Great hospital performance is positively influenced by great governance. Great governance is possible only with great board-CEO relations. The CEO performance planning and appraisal system is one of the central vehicles in which board-CEO relations can be clarified and enhanced. At recent leadership conference of The Governance Institute, board members, physicians, and CEOs were invited to identify practical strategies that have the potential to nurture great board-CEO relations by focusing on enhancements within the process of CEO performance planning and appraisal. Their input is included in this two part white paper. Part A explores trends in CEO performance development that are shaped by the organization’s business strategy and argues for developing talent through the three concepts of trust, transparency and truthfulness. Part B provides a short review of how to introduce an effective CEO performance planning and appraisal system in high performance health services organizations. The papers are intended to provide an easy read and a tool to stimulate conversations among the senior leaders of the board, executive team and medical staff.