal and Medicare make up about 80 percent of the patient population. The relationship with Adventist Health has allowed the hospital to survive serious and ongoing funding cuts in government programs that cover most of its patients. Carmen gives much credit to the board, staff and physicians for making things work.

“Instead of moving the hospital to follow growth, we made a long-term commitment to our mission and community,” he says. “We stuck through good and bad. It’s made us an important part of the community.”

Paradise Valley has been holding its own the last two years, Carmen says.

Sharp HealthCare

L. Robert Payne, a real estate investor, chairs the hospital board at Sharp Healthcare. He has been part of the effort to successfully stabilize the hospital’s finances.

In sound financial shape these days is Sharp HealthCare, thanks in large part to the efforts of its board. “Sharp had significant financial and operation challenges in the mid-1990s,” says board Chair L. Robert Payne. “Working with management to stabilize the operations and to chart an aggressive course to maintain and enhance the wonderful history of the facilities and people that make up Sharp HealthCare is my personal and the board’s greatest accomplishment. I also am proud to have set up a stable board of directors.”

Sharp’s 25-person board meets monthly. The president and CEO of Sharp HealthCare and its foundation’s chair fill two seats. Seven members are appointed by Sharp HealthCare entity boards, representing Sharp Memorial, Sharp Chula Vista, Sharp Grossmont, Sharp Coronado, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group and Sharp Mission Park Medical Group. The remaining 16 directors are nominated by a committee consisting of at least five board members (including at least one physician). There is no compensation for board members.

At least 75 percent of Sharp’s board members must be residents of San Diego County (currently all meet that requirement) and at least one-third must be physicians licensed to practice in California. Directors are selected based on a nominating committee’s judgment of their expertise, value and interest that each would bring to the overall board. Members may serve no more than three consecutive three-year terms.

The board is primarily responsible for guiding the organization, setting goals and ensuring high levels of executive management. It sets standards for quality of patient care, financial health and stability. The board works closely with the individual hospital boards, their respective medical staffs and management teams, and with the medical group boards.

Payne is the president and CEO of Multi-Ventures Inc., a real estate development and investment company that also is the managing partner of the San Diego Mission Valley Hilton and the Red Lion Hanalei Hotel. He also is chair of finance at SDSU and the chair of the finance committee at Jack in the Box Inc.

A director for seven years, Payne has served one year as president. “With more than 30 years in business management, I think I bring a wealth of experience to the table,” Payne says. “I have a long history of working with boards in multiple industries, and I have the skills and experience necessary to read and understand financial statements and planning. I understand that the health care industry is a business and we have to plan and work together accordingly.”

Payne spends about 20 hours a month on his hospital board duties. “A challenge in most organizations, and not limited to ours, is to maintain profitable operations to support required operations and investment in needed infrastructure, technology and salaries,” Payne says. “What is also increasingly important to Sharp is the future of unfunded government mandates around nurse-staffing ratios, seismic legislation and privacy regulations related to federal HIPAA legislation. General health-care workforce shortages in nursing, pharmacists, radiology techs, lab techs, medical records coders and even some physician specialties are all also driving up workforce costs.”

In running the hospital system, Sharp’s board faces the task of dealing with two complicated and expensive health care issues: funding workers’ compensation and health insurance for the organization’s 14,000-person workforce. It also must recruit top staff in San Diego’s already high, and escalating cost of living.

But the hard work pays off.

“I am most proud of Sharp’s ability to provide quality health care and maintain stable financial operations over the last six years in one of the most challenging health-care environments in the country,” Payne says. “I am also proud to be part of an organization whose physicians and clinicians use cutting-edge clinical advancements to provide better and better health care to San Diegans.”

UCSD Healthcare

Governed as part of the University of California San Diego system, the hospital falls under the direction of the 26-member UC Board of Regents which, under Article IX, Section 9 of the California Constitution, has “full powers of organization and governance” subject only to very specific areas of legislative control.

Oversight of the hospital is addressed directly through one of the Regents’ seven standing committees. The board meets six times a year every other month in two-day meetings. It is through this board that the UCSD hospitals get funding and approval for major initiatives.

By coincidence, San Diegans today hold the two most influential positions on the Board of Regents. The chair is John Moores, chair of the San Diego Padres and JMI Services Inc., and vice chair is Peter Preuss, president of The Preuss Foundation in San Diego.

Kaiser Permanente

A membership-based nonprofit health care provider with members in nine states, Kaiser Permanente operates unlike most community hospitals. It is overseen by area managers instead of a governing board. The three people heading the San Diego region are Nate Oubre, senior vice president and service area manager for San Diego since Dec. 1, 2001; Dr. Arthur M. Flippin, medical director of Kaiser’s San Diego service area; and Chris Crisafulli, medical group administrator of the San Diego service area for Southern California Permanente Medical Group.

Alvarado Hospital

Part of the for-profit Tenet HealthCare network, Alvarado Hospital Medical Center declined repeated requests for information about any local board or committee that provides guidance on San Diego operations.

Different But The Same

Hospitals differ in many ways. It only seems appropriate that those overseeing their business operations represent a cross section of the communities they serve. One factor seems to be constant: Those keeping on top of the daily operations of the health care industry are competent people who know how to run a business. Trustees have the ultimate legal and fiduciary responsibility about how the hospital answers the needs of its community, and they know it.