Positioning boards to exercise heightened engagement within the current “climate of uncertainty” is possibly the most important health system governance challenge of 2017. To adequately address this challenge will require an extraordinary commitment of time and energy by the board.

This “uncertainty” extends beyond the fate of the Affordable Care Act to an increasingly volatile political climate and global economy, all of which present enterprise risks to health care organizations. Health system directors should maintain a sharper awareness of how issues like border security, immigration restraints, trade conflict, regulatory reform and significant market fluctuation affect the health system. Would a Dodd-Frank rollback have spillover effects? Could administration pressures on certain key industries expand to include health care? Will the new US Supreme Court justice influence upcoming rulings on health care-related cases?

The necessary level of engagement can be manifested in several ways. The most obvious way is by increasing the amount of time devoted to the board agenda. A second, related way is by being fully informed on political, economic and regulatory developments of relevance to the system and its business model. A third way is by repositioning the composition and structure of the board to assure responsiveness to these and similar developments. A fourth way is fulsome understanding of the board’s role as a “partner” to the executive management team. Such indicia of heightened engagement will directly support the director’s performance of his or her oversight and decision-making duties. The general counsel can help coordinate executive team support to the board as it seeks to address the need to increase engagement.