In the USA, hospital boards are leading the way on quality and patient safety

As part of the recently completed 5 million lives patient safety campaign by the Institute for Healthcare Improvement (IHI) in the USA, more than 2100 boards of over 4000 participating hospitals signed up for the “Boards on Board” intervention. In doing so, they were publicly embracing their responsibility for improving quality and patient safety.

Joe McCannon and James Conway from the IHI have written an article titles A new era for leadership of quality and safety in

They say that as a result of the commitment demonstrated by boards, IHI and their partners working on healthcare governance were flooded with requests from board members for content, information, ideas, and help. And board members made great personal investments of time and talent. Thousands of trustees and executives went to the classroom, studied hard, and demonstrated relentless resolve. (After one recent nine-hour training session with nearly 200 board members and other executive leaders, more than half of those attending remained afterward for further discussion. They continued at their tables, with their teams, solving problems for patients and staff.)

Hospital boards and executive teams took on this challenge, when it has not been their traditional role practice, because they believed they must. Patients deserve it, standards-makers and regulators increasingly expect it, and they know medical errors can undermine the best-laid business plan. But, for the most progressive boards, a strong commitment to safety and quality also creates significant opportunities-for better patient outcomes, for managing costs (particularly with new Medicare reimbursement incentives), for gaining local market share, and particularly for bringing energy to professionals and staff who can reconnect to their own care-giving vocation.

Alongside executive leaders, the most progressive boards set clear organization-wide aims for quality that are transparent and that translate into clear action for every leader, clinician and staff member in the facility. Quality appears as the first agenda item in every meeting of the board and management. Quality meetings-once held quarterly, if at all-are now held monthly with a clear focus and priorities. Leaders are getting out on the floors, interviewing patients, families, and staff. They are observing barriers to progress and removing them. Expectations change, and a culture of quality and safety follows suit.

Further, McCannon and Conway cite promising examples of boards leading the way on quality and patient safety such as:

– At the Henry Ford Health System in Detroit, Mich., the board and executive leaders set a goal to reduce hospital mortality by 25% over three years, and they achieved it. With the board and leadership together at every step, they created the will, brought together the ideas and the plan, and then assured relentless execution.

– At the 159-bed Delnor-Community Hospital in Geneva, Ill., a “patient experience” story has been presented at board meetings since January 2006. Each story is specifically selected and connected to highlight a “Big Dot” or “Driver” measure on the Clinical Dashboard (i.e., “connecting the dots”). The story is told by a patient, a medical staff member and/or senior management, at the start of the meeting and usually lasts about 30 minutes.

– At one of the largest healthcare systems in the world, the New York Health and Hospitals Corporation, the board has set the goal of being the safest public hospital system by 2010 and has gone fully transparent on their key measures for every hospital.

According to McCannon and Conway, most of the hospitals that have adopted the “Boards on Board” intervention have not yet demonstrated this level of commitment, but a new trend is apparent. And, as a result of the 5 Million Lives Campaign and complementary governance initiatives, a permanent national learning network is now in place to help hospitals learn from and mentor one another on trustee accountability and additional important improvements.

 “This mobilization could not be more timely. Tense external pressures-terribly difficult economic constraints chief among them-can distract organizations if their leaders lose resolve or fail to see quality as a force for organizational progress and prosperity. Instead they must make sense of competing demands, and give everyone in their facilities a sense of purpose.

“Hospital boards in the USA are now engaged as never before, and, more than ever, there is a belief that they need to lead the way.”

Read McCannon and Conway’s article here (free registration required).

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