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The purpose of this book is to help boards of directors of nonprofit organizations improve their performance after completing the online board self-assessment tool found at www.boardcheckup.com. However, it can also be used as a stand-alone resource for any board seeking to enhance its effectiveness in that it also contains the diagnostic questions on which the online tool is based.

The approach taken here is similar to that which lies behind health checkups for individuals. Doctors usually begin by asking us to review a lengthy list of many possible health issues and we check those about which we have concerns. The doctor and patient then focus their discussions on these issues. The typical process proceeds through the following three stages:

1. Understanding the symptoms. The doctor and patient begin by trying to define the issues more clearly.
2. Diagnosis. Effort is made to understand the causes of the problems through tests and further examination.
3. Treatment. Once the problem has been properly diagnosed, a treatment program to remedy it is begun.

While the Board Check-Up survey on which this book is based does not pretend to be as scientifically rigorous as a medical examination, it is based on the same logic. It begins by having those who belong to, or relate to, boards provide their perceptions of how well the board is working by guiding them through a list of potential "health issues”, i.e. statements of possible problems, issues or challenges that boards might encounter in their work. These statements have been derived from comments made by those who serve on boards or interact with them as well as from the work of researchers and consultants who have studied boards over the past 30 years. Once issues (symptoms) have been identified, they become the focal point for discussions that explore how serious they are, what might be causing them (diagnosis) and what can be done to resolve them (treatment).

As noted above, this book is intended to help boards assess performance and make decisions to improve the effectiveness of the governance process. Each chapter deals with one of the nine dimensions of governance effectiveness. It starts with the items dealing with that dimension on the Board Performance Self-Assessment Questionnaire. These items represent the symptoms that indicate possible issues, problems or challenges faced by the board. This is followed by a discussion of possible reasons that such symptoms might exist (diagnosis) The third part of each chapter looks at what might be done to alleviate the symptoms once a diagnosis is made (treatment). Included in this final part of the chapter are references to websites, books, and articles that provide additional advice and assistance on how to deal with the issues raised.

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