Online Insights

Editor's note: This is an excerpt from Cheryl Clark's Nov. 11 online column, "Tell Your Trustees Real Stories of Patient Harm."

A Harvard report showed that half of 722 sampled hospital boards don't see clinical quality as a top priority. That wasn't much of a surprise.

Nor was it startling that two-thirds of these nonprofit boards had not received formal training in clinical quality. Or that those hospitals whose boards downplayed quality were more likely to perform worse in Hospital Quality Alliance measures than hospitals where quality was a top priority.

I've heard many complaints from physician leaders over the years that data on outcomes and adverse events just weren't on their trustees' radar. Financial performance and philanthropy? Sure. Reputation in the community? Definitely. Building projects? Let's meet with the architect.

But I wonder: With so much emphasis on quality and pay for performance—and with the threat that Medicare now can withhold reimbursement when avoidable mistakes require additional care—shouldn't this board culture be changing?

Yes, it should, says James Conway, the Institute for Healthcare Improvement's senior vice president.

He ought to know. The IHI is now promoting "Boards on Board," a campaign to get hospital leadership "deeply engaged, starting with the board of trustees." He personally visits boards around the country to see how they are addressing quality improvement.

"Traditionally, hospital boards and trustees have focused on topics they were most comfortable with, which have been issues of finance or building a marketing strategy," Conway says.

"But this is no dinner party anymore. Sitting on a board is a tremendous responsibility."

Conway sent me the Boards on Board 36-page how-to guide, which begins with a list of routine board activities to improve quality and safety within their hospitals. For example, boards should know their mortality and harm rates and set specific goals to reduce them. They should also establish a monitoring system for adverse events.

Of course, some of hospital boards' failure to grapple with these topics might be blamed on CEOs, who keep their boards in the dark. Boards must insist that they expect to be informed.

"Good organizations talk about the wonderful things that go on in their hospitals and bring you to tears with their beautiful stories. But the problem is that those stories are seductive. The arrogance of excellence is that you don't create a space to talk about the harm, the tragedy, and the waste."

Conway says one board meeting he recently attended "was lovely. Everyone was very nice to each other. But there was no discussion of the degree of harm that had gone on. There was a detailed report, and if you were smart enough, you could go find it, but no one pointed it out to the board that it was there."