The Health Management Academy
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Episode 17

Building a Modern and Diverse Health System Board

Episode Description

In this episode, Andrew Chastain, President and CEO of WittKieffer, a global search firm focused on healthcare, joins Renee at The Table. They discuss many aspects of diversifying and modernizing healthcare system boards, including where and how board members are found as well as implementing age and term limits. Andrew shares from his experience with helping people prepare to serve on boards, giving several practical pieces of advice. Finally, the conversation covers workforce limitations and characteristics of successful CEOs.

About Our Guest

Andrew Chastain, President & CEO, WittKieffer

As President and Chief Executive Officer of WittKieffer, Andrew Chastain is responsible for charting the firm’s strategic trajectory while ensuring excellence and exceptional service for the firm’s clients. Andrew brings over 20 years of leadership experience to the firm and continues to play a key role in select, high-profile search assignments. Read more


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Renee DeSilva 0:06

Welcome back to the Academy Table. I’m Renee DeSilva, CEO of The Academy and your host. In this episode, I welcomed Andrew Chastain to The Table. Andrew is the President and CEO of WhittKeiffer, a global executive search firm with a particular focus on healthcare and life sciences. Our conversation centered on a topic I’m very animated by and that I also think is often overlooked in equity and inclusion efforts — diversifying and modernizing healthcare boards. There are so many interesting points to note from our time together, but here are a few of my takeaways. First, truly modernizing health system boards is a significant commitment. It will require organizations to change how they search for new board members, reducing the reliance on personal networks and geographic convenience. It also means updating existing policies, including the frequency of meetings and introducing age and term limits. As we discussed, these changes will lead to a more diverse, inclusive board that’s better positioned for success. Next, I loved Andrew’s suggestions for individuals interested in board service. As he says, “Candidates should know why you’re wanted and asked specifically what the board views as your expertise.” This can be especially helpful for candidates from diverse backgrounds who want to rightfully avoid feeling like they just checked a box. Lastly, we ended our discussion more broadly on the hallmarks of a successful CEO. Andrew points to creative and courageous thinking and leveraging good processes that encourage bold action. With that, let’s head to The Table.

Renee DeSilva 1:53
Andrew, thank you so much for joining us at The Table. Happy to have you here today.

Andrew Chastain 1:57
Great to be here. I’m looking forward to the conversation.

Renee DeSilva 2:00
You and I have gotten a chance to know each other across the last couple of months. You serve as the President and CEO at WhittKieffer which is an executive search firm. I know that you also spend time on leadership effectiveness. I look forward to having a broad conversation with you today.

Andrew Chastain 2:15
I’m looking forward to it as well.

Renee DeSilva 2:17
Let’s start with how you arrived in search. What was your path to your current role?

Andrew Chastain 2:23
Great question. Thanks for asking, Renee. I started as a client of our firm. I worked in hospital administration at an academic health science center in Chicago where I had a portion of the house that I supported the operations of. As part of that role, I supported the searches across the organization as the new leadership team was being brought in. I loved working in healthcare, but I loved this intersection of talent, strategy, and operations. When our firm was opening an office a couple of years later, I was recruited as, what I refer to, an inexperienced assistant to cope with the development of the office here in Atlanta. I have been here for 24 years.

Renee DeSilva 3:09
That’s great. I know that WittKieffer as an organization spends 60% or greater on healthcare. Do I have that right?

Andrew Chastain 3:18
That’s correct. Yes.

Renee DeSilva 3:19
What I’d love to explore is the 40% that you spend outside of healthcare, where do you think there might be some interesting lessons for the provider or healthcare community in that. I’ll ask you to particularly talk about what you observe from non-healthcare, maybe publicly traded or for-profit entities and how they think about governance and search holistically.

Andrew Chastain 3:44
They tend to use executive search or look outside of their comfort zones when they’re looking for new governance members. Those that we serve who follow best practices have a competency grid. When they’re looking for new governance members, they have a process and they have a competency grid that they work against. The process is that they have normal turnover, they have a nomination and governance committee that is responsible for nominating new members, and they use the competency grid to look broadly at how they fill the gaps that they see inside the competencies of the organization. Those can include things like strategic planning, cybersecurity, marketing, diversity, equity and inclusion. It’s a very thoughtful process about how they diversify competency skills and the demographic makeup of the boards whereas we tend to see our hospital and health system clients rely on a more traditional way of identifying talent for the next generation of governance, be that through personal networks or particularly looking inside their own geographic spaces.

