The days when a hospital board's fiduciary duty revolved primarily around financial performance and strategic planning are long gone. Today, there is an increasing expectation from regulatory, judicial and public sectors that trustees are accountable for the quality of health care services that their organization provides.
But how can lay board members have meaningful conversations with physicians and administrators about clinical quality? How can board members foster a culture of continuous improvement? One of the most powerful ways is to invite a recent patient to tell his or her story at a board meeting. After all, patients and family members see the best—and the worst—of the systems and professionals who strive to diagnose, treat and care for them.
Having a patient share his or her story at a board meeting changes the dynamic in the room. Governance comes face-to-face with the 81-year-old veteran who developed an infection and refers to the event as his "lost summer," adding, "When you're 81, you don't have a lot of summers left to lose." It forges an emotional connection to a particular opportunity for improvement and inspires action. In this conversation, medical jargon and acronyms disappear, and the issue is understood by everyone in the room. Board members now have a different perspective from which to examine data on health care-associated infections, readmission rates, mortality rates and other complications that prolong hospitalization or cause patient harm. Trustees are empowered to ask hard questions such as, "Is this result acceptable to us?", "What resources do management and medical staff need to improve this result?", "What is our improvement goal on this measure?", "Are we on track to achieve our quality aims?" and "Who is the best in the world at this, and what can we learn from them?"
At first, inviting a patient to tell his or her story to the board may seem risky. Using the following guidelines, however, can help ensure this powerful practice yields the intended results.
Pick the right patient. Select a patient with a recent experience at your organization. The patient's event or treatment should relate to measures on your quality dashboard, but be sure to connect the dots for trustees at the beginning and end of the session on why this particular patient was chosen. Potential speakers might include a patient with a post-operative hip or knee infection as related to the Surgical Care Improvement Project measure involving the timing and selection of prophylactic antibiotics; a congestive heart failure patient who experienced a harmful event such as a fall during a readmission; or a pneumonia patient who developed C. difficile with profuse diarrhea after prolonged courses of broad-spectrum antibiotics. If you need help in identifying a patient who will be able to effectively communicate in this setting, ask your medical staff members for some leads. As a courtesy, let the physicians who were most directly involved in the patient's care know that he or she will be talking to the board. Also, consult with general and internal counsel regarding the patient selection and speaking process. Patients with active claims or lawsuits should not be selected.
Set expectations. Ask the patient to help improve the organization's quality of care by sharing his or her story at a board meeting. Let the patient know that trustees are very engaged with the organization's quality of care and want to learn from patients' experiences. Explain that the agenda will allow them about 15 minutes to provide some background on why they were in the hospital and what happened to them. Ask the patient to prepare for two open-ended questions: first, how did this event affect you and your family? Second, how has your lifestyle and daily routine changed? Allow a few additional minutes of meeting time for board members to ask questions and to thank the patient for speaking with them. The patient then leaves the meeting, and the board begins an examination of the organization's performance data in a deeper and more meaningful manner.
Change the culture. Make the patient's visit the first item on the agenda. Its importance cannot be overstated. Board members should understand that their role is not to fix this problem themselves, but to set priorities, foster the right culture and values, and hold management accountable for system-level improvements. This is an opportunity for trustees to demonstrate to management and the medical staff that they are there to remove barriers and support their courageous leadership. When the board adopts a specific quality goal and asks management and medical staff leadership, "What can you do to make certain we achieve this aim?" it sends a powerful message.
Continue to educate. Use these stories as a springboard to educate trustees on organizational policies or topics such as root cause analysis, sentinel events, never events, disclosure, transparency and a nonpunitive but just culture for employees. Meeting minutes should reflect high-level messages and any resulting actions. Plan to follow up on changes in six months.
Since Delnor began the practice of listening to patients' stories, our quality committee has become much more engaged in and knowledgeable about the organization's quality statistics and improvement efforts. At first, hearing directly from patients made most of us squirm a bit, but it has had a much greater impact on us than any control chart ever did. Most importantly, since the quality committee and the board of directors have been listening to patients' stories, our quality focus is much clearer, resulting in setting appropriate "how much by when" goals and leading cultural change. Inviting patients to share their stories has made all of us understand that these are our patients, too, and what happens to them while in our care is ultimately our responsibility. We may never be at their bedside, but we now have a better understanding of how our decisions impact the quality of care our clinicians and staff provide.
Roger Harris is past chairman of the board of directors of Delnor-Community Health System, Geneva, Ill. John Hubbe, esq. (firstname.lastname@example.org) is vice president, medical and legal services, at Delnor-Community Hospital.