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On Board with Quality

Cheryl Clark, for HealthLeaders Media, May 13, 2011
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The Office of Inspector General and the Internal Revenue Service are weighing in and now there are consequences for not paying attention, or for using your board position in a conflict of interest, says Jim Conway, senior fellow for the Institute for Healthcare Improvement, which runs a “Boards on Board” training program for trustees. “Some boards are still early in their journey, to be diplomatic. But there is no confusion, absolutely no confusion, that they now are accountable for patient safety.”

Federal financial penalties for higher infection and readmission rates, medication errors, and other mistakes that cause avoidable harm now will impact the hospital’s bottom line. “We see the whole movement on pay for performance as one motivating factor for the change,” Haartz says.

On Jan. 1, 2009, the Joint Commission set forth its new leadership standards calling for board involvement in quality, safety, and levels of training, and oversight of executive decisions. Many boards are now tying their executive compensation packages to benchmarks, such as reductions in readmissions or rates of Clostridium difficile.

But as much as there are success stories, the journey has been much tougher for some. Paul Schyve, MD, senior vice president of the Joint Commission, says making safety and quality a prominent part of the board’s fiduciary responsibility “to act in trust for patients” has not quite gotten off the ground. “It has not been easy,” Schyve says. “There are still many governing bodies that act the old way. They think that fiduciary means financial because they both start with f-i.”

Two major reasons block the effort, he explains. 

First, the Joint Commission has historically had its direct contact with the CEO or the president of the medical staff, not the board. “And it has sometimes been difficult to reach the people who make up the governing body. There’s a lot of trustees out there still today who for one reason or another don’t actually understand that this is an expectation for what they do. ”

The second reason has to do with a hospital’s “internal politics. The CEO is concerned about losing control of communication with the board. And consequently, there’s resistance from at least some CEOs that the Joint Commission or others would develop a very direct relationship with the board.”

As each hospital undergoes its triennial unannounced accreditation review, Schyve says reviewers will be looking for very specific things, for example, “whether there is a culture of safety, and whether the board is receiving regular reports” on such incidents as infections and medical errors.

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