Renee DeSilva 5:06
It’s interesting. I spend a fair amount of my time with our Chief Executive Officer group. There is this sort of beginning reconciliation that we need to as an industry think about how we seed and prepare our boards differently. You mentioned a couple of things that you feel might be in that best practice bucket, the competency piece of it, broadening the network a bit to make sure that you’re not just going to the folks that you may know. Are there other things that you’ve seen shift over time that you feel should be on that list of best in class ways of approaching it?

Andrew Chastain 5:44
Yes, a couple of things I would add beyond self-referral. When we look at self-referral or identifying through our networks, we tend to end up with people who are “like us” — so those who think like us or look like us or approach problem solving like us. When you can get outside of that self-referral, you’re more likely to get diversity of thought and diversity of demographics on your board. Getting beyond just self-referrals is important. Opening it up beyond just your geographic limitations. Now, I realize that some organizations have that in their bylaws. I would highly recommend they reevaluate those so that they can get folks from outside of the geographic limitations. I think a lack of compensation limits your ability to find some talent that would be more interested should they be compensated for their time. I also think, Renee, that many health systems suffer from the time requirements and over governance where they create more work by meeting more often than they need to. Another comparison would be most organizations we serve outside of hospitals and health systems meet quarterly versus monthly which forces them to only talk about strategic topics, not operational topics. If you’re able to pitch that to a great potential board member, you’re more likely to be able to hook them on their service than if they’re meeting every month and have a 200-page board book to read.

Renee DeSilva 7:34
Yes, those are all good. The other thing that I’ve noted from folks that I feel like have been trying to be more progressive around this, in addition to what you mentioned, is looking at their policies around governance that make that hard. Do they have term limits? Some outside of healthcare boards have age limits. They’re trying to get a demographic lens. The majority of board members, 60% or so, tend to be 60 and older. I think you’re right. It’s both, how do I think about approaching my new board searches in different in kind ways? Then also, are there any existing policies in place that make that harder to do?

Andrew Chastain 8:13
Yes. Term limits are critically important. It’s remarkable how often we run into organizations that don’t have term limits. One quick story for you. I had met with a board, luckily I can say this was a few years ago, where the chair of the board and the vice-chair had been on the board for 40 years. The person they were trying to prepare to be the next board chair had been on the board for only 26 years. My question was, at what point do you think they’ll be ready? That’s not uncommon. The most basic of best practices is having term limits in place and staggering between those terms to make sure that you’re opening up to a diversity of thought and a diversity of demographics on your governance team?

Renee DeSilva 9:00
That’s interesting. Staying with that for a moment, I was meeting with a friend of The Academy recently, a current CEO. His sentiment, which I thought was so interesting, was if you think about the role of governance, oftentimes, what you want that trustee to do is operate as an independent thinker. One of the things that he mentioned that sometimes becomes a challenge is if you think about the currency that not-for-profit boards exchange in, it’s less about stakeholder value in traditional terms, it’s often about independence and board seats. You can see how that sometimes makes it harder to move performance or to be provocative on the direction of the organization when ultimately, based on a lot of the things that we’re talking about, what the trustees on the board value, is independence and how do board seats come together. Your point is very well taken.

Andrew Chastain 9:56
Correct. Most of the CEOs that we work with are trying to update the best practices of their board and educate them on what those look like. Ultimately, it’s not the CEO’s responsibility; it’s the board’s responsibility for holding specific accountabilities around these things. As a CEO you can provide support to the board, but the board is ultimately responsible for how it governs itself. That’s an interesting dynamic, particularly when a CEO is interfacing with other CEOs about the need to diversify their governance and have good governance, but they’re not ultimately responsible for implementing it; they’re responsible for supporting it. It’s an interesting dynamic when you report to that body.

