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Tell Your Trustees Real Stories of Patient Harm

Cheryl Clark, for HealthLeaders Media, November 11, 2009

The Harvard report released this week that showed that half of 722 sampled hospital boards don't see clinical quality as a top priority 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 reviewing last month's stats on the number of avoidable falls or the number of medication mistakes? Those details get delegated to management.

"All our board members care about is the artwork and the atrium," I often heard one physician executive grumble.

Parodied another: "The flowers in the lobby are drooping. Isn't it time for lunch?"

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. And the IHI's "Boards On Board" Campaign is trying to do just that.

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.

Evidence shows a more engaged board can power the push for programs or controls that prevent adverse events from happening. IHI has run educational programs for thousands of trustees and executive leaders.

"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.

"At a minimum," the campaign advises, boards should spend "more than 25% of their meeting time on quality and safety issues and by conducting, as a full board, a conversation with at least one patient, or family member of a patient, who sustained serious harm at their institution within the last year."

That will make trustees understand in a powerful and personal way the consequences of avoiding the issue, Conway says. It may seem like a harsh order. But it really works.

"There's nothing we find more powerful than having the board meet with the patient," he says. Some hospitals now regularly show a video of a person with a hospital-acquired infection, or meet with a patient who sustained an avoidable fall, he says. At one hospital in Vermont, the chairman of the board and the CEO interview some of the patients who were hospitalized in the preceding month.

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