Back to Basics 3
Understanding and Improving Clinical Quality: The Role of Trustees
By James L. Reinertsen, M.D
Hospital trustees often express uncertainty about their role in overseeing and improving the quality of their hospitals' services, particularly when it comes to clinical measures. At a recent American Governance & Leadership Group conference for trustees, administrators and medical staff leaders from hospitals across the country, when the subject turned to improving intensive care services, evidence-based medical care, risk of hospital-acquired infections, and other clinical matters, typical trustee reactions were:
"These clinical quality problems are the job of the doctors, nurses and administrators. I wouldn't know the first thing about those issues. I'm a banker. The board's job is just to make sure that our physicians are excellent and credentialed properly, and then the clinical quality should take care of itself. Isn't that right?"
And, "At our last board meeting, the [information] packet included 322 separate so-called 'quality indicators,' ranging from the time to answer a call button on 5 West to the percentage of heart attack patients who received aspirin, to the hospital's overall mortality rate. I have no idea what all these things mean and what's important and what's not. I assume the administrators and doctors must know. Don't they?"
The purpose of this article is to address these and other questions about the board's key responsibilities in overseeing the primary work of their institutions--caring for the sick. The board's roles can be summarized as:
1. To understand the community's expectations
2. To ensure that a few organizationwide measures of those expectations (these are the "big dots") are established, understood and monitored
3. To hold management accountable for improving the big dots and linking that improvement to the organization's strategic goals
4. To build the hospital's will to achieve these aims
5. To maintain constancy of purpose for the long-term quality transformation of the hospital
6. To promote collaboration across the community for redesigning care.
What Do Patients Want?
If you were to ask your patients and community why they need the hospital and what they want it to do for them, you would get a variety of answers. But the core themes, particularly with regard to clinical care, would sound something like the following:
- "Cure me. If I get sick or injured, I want you to cure me if a cure is possible."
- "Heal me. I want you to help me to heal, even when a cure is not possible."
- "Don't hurt me. I don't want you to make my condition worse in the course of diagnosis and treatment."
These needs form the three pillars of the hospital's clinical mission: cure when cure is possible; heal even when cure is impossible; and throughout the process, do no harm. The first is about clinical effectiveness--about organizing and delivering care in such a way that all the known science of medicine is applied to each patient and produces the best possible results. The second need is about building healing relationships between patients, doctors and nurses and centering the care design around each individual patient and family. The third need primarily concerns safety and confidence, but it can also be broadened to include unnecessary costs as another form of harm. Hospital boards must understand and accept all three of these drivers of the hospital's clinical mission.
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This article 1st appeared in the September 2003 issue of Trustee Magazine.
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