Renee DeSilva 10:54
That’s right. You’re serving at the pleasure of the board in some ways, so how do you influence that body while keeping all of this aground and afoot? That makes a ton of sense. Let’s talk a bit more about the extrinsic factors that we’ve all seen across the last 18 months. As it relates to equity and inclusion, as a country we’ve had a bit of a reckoning. When you and I chatted in the past, I think there is much more of an acknowledgment of the need to be intentional about diversifying the board. We’ve seen Goldman Sachs come out around a year ago saying that any company that they take public would have at least two members of the board who represented a diverse audience. We’ve seen NASDAQ asking the SEC for permission to do something about having greater parity around gender and race. There are extrinsic factors that are converging around having our boards look like our countries, having much greater representation. I’ll ask you this question. With those extrinsic factors happening, have you seen progress and momentum around that that can be measured in outcomes or are we still in early innings around that?

Andrew Chastain 12:09
We’re still early in the game. I would say that every search that we’re involved in or every board that we support is genuinely interested in diversifying their governance structures. It is happening both from the external factors that you mentioned that are requiring it, but also to the accountability to the communities that they serve, be it community, not-for-profit organizations or organizations who have stakeholders, as defined by the leadership advisory group. Everyone feels the pressure to meet these requirements. I don’t know that I’ve mentioned this to you, but I participate with the McKinsey & Company Black Leadership Academy Program. I teach a couple of classes through this. One that I teach is how black executives can prepare for board seats. We’ve graduated over 2,000 executives in the last year from that program. There’s a whole generation of folks who are becoming aware of what it is like to serve on boards and how they can prepare themselves for this. Having been introduced to all 2000, what are their backgrounds and so forth, they’re very different than your traditional candidate who lives in your community and runs a business in your community. Oftentimes, they are a functional leader inside of a big, multinational organization and they would provide extreme value to an organization. But if you’re looking for that traditional prototype of the local business leader who’s civic-minded and has influence in that community, you’re going to have to look beyond that to be able to help to diversify your governance structures.

Renee DeSilva 13:58
I think that’s an excellent point. That also points to the fact that there is talent that is available that may not be visible or as visible as maybe we’d like. Programs like that are incredibly powerful in creating greater visibility to where the talent pipeline exists.

Andrew Chastain 14:20
It does exist; it will just look different. If you don’t want your board to be full of CEOs or former CEOs who have the time to meet monthly and have committee meetings all the time, you’re probably going to have to change the way that you look at the commitments to be on your board or that can give a lot of money. Some of this is, you’re going to have more up and comers which will give greater age diversity as well. But when you’re looking at how to tap in, you said that there’s availability but maybe not visibility, how you’re tapping into that, particularly as you look beyond your local community, there are resources that exist. You can access talent outside of your traditional board network. One way is to tap into networks like the NACD, the National Association of Corporate Directors. That is an organization that specifically caters to developing the capabilities and responsibilities of board members. You can bet that if your nominating governance chair is participating in that as well, they would be sitting alongside other potential board members that you can look to find skill sets outside of that.

Renee DeSilva 15:36
Absolutely. I’d also add, in terms of the organizations that are focused on this, the Leverage Network is another organization that does a lot around advancing leadership for people of color. Executive Leadership Council is another source for that. The way that I’ve historically thought about that, just like anytime you are recruiting for anything, you will always be better served in terms of building connective tissue in advance of need. If folks were investing in that, and I know that you spend some personal time there, when you have a near-term role to fill, whether that’s a board role or an executive role, you’ve done the work required to move that along more quickly.

Andrew Chastain 16:19
Because there’s been so much writing about this issue, you are starting to see executives from outside of the traditional sources begin to wonder, how might I be on a board and how do I make myself visible on that board? A large part of the McKinsey program that we’re talking to them about is, how do you build your brand and your availability to interest and serve on boards? How do you present yourself and make yourself visible, to use your word, Renee? How do you make organizations interested in you? Why would a board want you? You need to define this and promote it. In that class, interest and presence can’t be your differentiator. Just because you’re interested in being on a board and just because you’re there cannot be the reasons that someone would choose you. What is your elevator speech of why you should serve on the board? This is a critical thing that we’re trying to help these folks think about in how they promote themselves.

