North county health services BOARD OF DIRECTORS STRATEGIC PLANNING RETREAT

1. North county health servicesBOARD OF DIRECTORSSTRATEGIC PLANNING RETREAT October 12/13, 2018

2. Why do strategic planning? • High level plan to achieve one or more goals under conditions of uncertainty • Roadmap for future initiatives • Provides Board, Staff and Community with common focus and perspective • Focus on members

3. Board of Directors Strategic Planning Role and Responsibilities • Evaluate organizational performance and community needs • Participate in periodic strategic planning • Monitor strategic plan progress • Provide strategic guidance to CEO/Executive Team on changes in priorities or direction • Be a compass and an anchor

4. Planning Retreat Agenda FRIDAY • Introduce the DRAFT Plan and Solicit Board Questions/Comments • Discuss the external environment and NCHS organizational position • Review Board Role/Requirements, Best Practices and Board Development Priorities SATURDAY • Solicit Board feedback, guidance and adjustments to the DRAFT strategic plan framework • Agree on next steps

5. Group Agreements • Step up, step back • Assume best intentions • It’s OK to disagree – constructively • Speak one at a time • What’s said here, stays here

6. DRAFT Plan Review/Comment

7. DRAFT Strategic Plan Framework FOR DISCUSSION ONLY

8. Small Group Exercise Questions: • What concerns or questions do you have about the priorities and strategies outlined in the DRAFT strategic plan? • What information would help inform your discussion of the plan? • What issues in the DRAFT plan do you think merit the most discussion this weekend? Small Group Process: • Encourage everyone to share their thoughts • Record your notes/themes for each question on a flip chart and be prepared to share with the group • This is a Board discussion – staff are there to listen only! • You have 20 minutes for the discussion

9. External Environment and Organizational Position

10. Data Collection Activities • Organizational Profile • Board of Directors Survey • 4 Staff Focus Groups • All-Staff Survey (467 responses) • Executive Team SWOT Analysis • Patient Survey (199 responses) • Patient Action Committee Focus Group • Community Stakeholder interviews (7 responses)

11. Organizational Position • Strong fundamentals • Timely access still a significant challenge – system issues • Compartmentalized operations • PNC, call center, centralized service challenges • New patient complexity • Strained infrastructure – operations, IT, project management

12. Growth and Competition • No substantive changes in FQHC penetration and competition since 2015 • Crowded SD, minimal growth by all north county FQHCs • Unmet need in Riverside but challenges to maximize Perris utilization • No more growth in county Medi-Cal enrollment • NCHS growth driven by comprehensive services (e.g. IBH, chiropractic) and more cross-utilization

13. Patient and Community Needs What staff say… • Unserved pockets in existing service areas (e.g. teens/young adults, seniors) • Increasing patient complexity • Need to go deeper – patient health literacy, specialty, care coordination • Define a Social Determinants of Health (SDOH) path What community leaders say… • Mental health • Substance use • Housing, affordability

14. Community Partnership and Visibility • Competent, responsive medical service provider • Limited reputation and visibility as a community leader or partner • Opportunities for greater partnership and community linkage – service partnership, community engagement

15. External Environment

16. Board Development Discussion

17. TOPICS FOR TODAY’S DISCUSSION • Board Roles and Responsibilities – A Review • HRSA Requirements of 330 Boards of Directors • Code of Conduct and Ethics • Board and CEO Division of Responsibilities • Developing Issues for Board Discussion • Role and Effective Functioning of Board Committees • Board Group Spirit

18. BOARD ROLES AND RESPONSIBILITIES:ACTING ON BEHALF OF NCHS • Advocate for mission and purpose • Support and evaluate CEO • Approve major programs/policies and monitor them • Approve annual budget and financial controls/audit • Recruit and retain board members • Legally and financially responsible • Act as a whole; not as individuals • Section 3 of NCHS By-Laws

19. INDIVIDAL BOARD MEMBERS • Attend all board and committee meetings • Stay informed and ask questions • Make a personal financial contribution • Inform others about organization • Help with recruitment/retention of board members • Keep up-to-date on developments in field • Refrain from making special requests of staff • Assist board in carrying out fiduciary responsibilities

20. HRSA REQUIREMENTS OF 330s • Consumer board composition and active engagement • Approve budget; review financial statements/audit • Participate in development, approval, monitoring of strategic plan • Approve job descriptions/compensation • Approve policies

21. CODE OF CONDUCT and ETHICS • Duty of Care • Duty of Loyalty • Duty of Obedience • Code of Ethics

22. DIVISION OF RESPONSIBILITIES:BOARD and CEO BOARD OF DIRECTORS CEO/EXECUTIVE DIRECTOR • Legal oversight • Management oversight • Financial oversight • Program oversight • Board development • Staff management • Management of programs/policies • Liaison and external role

23. SHARED RESPONSIBILITIES:BOARD AND CEO • Strategic leadership • Fundraising • Evaluation of organization • Program oversight/monitoring

24. WAYS TO FOCUS ON ISSUES THAT MATTER • Take reports off agenda • Schedule educational sessions before board meeting • Use consent agenda • Other avenues for bringing key issues forward • CEO/executive staff written reports • Committee meetings/summaries

25. DEVELOPING ISSUES FOR DISCUSSION • Key questions in advance • Identify • What is situation? What’s going on • What is role of board in issue? • What information does board need • Who should present • Board members must • Come prepared • Understand discussion process • Listen and respond • Share critical thinking – ask questions • Support others in discussion

26. EFFECTIVE BOARD COMMITTEES NCHS By-Laws, Article VIII Most CHCs have: • Executive Committee • Finance and Investment Committee • Governance and Board Development Committee • Program Committee • Quality Assurance Committee • Audit and Compliance Committee • Marketing and Communication Committee • Fund Development Committee • Special Committees • Executive Committee • Finance Committee • Governance Committee • Quality Assurance Committee • Audit Committee • Ad-Hoc Committees

27. GROUP SPIRIT • What is CULTURE of the Board? • Characteristics of positive group spirit – allows members to work well together and to take pride and satisfaction in work done together • Developing positive group spirit • Maintaining positive group spirit • Holding Board members accountable • Role of Board Chair/President • Role of CEO