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A New Seat at the Table

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As the focus on quality intensifies, more hospitals are adding quality officers to the C-suite.

Trustees of The Memorial Hospital in Craig, CO, used to concern themselves mostly with the hospital's financial outlook. If the hospital's bottom line looked good, the board was happy. But not anymore.

"Today, in this hospital, we look very much at the quality things that are going on, as well as the people things," says Beka Warren, RN, chief quality officer for the 25-staffed-bed critical-access hospital. "It is equally as, or sometimes more important than, the financial."

This shift in focus is not unique to The Memorial Hospital, nor to hospital boards of trustees. Quality and patient safety are under increased scrutiny from regulatory agencies, the media, and performance improvement agencies. Such pressures have led many CEOs to the conclusion that beyond the traditional position of quality director, their hospitals need another seat at the executive table to help guide the process of defining quality care: the chief quality officer.

"It's this big, nebulous area. You could make the argument that quality should only be measured by the outcomes required, or you can look at the food served in the cafeteria," says Eric Dobkin, MD, chief quality officer and vice president for patient safety at Crozer-Keystone Health System, a 774-licensed-bed, five-hospital system in Delaware County, PA. "They all fall into the rubric of quality."

Finding the right fit
Your organization's culture will largely determine the right CQO for your hospital, but there are some common traits that will lead to success.

Warren oversees her hospital's clinical improvement and Joint Commission compliance efforts; she's also in charge of infection control and health information management. "You have to understand statistics and how things are measured," she says. "You have to believe in your institution and believe that it does a good job."

Dobkin adds that the CQO must understand that quality must be an organizationwide endeavor. "It's your job to inspire a hospital to measure more than what's easy," he says. "Part of a CQO's job is to educate everyone—from the board to the C-suite to the staff level—about what quality and patient safety are all about." Educating, however, doesn't mean preaching. In his year and a half as Crozer-Keystone's CQO, Dobkin says he's learned that listening is just as important as talking.

"I think you have to listen in order to learn what others are thinking, what their thought processes are about quality," he says. "From my experience, there are a lot of misperceptions and miscommunication, particularly when it comes to quality."

Still a team effort
No matter how your hospital chooses to define quality or whom it chooses to lead that effort, CEOs must remember that quality improvement is still a team effort. Without support and involvement from above, a CQO won't have much success.

"[The CEO] needs to send a message that quality and patient safety are the leading reason for why we exist. If we can't provide good quality and safe care, there's no reason for our patients to trust us to do anything to help them," Dobkin says. "The CEO needs to show support for quality endeavors and, whenever possible, lead by example."

At The Memorial Hospital, CEO George Rohrich makes daily rounds and meets with his executive team daily to discuss what he observes on those rounds, Warren says. He has involved himself firsthand in the quality improvement process.

"When we do strategic planning, when we plan agendas for our committee work, quality is always the first thing discussed," she says.

Perhaps most important is the CEO's role in communicating the importance of quality improvement efforts hospitalwide.

"The other thing that is really important in a CEO is the way that he or she talks about the things that are going on at the hospital," Warren says. With Rohrich, "there is an attitude of positiveness about quality. It emphasizes its importance."

Maureen Larkin

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