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Improve quality with help from the hospital board

November 7th, 2012

by Raymond Hino

With the growing emphasis on patient safety and improved quality outcomes in healthcare as a part of national healthcare reform, I am asking today: What is one of the most important interventions that a hospital executive can implement that will improve performance?

According to Jim Conway, adjunct lecturer on healthcare management at the Harvard School of Public Health, the answer is to actively engage the hospital board in the quality program.

I recently had the good fortune of attending one of Conway's presentations on the role of hospital boards in quality initiatives. He said when hospital boards devote time and energy to establishing quality goals, monitoring performance and holding executive leadership accountable, outcomes are substantially improved.

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In fact, it can be argued that board engagement is the single best thing that a hospital can do to improve quality.

This means it is key to take time on board meeting agendas each month to thoroughly educate our boards on our quality goals. Board members want to know "how do we know that we are providing the best quality care?" It is up to senior management to educate them.

The answer may lie in aggressive quality goals and measurable performance (e.g., zero tolerance). But that is still not enough. I have learned, and Conway concurs, that one of the most common mistakes that we as executives often make is to not keep our boards well informed when a crisis occurs. The board needs to know when an avoidable injury takes place, for example.

It was sobering to learn that hospital executives, when asked "how long it takes to notify the board when a serious event occurs?" gave the following answers. The answers included "same day" up to "30 days."

Some said they would inform the board "on the day of the next regular board meeting."

I, myself, have learned the hard way that we as healthcare executives have a duty to inform our boards the same day the event occurs. I have learned to immediately inform the members of our board when an event occurs and to even, in some cases, provide daily updates.

When we don't inform our boards timely, we run the risk of our board members being "blindsided" and potentially ignorant of the quality challenges that we all face. And make no mistake about it. None of our hospitals is immune. We all have our quality lapses and we all have had avoidable injuries, or worse, take place in our hospitals.

Finally, Conway advises each hospital board create a board quality committee to help set the quality goals for the year, monitor results, and to be an engaged partner with executive leadership and the medical staff.

The evidence supports the conclusion that your hospital's quality will improve. For more information I recommend you become educated on The Joint Commission 5 Million Lives Campaign and "Getting Boards on Board," written by Conway.

Raymond Hino, MPA, FACHE is a board member of the Health Research & Education Trust. Previously he served as Chief Executive Officer of Mendocino Coast District Hospital in California.

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