INSIGHT | Healthy Board Dynamics are Key to Effective Strategy
The Challenge
Boards in crisis are easy to spot: alignment falters, trust erodes, and decision-making slows, often when urgency is greatest. In healthcare, where organizations face unrelenting financial pressures, workforce shortages, policy shifts, and evolving community needs, the margin for misalignment is razor-thin. Strategy cannot succeed if boards and leadership teams aren’t moving in step.
Healthy board dynamics are key to effective strategy. The way boards and leaders communicate, build trust, manage conflict, and make decisions directly shapes whether a strategy can take hold and deliver results.
These dynamics became especially clear during the transformation to Merrimack Health, when Lawrence General Hospital (a medium-sized, community-based hospital) executed a high-stakes acquisition involving financially distressed hospitals; coordinated across public and executive stakeholders; and established the region’s first integrated health system. Operating under sustained financial pressure, public scrutiny, compressed timelines, and material operational risk, the organization provided a real-world test of how governance performs when alignment cannot be assumed and decisions must advance without complete information. The experience revealed how a board’s clarity of purpose, diversity, trust, constructive debate, accountability, and learning are tested under pressure, and how board composition, leadership norms, and decision discipline determine whether strategy accelerates or stalls.
The Approach
As board chair of Lawrence General Hospital, our CEO, Rosemarie Day, led transformational change during a pivotal time in the community hospital’s 150-year history. She navigated a high-stakes acquisition of two nearby hospitals that were facing bankruptcy and possible closure. She recruited a diverse board to help broaden perspective and build legitimacy. She coordinated across public and executive stakeholders to build the case for the acquisition and to secure funding. The result was the establishment of Merrimack Health, the region’s first integrated health system. The work unfolded amid public scrutiny, compressed timelines, and operational risk. These were just some of the many conditions that sharpened Day’s perspective on what enables boards to lead with clarity when information is imperfect and stakes are so high.
Here are the key elements of healthy board dynamics:
Clarity of Purpose – A shared understanding of mission, priorities, and long-term organizational direction.
Diversity of Membership – Board brings diversity across multiple dimensions, including demographics and professional expertise, so that it represents all of the communities it serves in a meaningful way.
Trust and Respect – Confidence that leaders and Board members can navigate hard choices together with transparency and mutual respect.
Constructive Debate – Space for a variety of perspectives and robust, candid discussion that leads to stronger decisions.
Accountability – Clear roles, responsibilities, and follow-through that prevent drift or duplication.
Culture of Learning – A willingness to adapt, reflect, and continuously improve how the board governs.
Presence and Connection – When possible, in-person engagement adds nuance, context, and relationship-building that strengthen alignment.
For Rosemarie, the work to create Merrimack Health surfaced important leadership lessons about board engagement and making high-stakes decisions with imperfect information. She learned the importance of humility and deep listening as a leader, in an ongoing effort to strengthen trust and respect and elevate constructive debate amongst a diverse board. Creating Merrimack Health also demonstrated that strong governance is rarely linear, requiring recalibration, accountability, and sustained leadership maturity as conditions evolve.
Together, these lessons reinforce that clarity of purpose, diversity, trust, debate, learning, and accountability must be intentionally built and continuously strengthened rather than assumed to emerge organically.
Rosemarie has gone on to work closely with other healthcare CEOs and lead board retreats along with members of the Day Health Strategies team. Her deep experience reveals this simple truth: Healthy board dynamics don’t happen by accident. It takes a concerted effort to build and sustain them.
Our Impact
When boards and leadership teams operate with clarity, trust, accountability, and presence, organizations are better equipped to act decisively, allocate resources effectively, and sustain momentum through uncertainty. The payoff is sharper focus, greater resilience, and a stronger ability to deliver on mission.
The Merrimack transformation serves as a case example of how these dynamics translated into successful governance performance under pressure that made large scale transformation possible.
In short, strategy is more than what’s written on paper; it’s the discipline, alignment, and dynamic partnership with which boards and leaders bring it to life. Together, these dynamics operate as tangible organizational assets, shaping institutional trajectory well before outcomes are reflected in financial or performance metrics.
CLIENT TESTIMONIAL:
“Rosemarie Day is one of the most dynamic, inspirational, perspirational (i.e., hard-working), and compassionate leaders I have ever met. Merrimack Health and the entire Merrimack Valley is fortunate for her leadership through one of the most challenging times in our collective 150-year history.”
— Lane Glenn, Incoming Board Chair, Merrimack Health; President of Northern Essex Community College
CONTACT US!
At Day Health Strategies, we view board engagement as a strategic function, not a procedural requirement. We help boards and leadership teams move beyond routine oversight to authentic, strategic partnership. Our work focuses on creating the conditions for trust, clarity, and constructive debate, ensuring that governance accelerates progress instead of impeding it.
We guide organizations to elevate meetings into forums for strategic alignment: surfacing tensions, framing complex tradeoffs, and unifying stakeholders around a shared direction. By reinforcing both the mechanics (structure, decision rights, roles) and the dynamics (relationships, culture, trust), boards become a catalyst for execution rather than a brake on momentum.
Interested in learning more? Contact us today!