Renee DeSilva 17:28
Let’s stay on that. I know this is a personal passion of yours. You recently wrote a LinkedIn article about the steps that one can take if they want to prepare themselves for a board seat. You talked about some of them — building your brand, the importance of having scale, investing in some of the training and education that would be needed. What are some other things that you would offer advice for or advice around for people who are looking for their first board role?

Andrew Chastain 17:58
Sure. In addition to building your brand around it, you promote yourself a little differently when you’re looking for a board seat. Creating a board bio is different from a resume, but it highlights those things that might help you catch the eye of a board beyond your expertise, the strengths that you build. It’s organized just a bit differently than a resume. You need to gauge the time commitment that you can put forth into this. The easiest way to catch the eye of a corporate board or a large health system board is to get involved with something that you’re passionate about on the not-for-profit side which allows you to show that you are involved enough, that you’re interested enough, and that you can take on leadership inside of a board. It is hard to convince a public board that you would be a good board member should you not have experience in what compensation committees do and how you govern the audit and finance committee, how you evaluate risk at a governance level versus a management level. Start small and simple by getting involved in something. Another is that you need to clear it with your employer. It is a big time commitment. Most organizations encourage their senior leadership team to be involved both in their community and with other governance opportunities. However, there are a few of my clients, large multinational retailers if you will, who have so many conflicts of interest that they can’t allow their senior leadership team members to serve on boards. You’d want to clear that with HR and compliance before you put your name out there. You want to know why you’re wanted. This is a really important thing, I think particularly for candidates who come from underrepresented minority backgrounds. You want to know that the organization is looking at your skills and experiences as much as they are looking at you for the diverse background that you might bring unless you’re comfortable with that being the reason that they’re most interested in you. On my board, I have diversity and I’ve not chosen to have an executive on my governance team who is diverse lead my diversity, equity, and inclusion council because he comes from an accounting background. He’s much more involved in the accounting pieces, but he does bring diversity of thought and diversity of experience to the board as we’re making strategic decisions. If a board is wanting an individual to be there to represent diversity, equity, and inclusion but they come from a legal or compliance background, it could present an awkward future. I always make sure that candidates ask that question about, what is it about me and why should I want to be on this board?

Renee DeSilva 21:02
I love that both from the perspective of wanting to be thoughtful about how you pull together a cohesive team to drive an agenda or strategy forward and also not requiring that the BIPOC individual be the carrier of the flag on issues that all of us as executives and humans need to own. I think that’s a really important point that you make about how to think about that. I serve on two boards outside of The Academy board right now. I think I learned this from you when we spoke at the beginning of this year and that is not to underestimate the time commitment. What is your rule of thumb for the number of hours of preparation required for every one hour of a board meeting?

Andrew Chastain 21:02
I would say at least eight, to be honest with you. It is a lot of work. For every hour you’re in the boardroom, I think it’s about eight hours of prep work, committee work, and all these kinds of things. It is a considerable amount of time. If you’re the chair of a board, you’re probably looking at 20% of your time. It’s hard to have a full-time job and be the chair of a board. It is difficult. It’s 4-8 hours that you’re going to spend reading through, traveling too. That’s why we strongly encourage our boards to only meet quarterly. Many of our client’s boards meet monthly and I think that’s too much. It forces you to only focus on the critical, strategic decisions that the board has to make. You can do a lot of other work in committees now with Zoom, although we’re encouraging our clients to meet at least half of their board meetings live starting in the calendar year 2022.

Renee DeSilva 22:57
That’s great. The only other thing that comes up from me as you were talking, reflecting from an individual lens would be to not underestimate how your domain knowledge can apply in other settings or industries. This notion of, if you have a passion for talent and if you’ve run big organizations around talent, strategy, and operations, that’s a little bit of my background, that can be applied in healthcare and consumer products and government contracting. There is some fungibility and skill set that if you think with a governance hat on, you may open yourself up to opportunities that you might not otherwise know existed.

