Your organization has a stellar CFO who has just presented mid-year financials reflecting updated cost-based reimbursement estimates.  The presentation is fantastic; clear, concise, and accurate.  She even has a sheet of notes tucked under her copy of the financials, ready for any question the board could ask.

And then… silence.

No questions.  No requests for clarification or context.  Just an awkward pause and a motion to approve.

It’s tempting to take this as a vote of confidence, but more often than not it’s a sign that board members aren’t comfortable asking questions.  Maybe they think everyone else understood and they don’t want to slow down the meeting… or they don’t want to appear uninformed… or they just hope someone else will ask.

While common, this silence can allow errors or omissions to go unchecked, sometimes for months (or years).  It also leaves board members short of fulfilling their fiduciary duty to understand the organization’s financial health.

Here’s why board engagement matters and how to make it easier.

Financial Literacy is a Fiduciary Duty

Board members don’t have to be accountants, but they do need to understand the basics. Fiduciary responsibility includes knowing what the financials say, asking questions when things aren’t clear, and connecting the numbers back to the mission.

Healthcare boards face unique challenges here.  Certain types of reimbursement, such as cost-based reimbursement, can swing financial statements dramatically and the impact isn’t always intuitive.  It’s not enough to skim; board members need to ask questions until they understand.

It’s perfectly acceptable for a CFO to say, “I’ll need to check on that.”  This isn’t a sign of incompetence.  It means they value accuracy and are willing to do the research to ensure the board has reliable information.

Why Board Members Stay Quiet

There are plenty of reasons that board members hesitate to ask questions:

• They assume everyone else understands.
• Someone has already asked the question, but they can’t remember the answer.
• They don’t want to look uninformed, especially if the meeting is public.
• They don’t want to draw attention to poor financial performance.
• They don’t want to be the reason the meeting runs long.
• They don’t feel comfortable enough with the leadership team to speak up.
• They only feel comfortable diving into areas they know well.

That last one is particularly common.  A board member with a construction background may want to discuss the quality and cost of wood chosen for a repair project (well outside the board’s scope) because it’s familiar territory.  It’s natural to focus on what we know best, but board service requires going further.

Practical Ways to Engage More Deeply

1. Don’t Wait for the Meeting

For new board members, it can be helpful to meet with the CFO (or finance lead) before your first meeting.  This provides space to go deeper into the financials and ask questions without fear of judgment.  Even seasoned board members may benefit from a one-on-one when a complex topic is on the horizon; a capital project, cost-based reimbursement changes, or the addition or closure of a service line.

Here are some questions you might ask:

• “Can you walk me through how to read the financial reports we will see each month?’
• “What are the biggest factors that can change our numbers quickly?”
• “Which metrics do you think board members should focus on most closely?”
• “Can you explain cost-based reimbursement and how it shows up in our reports?”

Depending on the organization’s structure, your CEO or board chair may prefer to join this meeting.  That’s fine as long as you still have the space and ability to ask questions and get full answers.

2. Observe or Connect with the Finance Committee

Many boards have a finance or audit committee that reviews financials in detail before they reach the full board.  If your board has one, use it as a resource.

Even if you’re not a committee member, you can:

• Ask to sit in as an observer on a meeting or two.
• Request a summary report so you understand what the committee is monitoring most closely.
• Meet with the committee chair or CFO afterward to get context in plain language.

These committees are often where complex questions get unpacked — things like capital financing, debt service coverage, or reimbursement changes.  Sitting in can give you valuable perspective on how leadership and finance staff think through these issues without slowing down the full board meeting.

If your organization doesn’t have a finance committee, ask whether there are other ways the board prepares for financial discussions.  The goal isn’t more meetings; it’s making sure you’re equipped to participate meaningfully when financials come before the board.

3. Speak Up During the Meeting

Silence doesn’t serve anyone.  Even simple questions create space for clarity and accountability.

You might consider asking:

• “I see our cash on hand went down this month.  What drove that change?”
• “What assumptions are built into our revenue projections?”
• “How do these results compare to budget or to last year?”
• “Are there any red flags you’re watching that aren’t on the report?”

The goal is not to interrogate, but to ensure the board understands the story behind the numbers.

Leadership’s Role in Building Confidence

If you’re in executive leadership, you have a role to play in encouraging financial engagement.  Watch the room when financials are being presented.  You may see board members with their eyes glued to the reports, carefully avoiding eye contact.  You may notice uneasy glances exchanged across the table. These are signs that questions are going unanswered.

You can make space for those questions by:

• Asking the CFO a question yourself: “It’s been a while since we discussed how cost-based reimbursement impacts our ambulance service—would you mind giving a brief summary?” or “I want to bring attention to the fact that we’re running in the negative right now, but we haven’t settled our cost report. Can you walk us through what this will look like?”
• Providing simple executive summaries alongside full reports.
• Using visual dashboards that highlight trends.
• Normalizing questions by inviting them explicitly: “What questions do you have?”
• Offering ongoing training refreshers, not just one-time orientations.

When the board feels equipped to participate, discussions become richer and decisions become stronger.

Final Thoughts

Financial reports are not just the boring opener to your board meeting. They are the clearest picture of whether your organization can keep serving the community.

Board members don’t need to master accounting or become experts on cost-based reimbursement, but they do need to ask, learn, and stay engaged.  And leaders need to create the environment where those questions are welcome.

Fiduciary responsibility doesn’t sound like silence.  It sounds like curiosity.

Interested in what we can do for your organization? Contact us to learn more or book a free consultation using Calendly.