All too often, board members misunderstand a hospital or health system’s strategic and operating risks. If board members have significant differences in how they understand the nature and acuity of the risks confronting the hospital, reaching a well informed and relevant consensus on a prudent strategic direction becomes much more difficult. During a recent Stroudwater webinar for county- and district-owned hospitals, nearly 40% of participants indicated there was significant misalignment between the hospital board and the county or district board regarding the organization’s risk profile.