Transcript Document

Leadership for
Healthcare Excellence
The Power of Boards
Healthcare Trustees of Montana
Mountain – Pacific Quality Health
Barbara Balik, RN, EdD
May 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 Board
6 Things All Boards Should Do
1. 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 Do
3. Establish and monitor system-level
measures
– Identify a small group of organizationwide 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 Do
5. 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 Do
6. 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 Good
Boards are powerful and make an enormous
difference.
•
TGI/Solucient Top 100
–
–
–
–
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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:
–
•
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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)