UNLEASHED: Redesigning Health Care
Oct 12, 2026 · 22 min · 13 segments
Don Berwick, co-founder of the Institute for Healthcare Improvement, joins us to explore: Who should be on hospital boards? What metrics should their pay be tied to? We also touch on universal health…
Chris TrimbleHost
Glyn ElwynHostMost boards, most executives are well-intended.
They want to be proud of their work.
They want their organizations to help.
But their definitions of success come from their backgrounds, and their backgrounds are largely financial.
In fact, experience in healthcare is generally not a prerequisite to getting a board seat.
I, I oversaw a study done by two Harvard medical students of mine maybe seven or eight years ago who looked at the membership of boards of directors of hospitals.
I think they looked at 15 health systems.
There was enough information to characterize the experience of the board members in 10 of them.
And in those 10 health systems, uh, only, uh, slightly less than 15% of board members had, had in their careers anything at all to do with the delivery of care.
They were, uh, real estate entrepreneurs and hedge fund investors and, uh, people prominent in the community, but not knowledgeable about care.
Prominent in the community as opposed to prominent in healthcare, and charged mostly with managing financial health.
What's happened in healthcare, to my chagrin, is it has become ever more financialized and ever more corporate and really ever more focused on bottom lines and top lines, revenue lines, th- than ever.
This financialization has focused people a lot on revenue, revenue cycle management and so on, where it's, uh, every dollar that you can pull in, you value, and you don't ask the question, "Is this really adding help to society?"
So an overly financialized board might place equal value on two procedures, even if one of them is of dubious medical necessity.
[on-hold music] Redesign of boards, to me, would be to follow a number of principles.
One is to, to redirect board attention in its daily work, uh, toward mission, which w- does not, does not include, uh, financial success.
Financial success is a support to mission.
It's not the mission.
I wouldn't remove financial competence as a, as a, a good thing to have in a board, but right now they're running the show.
Most boards, most executives are well-intended.
They want to be proud of their work.
They want their organizations to help.
But their definitions of success come from their backgrounds, and their backgrounds are largely financial.
In fact, experience in healthcare is generally not a prerequisite to getting a board seat.
I, I oversaw a study done by two Harvard medical students of mine maybe seven or eight years ago who looked at the membership of boards of directors of hospitals.
I think they looked at 15 health systems.
There was enough information to characterize the experience of the board members in 10 of them.
And in those 10 health systems, uh, only, uh, slightly less than 15% of board members had, had in their careers anything at all to do with the delivery of care.
They were, uh, real estate entrepreneurs and hedge fund investors and, uh, people prominent in the community, but not knowledgeable about care.
Prominent in the community as opposed to prominent in healthcare, and charged mostly with managing financial health.
What's happened in healthcare, to my chagrin, is it has become ever more financialized and ever more corporate and really ever more focused on bottom lines and top lines, revenue lines, th- than ever.
This financialization has focused people a lot on revenue, revenue cycle management and so on, where it's, uh, every dollar that you can pull in, you value, and you don't ask the question, "Is this really adding help to society?"
So an overly financialized board might place equal value on two procedures, even if one of them is of dubious medical necessity.
[on-hold music] Redesign of boards, to me, would be to follow a number of principles.
One is to, to redirect board attention in its daily work, uh, toward mission, which w- does not, does not include, uh, financial success.
Financial success is a support to mission.
It's not the mission.
I wouldn't remove financial competence as a, as a, a good thing to have in a board, but right now they're running the show.
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