Thought leadership

Taking Community Activism Seriously

Taking Community Activism Seriously

As hospitals and health systems journey into population health, and invest in interventions to address the social determinants of health, community activists may get stirred up; agitation and frustration levels can rise. Your board members can expect new calls for interactions with passionate community representatives or assertive reporters.

How prepared are your board members to deal with stakeholders that press you for further actions, or when results come in more slowly than hoped from your investments into health status improvements?

How often do you include board level discussion in your meetings about gaps in health disparities, or family disruptions from exploding out-of-pocket expenditures, grass-root frustrations can be anticipated. Urban activism from the 1980’s may surface again in the coming decade.[1] But instead of maternal deaths, the frustrations may surface from inadequate responses to the opioid crisis, water borne disease from eroding underground water and sewer infrastructure, crime and community disruption from steady increases in drug abusers turning to crime, or disadvantaged teens unable to find employment.

As we work to enhance board effectiveness in an era of stakeholder activism, we would be wise to borrow insights from companies dealing with shareholder activism. Spencer Stuart offers these six useful insights:[2]

  1. Be your own fiercest critic. Anticipate the case that might be made against you, keep all your options constantly under review and prepare your response.
  2. Think the unthinkable. How does the board contemplate the kind of disruption that the objective, dispassionate outsider may envisage as necessary?
  3. Be objective. Disengage from your emotional investment in the status quo and the current strategy in order to match the objectivity of the analytically driven activist.
  4. Take the activist seriously. They will have done their homework. It is free advice.
  5. Review board composition. Increasingly, the focus of attention will be the board itself — its leadership, composition and effectiveness.
  6. Be open-minded about board representation. Each request should be considered on its merits. The board’s response should be framed by the stakeholder’s  attitude to the long-term health of the business.

This preparedness is needed in rural and urban communities, especially as we struggle to design and implement new care modelas aliong the continuum of care.

For practical insights into how to engage with your diverse community, see this new guide from the Washington State Hospital Association,

Anticipating community activism should also encourage board and executive leaders to foster a culture of open communications and candid performance reviews. Being a hospital board member is challenging, valuable work that takes strength of will, courage, integrity and critical thinking. Holding your CEO to account, and acting early and decisively, means the hospital will have more options available to it — and value to the organization and community can be preserved.

In other words, “rocking the boat” sometimes is the only thing that will keep it from sinking.[4]


[1] See Lessons in Community Health Activism, The Maternity Care Coalition, 1970–1990

[2] See:

[3] See:

[4] From “Rocking the boat”

James A. Rice

Jim Rice, PhD, FACHE is the Managing Director & Practice Leader with the Governance & Leadership service line of Gallagher’s Human Resources & Compensation Consulting practice. He focuses his consulting work on strategic governance structures and systems for high performing, tax-exempt nonprofit, credit union and health sector organizations and integrated care systems; visioning for large and small not-for-profit organizations; and leadership development for Boards and C-Suite Senior Leaders. 

Dr. Rice holds masters and doctoral degrees in ...

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