What's a Board to Do?
Trustees can take specific actions to reduce the risk of quality fraud. Our short list is drawn from best practices noted in the Institute for Healthcare Improvement’s “Boards on Board” elements, as well as the American Health Lawyers Association guidance for boards.
1. Pay attention to quality.
The best boards spend at least 25 percent of their time as a board on quality and safety matters, reviewing performance, setting goals, clarifying expectations, and most importantly, asking hard questions. Among the hardest questions boards should ask are:
- Does the decision we just made put us at increased risk for quality fraud?
- Are we knowingly profiting from poor quality (e.g., re-credentialing poor-quality but high-revenue physicians, or approving excessively lean staffing budgets)?
- Are we really hearing the quality concerns of patients, families, nurses and physicians––the insiders who can become whistle-blowers?
- Are we hearing about quality and safety failures when they occur? How are we holding hospital management accountable for resolving these issues?
- Do we truly understand the quality and safety performance data shown to us as the board? If not, what are we doing to improve our oversight capability?
- How do we know that our publicly-reported quality data are consistent, complete and at least as accurate as our publicly-reported financial data?
2. Bring quality and compliance programs together.
In many institutions, compliance has developed separately from the rest of the business, often in an effort to maintain the independence of its functions. Unfortunately, all too many times this leads to a splendid isolation of the compliance office. The integration of quality concerns into the compliance function has the capacity to strengthen both quality improvement and compliance—and is a good step toward preventing quality fraud.
This article 1st appeared in the September 2008 issue of Trustee Magazine.
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