Sharing insight or blowing smoke? The case for descriptive patient representatives on community health center boards.

Abstract

Background: Community health centers (CHCs) receive federal grant money to reduce health care disparities. To be eligible, at least 51% of their board members must be descriptively representative patients (i.e., truly represent the population served by the clinic). However, research paints an unclear picture of how these patients influence board effectiveness.

Purpose: The aim of this study was to investigate the impact of descriptively representative patients on board conversations contributing to the board's effectiveness.

Methodology/approach: Two studies were conducted. Study 1 involved 23 semistructured interviews, observations of six board meetings, and five discussions with subject matter experts to examine the impact of descriptively representative patients on conversations that contribute to board effectiveness. Study 2 was a two-wave survey administered to 177 CHC chief executive or operating officers to investigate the impact of descriptively representative patients on the relationship between volubility (i.e., the amount of talking within a group) and board effectiveness.

Results: Study 1 revealed that although representative patients provided valuable insights, there was skepticism about their ability to contribute effectively, leading some to circumvent the requirement for such members. Additionally, we found that descriptively representative patients influence two key mechanisms-participative decision making and pointless discussion-through which conversations influence board effectiveness. In Study 2, we discovered that increased descriptive patient representation can mitigate the negative impact of volubility on pointless discussion and, in turn, enhance board effectiveness.

Conclusion: Descriptive patient representatives are valuable members of CHC boards, and the information they provide can keep conversations more focused.

Practice implications: CHC boards should not underestimate the value of truly representative patients. The Health Resources and Services Administration, which provides grants to CHCs, should be aware of efforts to circumvent the requirement for descriptive patient representation on CHC boards.