Leadership for Healthcare Excellence

The Power of Boards Healthcare Trustees of MontanaMountain – Pacific Quality Health

Barbara Balik, RN, EdDMay 25, 2010

Purpose• Understand the role and accountability of

healthcare boards in creating a culture of quality and safety– Understand the accountability in action– Identify how the board’s expectations of

respectful teamwork are essential to safe, effective care

• Describe the board’s role in developing and sustaining effective partnerships with physicians

• Understand the use of data-driven quality improvement in their governing role

• Identify principles to solve tough issues

Board Accountability

• Understand the role and accountability of healthcare boards in creating a culture of quality and safety– Accountability in action

Board Accountability

To represent the community – • Mission• Strategy• Executive leadership• Quality of care and service• Financial stewardship

IHI Boards on Board6 Things All Boards Should Do1. Set aims

– Set specific aims to reduce harm this year.

– Make an explicit, public commitment to measurable quality improvement.

IHI Boards on Board 6 Things All Boards Should Do

2. Get data and hear stories – First agenda item: Select and review

progress toward safer care at every board meeting

– Human face on harm data– Ground the work in transparency– Engage with patients and families

• Stories of harm; case study of a specific case

IHI Boards on Board 6 Things All Boards Should Do3. Establish and monitor system-level

measures– Identify a small group of organization-

wide measures of patient safety.

– Continually update them.• Every board meeting

– Make them transparent to the entire organization and all of its customers.

IHI Boards on Board 6 Things All Boards Should Do

4. Changing the environment, policies, and culture– Commit to establish and maintain an

environment that is respectful, fair and just

• Especially for all who experience the pain and loss as a result of avoidable harm and adverse outcomes: the patients, their families, and the staff at the sharp end of error.

IHI Boards on Board 6 Things All Boards Should Do5. Learning

– Starting with the board, develop your capability as a board.

• Expect the executive and clinical leaders are continually learning

– Set an expectation for similar levels of education and training for all staff.

IHI Boards on Board 6 Things All Boards Should Do6. Establish executive

accountability– Oversee the effective execution

of a plan to achieve your aims to reduce harm.

– Include executive team accountability for clear quality improvement targets.

The Power of Boards for GoodBoards are powerful and make an enormous

difference.• TGI/Solucient Top 100

– The CEO is held accountable for quality and safety goals.

– The board participates in the development of explicit criteria to guide medical staff credentialing and privileging.

– The Board Quality Committee reviews patient satisfaction scores.

– The board sets the board agenda for quality.

– The medical staff is involved in setting the agenda for the board’s discussion of quality.

» Lockee, Kroom, Zablocki, Bader, 2006

Governance and Quality – A sobering survey• 20% of board chairs reported the board chair, board

itself, or a subcommittee as one of the two most influential forces on quality.

• Lake Woebegone Effect:– Among the low performing hospitals, no respondent reported

their performance as worse than the typical US hospital.

• A little over half identified clinical quality as one of the two top priorities for board oversight.

• Fewer than one-third of nonprofit hospitals had formal board training programs that included quality.

» Jha A, Epstein A. Health Aff (Millwood). 2010;29(1): published online 6 November 2009; 10.1377/hlthaff.2009.0297]

Partnerships with Medical Staff• Describe the board’s role in

developing and sustaining effective partnerships with physicians– And the challenges in small

hospitals

Partnership Principles• Seek Common Ground

– Physicians as partners not customer

– In all activities we strive to -• Advantage both partners• At minimum, provide benefit one

partner and keep neutral for the other

• Never advantage one to the disadvantage of the other partner

» Learned from Vic Tschida, MD

Partnership Principles

• Seek Common Ground– Mission

• Care that is patient-centered, safe, effective, efficient, timely, equitable

– Core Values – the ground we stand on

– Respectful behavior – No waste - Efficient use of

everyone’s time and resources

Partnership Principles• When courage is required

– When autonomy conflicts with evidence based care• SCIP protocols• Surgical checklist• Use of Demerol or out-dated

medication practices

– Lack of patient/family partnership– Disruptive behavior

Partnership Principles

• When courage is required– Disruptive behavior

• Any behavior that interferes with the team achieving its intended outcome

» Gerald Hickson, MD

Partnership Principles• Addressing tough issues

– Assure the Board is doing the 6 Things All Boards Should Do

– Data that are a select few, clear, reliable, over time• Stats and stories• Avoid death by data volume

Partnership Principles• Addressing tough issues:

– Clear statement of Core Values• Systems to assure they are lived every day

by everyone– Hire/recruit for values then talent

• Assure executive & medical staff leadership have systems in place to honor core values

• Medical staff by-laws clear and up-to-date– Standards of behavior

» Consistent, fair process to address in: Credentialing, recredentialing, when disruptions occur

Partnership Principles

• Addressing tough issues:– Assure continual improvement

for safe, reliable processes• Begin with the hospital

processes not the physician’s processes

Partnership Principles

• Be clear on what conversation you want to have:– Why did he/she leave?– Why didn’t you prevent

this?

June Call

• What topics do we need to address?

• What requires more conversation?

Resources• Getting Started: Governance Leadership

“Boards on Board” How-to Guide; Insititute for Healthcare Improvement; 2008. (Available on www.IHI.org)

• Reinertsen, J, Gosfield, A, Rupp, W, Whittington, J. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)