How to Build and Improve a Board of Directors

Effective leadership is the cornerstone of a thriving senior care community, with the board of directors serving as its strategic backbone. A strong and active board of directors is a valuable asset, guiding the community’s vision and supporting its mission. Building and improving a board is a delicate and crucial process, one that’s worth investing significant time and effort.

Read on to learn how senior care organizations can build a strong board of directors, plus strategies for effective board management.

How to Build or Improve on a Board of Directors

Kimberly McNally, MN, RN, BCC, senior consultant, The Leadership Development Group

A board of directors guides the vision for a senior care community. It’s important to create a board that is able to guide the community through the challenges and changes the senior care industry faces. Kimberly McNally, MN, RN, BCC, senior consultant, The Leadership Development Group, explains that senior care communities are currently undergoing significant transformation. “The best communities have a vision to create communities where older adults can continue to grow, learn, and lead fulfilling lives,” she says. “The board needs to lead the way to deliver on this vision.”

To accomplish this goal, boards should feature individuals who are passionate for the senior care community’s mission. Board members also need to have the right expertise and interpersonal qualities to work well with others. “A well-functioning board makes use of their existing directors’ skills and qualifications while knowing when to bring in new perspectives,” McNally says.

It’s also essential to include different board member perspectives, which McNally says can lead to better decision making. “Different perspectives create the conditions for robust dialogue which can facilitate new ideas to emerge,” she says. She notes that it’s important to think about where the senior care industry is headed and what boards need in order to navigate the future challenges and opportunities. “Think about recruiting people who have experience with innovation and disruption, new partnerships, consumerism, population health, and technology,” says McNally. “Reach out to professional organizations to target young professionals.”

McNally recommends that senior care communities begin with a board competency matrix to evaluate their current board. The matrix is a grid listing the board members or potential member on one axis. Necessary skills, competencies, and experiences are listed along the other axis. “Once constructed, it will highlight your current board’s strengths and gaps and serve as a planning tool to create the best board for the future,” she says. She notes that the matrix typically includes several sections:

• Demographics, such as age, gender, race/ethnicity, and other characteristics that may be important to the community
• General areas of experience, such as healthcare/wellness, business, government, law, finance, real estate, construction, human resources, hospitality, marketing/sales
• Specific healthcare and senior care experience
• Community connections, including religious, business community, social services, education, healthcare, media, political, philanthropic, small business, insurance connections, and more

A matrix might also record any member’s past board experience.

Tracy Duberman, PhD, president and CEO, The Leadership Development Group

While a matrix can help identify a current board’s strengths and any gaps that need to be filled, a board competency assessment provides a deeper look into current board members. Tracy Duberman, PhD, president and CEO, The Leadership Development Group, explains that in working with clients, she often starts by conducting a board competency assessment to anonymously evaluate each member’s expertise against the board’s strategic priorities and governance.

“For example, in one recent engagement, we facilitated a structured self-assessment process where board members rated their proficiency in areas like financial oversight, healthcare policy, and strategic planning,” she explains. “We then aggregated and anonymized the results to highlight gaps without singling out individuals.

“Next, we conducted interviews with the CEO and select board leaders to understand their perspectives on challenges facing the organization. By cross-referencing these insights with our assessment results, we identified opportunities for professional development, recruitment, or targeted education for the board,” says Duberman.

The assessment identified gaps in certain areas, such as emerging technology in senior care, while also enhancing the board’s overall cohesion by identifying members’ shared strengths and needs. “The combination of data-driven insights and candid dialogue set the foundation for a more balanced, skilled, and engaged board,” Duberman says.

How to Recruit and Onboard New Board Members

McNally explains that a board needs to be strategic when it comes to member recruitment. She recommends beginning the process with the board competency matrix, and notes a board should start the recruitment process for an anticipated gap at least a year in advance. “Be sure to carefully vet potential board members for their skills in areas such as leadership, diplomacy, judgment and overall business acumen which may not be reflected in your skills matrix,” she says. “The ability to build consensus and collaborate with other directors and management is critical to a well-functioning board.”

When onboarding a new member, Duberman recommends a structured framework combining orientation, relationship building, and ongoing support. She shares a three-phase onboarding program that The Leadership Development Group helped design for a client:

1. Pre-Orientation: Before the new board member’s first meeting, they received a comprehensive orientation packet, including the organization’s strategic plan, financial statements, bylaws, and governance policies. This gave the member a clear understanding of their role and the board’s expectations.
2. Orientation Session: The Leadership Development Group facilitated an interactive session with the board chair, CEO, and other senior leaders. This included an overview of the organization’s mission, key priorities, and challenges. It also provided an opportunity for the new member to ask questions and clarify their contributions to the board’s goals.
3. Integration and Mentorship: To ensure a smooth transition, the new member was paired with an experienced board mentor. This mentor served as a sounding board, helping the new member navigate board culture, meeting protocols, and decision-making processes.

The Leadership Development Group also recommended ongoing professional development that included educational sessions on industry trends, regulatory changes, and governance best practices. “These steps ensure that new members are not only well-prepared but also feel valued and equipped to make meaningful contributions,” she says.

Strategies for Effective Board Management

Duberman has found that a governance framework centered on communication, clear roles, and continuous evaluation has proven successful in managing boards.

She shares the processes that The Leadership Development Group implemented with one client:

1. Annual Board Work Plan: “We helped the board create a calendar that aligned meeting agendas with key strategic milestones,” says Duberman. “This ensured that discussions were focused on high-priority issues like financial oversight, quality care metrics, and industry trends, rather than being reactive or operationally focused.”
2. Defined Roles and Responsibilities: “To enhance accountability, we collaborated with the board to clarify individual and collective roles,” she explains. “This included updating position descriptions for the chair, committee leads, and members, ensuring everyone understood how they contributed to governance success.”
3. Regular Performance Evaluations: “We introduced an annual board self-assessment process to evaluate the board’s overall effectiveness and identify areas for improvement,” Duberman notes. “The findings informed future agendas, education sessions, and even recruitment strategies for new members.”
4. Communication and Engagement: “To maintain alignment between meetings, we implemented a streamlined communication process,” she says. “Board members received concise updates on organizational progress and industry developments, ensuring they stayed informed without being overwhelmed by operational details.”
5. Leadership Development: “Recognizing that board leadership is a dynamic role, we facilitated periodic governance workshops to build skills in areas like decision-making, strategic planning, and navigating regulatory complexities,” says Duberman.

“These processes not only kept the board focused on its strategic responsibilities but also fostered a culture of continuous improvement and strong collaboration with the executive team,” Duberman says.

Investing in a Board of Directors

With the board of directors being such an essential asset to senior care communities, the importance of continuously building, improving, and managing a board can’t be overstated. Spending time to strategically evaluate and build a board is an excellent investment in a senior care community’s future.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.