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Home / All Insights / Who Takes the Chair? Succession and Term Limits on Health Boards

Who Takes the Chair? Succession and Term Limits on Health Boards

By Ace Robinson · · Last updated

Your executive director is out for three months. Or your board chair's term ends in June and nobody has been asked to step up. Does your board know what happens next?

Most boards don't. The numbers below come from health centers, but the pattern will look familiar to any health nonprofit.

What the Numbers Say

The National Association of Community Health Centers (NACHC) surveyed 667 health center board members and CEOs in 2023. Boards rated themselves well on most oversight work, with satisfaction between 88% and 95% on topics like understanding their roles, reviewing financial performance and supervising the CEO. Then came the exceptions:

  • 64% were satisfied with how the board plans for the CEO's absence, departure or replacement. That was the lowest oversight score in the survey.
  • Fewer than 40% reported having a process for board member and officer succession. On officer succession specifically, 34% said they had a plan or process.
  • 53% of health center boards limit consecutive terms. Across the nonprofit sector, BoardSource reported 76% in 2021.
  • Only 25% match new members with a board buddy or mentor. Far more, 79%, run an orientation.

Succession is the work boards put off because nothing is on fire yet. It's also the work that matters most when something is.

Three Plans Every Board Needs

1. An emergency plan for when the executive director is absent. Write down who covers what, who the board talks to, and who can sign. NACHC points out that this plan matters even when the board expects no change in leadership. Illness, family emergencies and sudden resignations don't send a warning.

2. A succession policy for when the executive director leaves. Decide how the board will run a search, who leads it, and how it will hold the organization steady in between. This is also where a founder's exit gets planned, instead of improvised.

3. A plan for the board chair and officers. Give the governance committee, or whatever committee handles recruitment, the job of writing down how future officers get identified and prepared. About two-thirds of the boards in the NACHC survey already have a committee like this. Give it the assignment and a deadline.

Term Limits Without the Fight

Term limits are uncomfortable because they sound personal. They shouldn't. A limit is a rule about the seat. It says nothing about the person in it.

What works:

  • Set a term length and a maximum. (BoardSource has guidance on terms and term limits.) The most common setup among health centers is two or three consecutive three-year terms, which means six to nine years of service.
  • Stagger the terms, so that no more than about a third of the board rolls off in any year. The board keeps its memory and still gets new people.
  • Plan the chair's rotation too. The seat that holds the most power is the one that most often has no end date.
  • When you introduce limits, let current members finish the term they're in. Nobody gets pushed out, and the rule is clear for everyone who comes next.
  • Keep a way to bring back a strong member after a break. Term limits shouldn't cost you your best treasurer forever.

Make New Members Useful Sooner

A good orientation covers the bylaws, the budget, the strategic plan and the organization's history. A board buddy covers everything the orientation can't: how this board talks in practice, who to ask, what the unwritten rules are. Pair every new member with someone who has served at least a year, and ask both of them to check in after the first three meetings.

Do This Quarter

1. Write the emergency plan for an executive director's absence. One page is enough. 2. Put succession for the executive director and the chair on the agenda for your next two meetings. 3. Ask your governance committee to propose term lengths, a maximum and a chair rotation. 4. Pair each member who joined in the last year with a board buddy.

If your executive director is the first person to hold the job, or a founder is getting ready to leave, this work is time-sensitive. See how we help with leadership transition and executive coaching for HIV nonprofit leaders, or start a conversation.

Onward. Together.

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