Trustee Profile
Vincent O'Reilly: Taking Patient Safety Personally
By Laurie Larson
When trustee Vincent O'Reilly speaks to MBA students in his leadership class at Boston College's Carroll School of Management, Newton, Mass., he tells them: "You need to listen carefully to those you work with--it's unusual for a single person to have all the information [needed] to solve issues." He also counsels future leaders to "spend time reflecting on your own performance, as well as others' performance; recognize that the issue may not be what it first appears to be."
He brings a lot of firsthand experience to bear as a senior lecturer at his alma mater, where he received his undergraduate degree in economics, followed by a Master of Business Administration from the University of Pennsylvania's Wharton School of Business. He is a retired partner at Coopers & Lybrand, where he served as chief operating officer and board chair. In addition, he has more than 25 years of experience as a trustee at Boston's Dana-Farber Cancer Institute, including eight years as board chair. But even as he instructs others, he knows he has more to learn now than ever before.
"The trustee's work is very different now," O'Reilly says. "It's more complicated, regulations are more intense, financial stability is more difficult to maintain, particularly in a single disease hospital--you can't vary the patient mix to balance reimbursement--and you must be more honest and open with the public than ever before."
He can certainly speak to that, after Dana-Farber's tragic experience in 1994, when patient and Boston Globe reporter Betsy Lehman died in the hospital as the result of a medical error. O'Reilly is currently vice chair at Dana-Farber, and was the board's outgoing chair when the highly publicized death occurred. In response to the tragedy and the intense publicity that followed, Dana-Farber had to respond with equal strength, O'Reilly says.
"We decided we had to get the facts [of what happened and how], and you can only get the facts through an analytical approach. We wanted to identify the processes and systems that broke down instead of [searching for] someone to blame."
In recognition of his leadership under fire, O'Reilly was given the New England Healthcare Assembly's 2004 Trustee Leadership Award. His president and CEO, Edward J. Benz Jr., M.D., says the award was "in recognition of [O'Reilly's] role in making Dana-Farber an institution that takes a leading role in patients' safety," and adds that O'Reilly was "instrumental in leading Dana-Farber through the crisis in 1994."
The board took three major steps after the Lehman tragedy: first, to involve the executive team in detailed quality initiatives; second, to form a committee of trustees, medical professionals, lay managers and patients to focus on quality and other issues; and third, to set up systems and procedures to keep all staff aware of patient safety and process improvements. The second step resulted in the board-level Quality Improvement Risk Management committee, which O'Reilly chairs--and it has had a profound positive impact on creating a safer culture. "Vin and his colleagues have been very instrumental in Dana-Farber's culture change," Benz says. "He brings rigor to the board. He has high standards, but he's very supportive and very committed."
The committee reports to the board five to six times a year, focusing on the results of ongoing patient satisfaction reports from each department. Lawrence Shulman, M.D., Dana-Farber's chief medical officer and senior vice president for medical affairs, has known O'Reilly for a decade as an ex officio board member and has worked closely with him on the Quality Improvement committee.
"We take nothing for granted. We challenge ourselves, and we expect to be challenged by management--that's the culture," Shulman explains. "Vin will challenge whatever we've thought of to make sure we have the best processes." Shulman adds, however, that O'Reilly never oversteps his bounds as a nonmedical person.
"He knows what he knows and what he doesn't know clinically," Shulman says. "He deals in smart systems. Vin said, 'If you can't explain [a system process or safety idea] to me in five minutes, you should change it'--and he was right."
O'Reilly says committee members make weekly rounds, asking physicians, nurses and pharmacists what may have happened during the previous week that impeded their ability to give excellent care. Improvements are suggested and followed through. The committee looks at everything from wait times to clinical trials, and does root cause analyses of any unexpected deaths that might occur, followed by process improvement.
"We have a frank discussion of all quality failings that had the potential to cause harm," O'Reilly says. He adds that the committee's work has spawned other spin-offs, such as an ethical practices committee, to further hone the quality control and risk management purposes of the original committee.
"We want to have more reported incidents than anyone else to find out what's not working," O'Reilly says. "We want a reporting mechanism to know what's gone wrong, to make sure it's not random, to tease out the process improvements."
"Vin is an incredibly smart person," Shulman says. "He has a way of viewing our work differently than those of us who are medically trained. We come to patient safety and quality problems from inside the profession ... but Vin looks at problems with different eyes and suggests solutions we haven't seen.... He serves as a very bright, very invested outside consultant."
Shulman adds that O'Reilly has handpicked all the other trustee members of the Quality Improvement committee and "directed them to be active, to know their responsibility--he's singlehandedly gotten together a group that does what he does."
O'Reilly says that because "trustees are the mechanism by which the board obtains its firsthand information--it's hard to get trustees off this committee."
That's one reason why he finds his trustee work "uplifting" and says he enjoys the opportunity being a trustee gives him to "be involved in something that isn't business, in the sense of a profit-making business. It's an opportunity to be associated with an organization that has a direct goal of helping people."
He adds that, "People know I stand up every quarter and report on the work of the [Quality Improvement] committee. It creates the right tone at the top."
Even from the top of the boardroom, however, O'Reilly remains down-to-earth.
"I think you need to constantly have a sense of humility," O'Reilly says. "The people at Dana-Farber are a unique group who do things brilliantly--they create miracles. We must remain humble, and always focus on the fact that there's a better way. There is an arrogance that comes from excellence--we have to channel that arrogance into patient safety and discerning cures."
Shulman commends his selflessness. "None of what Vin does is for Vin's benefit," he says. "He does this as a volunteer, and we know that. He cares deeply about the institution ... and when he demands something from us, it makes us better."
Laurie Larson is Trustee's associate editor.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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