Building a Board That Works: Lessons from the Boardroom

Seasoned executives and operators share what separates effective boards from expensive distractions — and why the right people at the top can make or break a company’s trajectory.

When a company is navigating the move from discovery to clinical development to full-scale commercialization, few decisions carry more weight than who sits in the boardroom. A panel of experienced CEOs and board members recently gathered to share frank perspectives on what makes boards work — and what makes them fail.

The consensus was clear: building an effective board is as much a strategic discipline as any other aspect of running a company, and the mistakes made early tend to compound.

The panelists

Una Ryan, PhD is an investor and board member, and former CEO of AVANT Immunotherapeutics and Diagnostics for All, with broad board experience across biotech and diagnostics.

Tiffany Olson is the former President and CEO of Roche Diagnostics Corporation, current board director at CastleBiosciences, MiMedx, and author of Real Leader. Real Legacy: The Power of Leadership at Every Stage of Your Working Life.

Bob Roda is the former President and CEO of HemoSonics and former VP/GM at BD Medication & Procedural Solutions, with hands-on experience leading companies through growth and commercialization.

The most common mistakes founders make

Two patterns emerge repeatedly when early-stage CEOs assemble their first boards. The first is chasing prestigious names. The second is defaulting to the familiar — pulling in mentors, former advisors, or colleagues from academia rather than filling genuine skill gaps.

“You want someone who has been down that mountain before — who knows the route, who knows where the bumps are — rather than necessarily the Olympic skier.” Una Ryan

The distinction matters. A Nobel Prize winner in your field may be a trusted confidant, but that relationship doesn’t need a board seat to function. What a board requires is a complementary mix of skills the founding team doesn’t possess, calibrated to where the company is right now — not where it hopes to be.

Availability is equally underrated. Many high-profile candidates are perpetually in demand — speaking, traveling, advising a dozen companies at once. True board membership requires genuine commitment: understanding the investors, staying close to strategy, showing up prepared.

Perhaps most critically, founders tend to think of their board as permanent. It isn’t — and it shouldn’t be. The scientists and advisors who help you write your first IND are almost certainly not the right people to navigate a product launch or a complex exit process. Planning for that evolution is something every CEO should be doing long before the moment of change arrives.

The line between oversight and interference

One of the most recurring tensions in board dynamics is the boundary between strategic guidance and operational meddling. The panelists were aligned: the board’s job is to stay high, to govern and provide direction — not to run the company.

“Noses in, fingers out” — a maxim cited more than once — describes the ideal disposition of a board member who is deeply informed but disciplined enough not to reach in and do the work themselves. Tiffany Olson

That said, early-stage companies operate in a different environment. When resources are thin and specialized expertise is scarce, it’s entirely appropriate for board members to roll up their sleeves — helping with fundraising, digging into clinical data, opening their networks. The key distinction is whether that involvement is invited or imposed. When the company asks for help, active participation is a feature. When a board member reaches in uninvited, it becomes a drag on the CEO’s authority and the team’s confidence.

The board members who make the biggest impact aren’t those who have the answers — they’re the ones who ask the right questions. Creating a space where a CEO feels comfortable being vulnerable, exposing uncertainty, and stress-testing their thinking without feeling judged or second-guessed is, in the view of many experienced operators, the single most valuable thing a board can offer.

What good board culture actually looks like

The early warning signs of a dysfunctional board are rarely subtle. Factions forming around particular investors. A majority-vote culture replacing the pursuit of consensus. A CEO who feels they’re selling to the board rather than thinking alongside them.

When board members have genuine rapport — with each other and with leadership — it shows. When the room is leaning in, engaged, challenging ideas constructively, the energy is unmistakable. One panelist put it simply: if everyone looks up and smiles when you walk in, that’s a good sign.

The board meeting itself is a useful diagnostic. Recap belongs in the pre-read; the meeting should be 80 percent discussion, built around genuine strategic questions and real risks — not a performance of competence for investors.

Evolving the board as the company grows

One of the most important — and least discussed — aspects of board governance is rotation. Fixed board terms, handled thoughtfully, give companies a natural mechanism to refresh composition without awkwardness.

As companies move toward commercialization, the board’s skill matrix needs to shift accordingly: operational expertise, marketing, financial structuring, reimbursement strategy — the unglamorous disciplines that actually drive commercial success. Getting ahead of that need, rather than scrambling to fill gaps under pressure, is a mark of mature governance.

On investment strategy and exit planning, the panel was equally direct: these conversations are too consequential for a standard board meeting. A retreat or offsite — where options can be genuinely explored and consensus built — is the right setting for decisions about an IPO, a partnership, or holding for a larger outcome.

Practical advice for founders

Build relationships with board members outside of formal meetings. Let them see the challenges, not just the progress. The CEOs who get the most from their boards are those who treat board members as genuine partners — not audiences to be managed or obstacles to be navigated.

From the CEO perspective, the value is clear. The best board relationships aren’t about being given answers, but about challenging the thought process:

“I don’t want you to tell me if I’m right or wrong. I want you to challenge how I’m thinking about it. Share experience that help me avoid the same pitfalls.” Bob Roda

Be honest about what the company needs right now, not just what looks impressive. Brand equity on a board has value in fundraising. It has far less value in an operating crisis. Ask hard questions of prospective board members during the recruitment process — about how they think, about where they’ve failed, about what they believe good governance looks like. Fit matters as much as a resume.

And finally, when the board trusts that the CEO is doing their job. That trust, built carefully over time, is what allows a board to function as the asset it should be: a group of experienced, committed individuals who are as invested in the company’s success as it is.