Defining the communicative work, roles, and inclusion in patient-majority boards
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This study conducted a qualitative examination of how patient and non-patient board members and executive level employees influenced governance communication at four Federally Qualified Health Centers (FQHCs) in the southwest region of the United States. The analysis of 62.5 hours of observation of 41 board events, 42 interviews, and 1,411 pages of board meeting packets identified a significant influence of the patient difference on the communicative work of governance, board member roles, and the process of “getting better” at communicative approaches to inclusion. The first research question examined the communicative work of governance as significant in establishing the board culture and defining the boundary between governance and micromanagement of paid employees. The communicative work of governance in establishing boardroom culture established the values and assumptions in how board members interacted with each other. The communicative work of governance in defining the scope of governing operational activities established the board’s relationship with the organization and the senior leadership team (SLT). The second research question examined the dynamics between board members in more depth by evaluating the communicative acts that shaped three distinct, yet permeable, roles within the boardroom as the Patient, the Contributor, and the Perennial. These roles carried perceived and enacted expectations due to differences in perceived socioeconomic status, differences in who needed to learn what, and differences in their participation in governing activities. The third research question examined how each site of patient-majority engaged in the communicative strategies of inclusion in response to crises of exclusion that divided the board between patients and non-patient board members and to episodes of exclusion of particular board members. The events of exclusion developed further architectures of inclusion in the boardroom by implementing policies and communicative patterns that valued inclusion within the boardroom. These findings hold significant implications in exploring inclusion as a communicative dimension of diversity to understand how diversity, particularly socioeconomic diversity, in the boardroom impacts communication among board members and between the board and executive employees.