Form 23 Guideline on Creating a Board Self-Assessment Survey

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<strong>Form</strong> <strong>23</strong> <strong>Guideline</strong> on Creating a Board Self-Assessment Survey Sample Questions on Board Efficiency and Performance 1. Board members contribute their skill and experience. 2. Board members respect and value the views of all members of the board. 3. Board members come prepared. 4. Board members treat each other with courtesy and respect. 5. Board members respect the confidentiality of board discussions. 6. Board members declare conflicts as required. 7. Board members are aware of and adhere to the board Code of Conduct. Comments: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Self-Assessment [Instruction #6 - Some evaluations will also include a self-assessment portion. Directors rate their own performance and their rankings as compared with the board as a whole are provided to them to assist in self-improvement.] Sample Self-Assessment Questions Knowledge 1. I have a good understanding of the hospital’s operations. 2. I understand the mission vision and values. 3. I am familiar with the strategic plan and take it into account in board decisions. 4. I understand the difference between the governance role of the board and the role of managers. 5. I understand the board’s role and annual work plan. 6. I understand and respect the roles of committees. Comments: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 6
<strong>Form</strong> <strong>23</strong> <strong>Guideline</strong> on Creating a Board Self-Assessment Survey Contribution 1. I apply my skill and experience. 2. I listen and consider the views of others. 3. I prepare for meetings. 4. I ask questions that will help me make a decision. 5. I express my views even when I may be in the minority. 6. I respect the decision of the majority. 7. I meet or exceed the attendance requirements. 8. I support hospital and foundation events. 9. I contribute to the committees on which I serve. Comments: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Other 1. I wish to continue on the board. 2. I am interested in the following committees. 3. I am willing to serve as a committee chair. 4. I am interested in becoming board chair. Comments: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 7
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Form 23 Guideline on Creating a Board Self-Assessment Survey

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