Andrew Chastain 23:37
That’s a real positive. When we’re trying to recruit folks in, we look for people outside of the industry more often than we look for people inside the industry. We think that diversity of thought, if you’re recruiting for a healthcare startup, when you want certain competencies and skills, say legal or M&A or something like that, to recruit someone in from retail who has those experiences, helps the organization. Now, they’d have to be committed to learning about commercial healthcare and they need to understand the industry that they’re serving, but I think recruiting them in from outside of the industry is a real plus.

Renee DeSilva 24:24
I agree. One other question on board and governance before I move on to a broader leadership topic. We spend a lot of our time talking about how to assess your board’s needs, how to find the right board members, ensure that you’ve modernized your board practices, maybe the one other area that you might be able to comment on is how do you then make sure that those boards are successful? My other observation is that the extent to which board members gel and that environment itself feels inclusive and safe and you can have a constructive debate, with respect, matters. I don’t know if you’ve seen any examples of when that has been powerful in action or maybe advice for people who were thinking, “Okay, I’m now excited about the board that I have in place. How do I ensure that we’re all working together productively?”

Andrew Chastain 25:13
This is a role that the CEO can help with. The CEO should work in tandem with the chair and the vice-chair, however you’re structured, vice-chair or maybe past-chair, to make sure that the boardroom feels like a place where people can speak up in a safe zone, that they can share their thoughts, and they can feel like they contribute or they’re not going to want to be there or they’re not going to contribute in any way. Having a self-assessment is a really valuable tool. Best practices are that the board should assess itself every year. That should include how we set agendas, how we interface with each other, how effective governance is, how effective management is for updating and informing the board with topics that need to be discussed. All of those are helpful. I have also seen where outside facilitators can come in and lead an exercise in how functional a board is. I participated in one about a year and a half ago that was incredibly valuable. Some things came out about people’s willingness to speak up or willingness to disagree with strong voices in the room. It was a cleansing experience for that board. Things were shared that had never been shared before. That would be hard to facilitate by yourself, but having a deft, outside facilitator to lead through some of those sensitive topics is helpful. I’ve watched that board advance in their openness of consideration and it has led to better decision making, and as important, more support for the decisions that they make in that room because they all felt like they were heard.

Renee DeSilva 26:56
Absolutely, which then should translate into better outcomes for stakeholders, whether that’s patients, communities, or however that board defines their stakeholder group. I think that’s powerful.

Andrew Chastain 27:06

Renee DeSilva 27:07
I would be remiss if we didn’t cover one other broad category. You had a board retreat recently. What were the main points that you wanted to cover with your board in terms of things that you’re worried about. The answer was, “workforce, workforce, and workforce.”

Andrew Chastain 27:26

Renee DeSilva 27:27
As you know, in almost every sector, whether it’s the great resignation sentiment or the challenge in people feeling like they are at the point of a break in terms of how overworked people feel, the need for executives to constantly be replenished and keep the teams together. What conversations are you seeing your peers across the industry and your clients as it relates to the workforce?

Andrew Chastain 27:54
It is the topic. Just like your experience, I was at a meeting with about a dozen health system CEOs and we spent the majority of our time talking about testing for who has ideas on how we can address the needs. No technology is going to enter the market that’s going to solve this. At the end of the day, care is hands on patients. How can we help to do that? There’s no easy solution. The entire industry is trying to solve it together. Having traveler nurses, it’s not just the expense side, it is all of the cultural issues that happen when you’ve got a large interim workforce inside working alongside people who’ve stuck with you for a long time and know that they could be making more money if they traveled. I came back from that meeting and reached out to our entire workforce at WittKieffer to say, does anyone have solutions to this? I hate, Renee, that I can’t say, here are two things that I’ve seen work. I have seen some Uber-style apps that people are putting into the search process for travelers to make that process more efficient, but it is not solving the systemic problems of a workforce that is more transient. I wish I had a silver bullet for you on this one. There isn’t one that I’ve been able to identify.

Renee DeSilva 29:24
It feels that way. Even folks who have been in the healthcare domain for 30-40 plus years would say that they’ve not quite seen a set of circumstances quite as challenging in the workforce. If I were to wear a glass half full view, we might start to see ways that we tap into parts of our population that have been underemployed and have to invest in skill building far afield of the need. There are lots of conversations in our circles around how do I think through high school kids to make it easier for them to get a skilled role within healthcare? How do I think through more credentialled programs and reduce the complexity of them being able to be ready to serve in the field? How do I reach back out to moms who may have wanted to take a pause, given all that’s been going on and invite them back into the workforce? My hope in all of this is that we can, rising tide, lift all boats and tap into parts of the market that may not have been on our radar quite as much.

