Quality Update
Leading The Drive For Quality: Is Your Board Ready?
By Eric D. Lister, M.D.
While most in the health care field have long agreed that boards have a fiduciary duty for their hospital’s or system’s financial performance, they often fail to acknowledge that trustees are equally responsible for the quality of care delivered there. This responsibility for quality, however, is far more complex than ensuring that a hospital’s bottom line is in the black.
So many competing sets of “definitive” quality metrics are constantly being introduced that trustees are often unsure how to define and measure quality. They doubt their ability to challenge the proclamations of physicians and administrators in these matters and hesitate to upset the medical staff upon whom the hospital depends.
This hesitation has often led to the extreme situation where boards simply become cheerleaders for quality, crossing their fingers and assuming on faith that their organization continues to deliver quality care.
However, a transformation is occurring. Boards are increasingly coming to understand that the era of “quality by proclamation” is gone forever. Thanks to ever-more consumer awareness of quality measures, government pressure and the linking of reimbursement to quality measures, such as pay-for-performance, hospital trustees are realizing that “good enough” is not, in fact, even remotely adequate.
What Should Your Board Do?
Becoming a board that embraces its responsibility for quality of care depends upon trustees who are passionate about quality, demand high standards, insist upon data prior to celebration, and have developed a level of comfort in respectfully, but firmly, challenging their physicians to strive for excellence. Following are some suggestions for how boards can begin:
1. Understand the issues.
Educational retreats focused on quality and national conferences addressing this issue all help, as does reading the relevant literature and recruiting trustees with backgrounds in the science of quality. Many boards have found that trustees with training in engineering, aerospace and manufacturing have valuable skills for leading this work. Providing the necessary resources to hospital trustees, such as those available through the AHA’s Quality Center, will help to demystify quality assurance.
2. Together with other senior leaders, learn about methods to monitor quality.
Medical staffs are often eager to connect with trustees because they understand the board’s authority and want to be involved in decision-making. This can be uncomfortable for CEOs, who sometimes fear losing control or being bypassed by direct trustee-physician contact. The challenge of transforming quality offers an opportunity to join forces and work arm-in-arm.
The board, medical staff and administration can come together and learn from experts and one another. (Don’t be fooled; physicians have as much to learn as anyone else.) Go to national meetings as a group. Bring in guest speakers who can address trustees, as well as administrators and physicians. In order for quality methodologies to succeed in an organization, the entire leadership team needs to rally behind the cause. Use the pursuit of quality as a gathering point for all who are committed to the health of your community.
3. Don’t be intimidated by technical jargon.
The board’s job is not to look over physicians’ shoulders as they work, but to ensure that peer review is conducted rigorously, to understand metrics related to trends and outcomes, and to ask hard, common-sense questions, such as: “How do our results compare with our competitors?” “What have we learned?” and “What should we change?”
4. Challenge your CEO.
If your board wants the executive team to balance its focus on dollars with an emphasis on quality, insist that senior staff’s compensation be linked to data showing improved quality outcomes. Your benefits consultant should sit down with board leadership, including the CEO, to arrive at meaningful and quantifiable measures. This sends a powerful message to senior leadership and helps foster a culture of quality throughout the organization.
5. Join national and regional collaboratives.
Historically, health care leaders have had a poor record of learning from others’ experiences and an even worse record of importing lessons from other industries. Whereas other industries are often eager to incorporate best practices from competitors, health care leaders seem to insist on reinventing the wheel each time they encounter a problem. There are many opportunities for leaders to share knowledge and learn from one another—state and regional consortiums, collaboratives such as the Institute for Healthcare Improvement’s learning communities, and national initiatives such as the “100,000 Lives Campaign”—offer exciting alternatives.
6. Collaborate with physicians.
Progress is much easier when quality of care is a top priority for boards, administrative teams and medical staff alike. While the path to this commitment may be difficult, trustees need to pursue this goal relentlessly. It involves treating physicians as customers while at the same time holding the organized medical staff accountable to the board for their delegated quality assurance functions.
Physician recruitment, the credentialing and re-credentialing processes, the structure of exclusive contracts, all need to be done with quality in mind. Physicians receiving administrative stipends (e.g., vice president of medical affairs, medical directors, service line leaders, etc.) need to have clear assignments related to your quality goals, and should be expected to commit enthusiastically to supporting your pursuit of the highest standards of quality of care.
7. Believe in quality.
My colleagues in this field and I know that boards can drive profound improvements in quality in their organizations. Unfortunately, all too frequently, we encounter boards that have been too passive, too overwhelmed and too deferential to the medical staff and administration to exert their authority. Their organizations and their communities pay the price.—Eric D. Lister, M.D., is managing director of Ki Associates, Portsmouth, N.H., consultants on governance, hospital/physician issues and the pursuit of clinical excellence. This article was provided on behalf of the AHA Quality Center, a resource designed to help hospitals accelerate their quality improvement processes to achieve better outcomes for patients and improve organizational performance. Go to www.ahaqualitycenter.org to explore these and other topics.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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