Andrew Chastain 30:25
Those are great ideas, Renee. Everyone’s so focused on filling the shift today, that if some entrepreneurs could come up with some solutions that are 2-3 years down the road, 5 years down the road, and start to build towards that it would be extremely helpful to the health system in the United States. We’re at this stream pressure point and looking for solutions.

Renee DeSilva 30:53
Agreed. Related to this, but maybe now getting back to the executive lens, this will be my last question before our wrap-up. You’ve got this privileged position where you see CEOs in particular come and you see them go and you probably have a beat on how effective they’ve been in that duration. If you draw upon your collective view of CEO effectiveness, in particular, what comes out for you as to the folks who have been in that role that feel differentiated from the rest?

Andrew Chastain 31:26
What a great question. The ones that differentiate themselves are those that are creative and have great courage. The ones who don’t try to look for patterns and say, “Well, this worked for me in my last job, let’s try and make it work here.” But instead use, “What allowed me to come up with a creative solution in the last role and with that process produce similar creative solutions here?” Those are the ones who change organizations and get out of the group-think of, “Well, they’re doing this in that organization and they have a great brand, we should try that here.” Creativity and then the courage to implement those things that are different. Courage is easy to admire and very hard to administer. It’s easy to sit back and say, “Wow, she was incredibly courageous when she did that” and admire that. The administration of sitting there going, “I could take the easy road with less risk or take this creative road with more risk. I’m going to take the risky road.”

Renee DeSilva 32:56
I love that.

Andrew Chastain 32:59
It differentiates people.

Renee DeSilva 33:01
For sure. I’ve got a good platform for observing successful CEOs that are running health systems and running large industry companies. A few things that have landed for me recently would be a high tolerance for complexity and comfort with ambiguity and not letting those things get in the way of this courageous, creative action.

Andrew Chastain 33:25
I would agree with you. Less linear thinking, looking for creative solutions, and having the courage to implement them would serve our industry well.

Renee DeSilva 33:35
I agree. One final question on a much lighter note. The thinking behind launching The Academy Table is this notion of one of our core beliefs as an organization is that there’s power in curating conversation when you’ve got the right people around the table. You get to ideas, actions, and outcomes in a pretty special way. If you could invite any two people for a conversation at your table, who would they be and why?

Andrew Chastain 34:07
Interesting question, again. You’re full of them today, Renee. I’ll go back to your last question where you said, “What are the things that I admire most about leaders?” I’m fascinated with creativity and courage. I just talked about them. I’m presuming that I can invite anybody from any period?

Renee DeSilva 34:30
Indeed. Yes.

Andrew Chastain 34:31
Da Vinci would be at my table. I read Walter Isaacson’s book on da Vinci and I was just blown away by his merging of art and science. I don’t believe you have to be an artist to be creative. I recently read a book called, How to Write a Song by Jeff Tweedy who’s the frontman for a band called Wilco. They are trying to implement not just creativity in how you write a song, but how you run the business, how you produce shows. I’d love to ask da Vinci, “How did you look at a stone and come up with a statue?” That would be interesting to me. If I’m looking for courage, as I mentioned earlier, how could you not have Rosa Parks sit around the table and say, “It came down to a decision and a moment. What was going through your mind when you refused to move? What was the calculus there?” That would be fascinating. Without a lot of thought, those would be two that I would find great inspiration from.

Renee DeSilva 35:39
I love that. That was a great response. Thank you. I could go on for another hour or so with you. These topics animate me and it’s your life’s work quite literally. I appreciate you joining us today. I would love to continue the conversation in the future.

Andrew Chastain 35:54
I would as well, Renee. Thank you.

Renee DeSilva 35:56
Thank you. Thanks again for joining me at The Table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website, or by subscribing on the podcast platform of your choice. If you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at I look forward to talking with you soon.