Many of my readers know of and admire Jim Conway, former COO of the Dana Farber Cancer Institute, and more recently a senior associate at the Institute for Healthcare Improvement and a faculty member at the Harvard School of Public Health. A regular feature of Jim's speeches and lectures is a presentation of this slide, an indication of the relative priority given by hospital CEOs to various current issues. He uses it to demonstrate that safety and quality are well down the list for most CEOs.You might expect that ranking of quality and safety would have risen over the past several years. But there was a major disappointment in 2009, as its place was lowered substantially.
But we can't blame just the CEOs for missing the boat on elevating safety and quality. It is the governing bodies of the hospitals, behind and above the CEOs, who should hold them accountable on this front.
I guess I'm in a cynical mood today, but you can lump the first 3 categories together under "financial challenges." This has been the complaint from docs about hospital administrators for years - that they only care about the bottom line. (although to some extent this is now the pot calling the kettle black...) I recognize financial stewardship is critical, as Paul's rescue of BIDMC from dire straits illustrates. But at some point the others have to share his vision of quality and value being inextricably tied together, and accept that quality does decrease cost. This lesson is lost on most.
ReplyDeleteAs far as the Boards, they still follow the lead of the CEO. How do they know enough to do otherwise?
nonlocal
Interesting survey. I am surprised by the ranking but i does support the current economic turmoil the government has palced us in as part of the recession. If they would focus on the itmes on the problem (more likely root causes) the the items at the top (resultants) would improve. You can't manage results but you can improve processes. Time to re-focus.
ReplyDeleteTim McMahon
A Lean Journey
http://leanjourneytruenorth.blogspot.co
I think that for any organization that wants to improve quality and safety, the CEO needs to provide leadership and take ownership. This includes developing appropriate measurable metrics that can be incorporated into the goals that determine incentive compensation especially for senior management and department heads.
ReplyDeleteI don't personally know any of the CEOs except you, but just looking at the numbers, the almost total lack of interest in patient satisfaction is conspicuous.
ReplyDeleteAny family that's been through the grueling experience of hospitalization that reflects this lack of empathy will know what I mean. So often individual workers are compassionate but it's entirely out of their own goodness - the machine grinds on, worrying about money, as shown here.
Lack of concern about patients is one of the primary points in the speech I'm giving in Washington in May: "The Invisible Stake-holder: Why American Needs a Patient In Chief." Speech proposal here.
Kudos to those whose priority is care! And I mean both social kudos and business kudos, because not focusing on the customer is a great way to go out of business.
As a pharmacist, I have been viewing this first-hand for years. If a pharmacist makes an error, there is suddenly a lot of focus on why the error happened (and what's wrong with that pharmacist) but the day-to-day management of the pharmacy often rewards productivity (in doses dispensed per hour, or turnaround time) and actively discourages pharmacists from taking the time to provide proper clinical management of medication orders. In that case, the management emphasis is clear, and clearly not on safety or quality.
ReplyDelete"Assumacide." Out of "x" number of surveys sent out, "y" were returned. Difficult to draw grand conclusions based on this sparse data.
ReplyDeleteIn defense of the CEOs, "no money; no mission".
It could be more meaningful if the denominator were "hospitals that are profitable".
I read this another way---I see "issues confronting CEOs" as "issues that are a problem for us that we are having a hard time controlling."
ReplyDeleteSo, for example, it's not that "patient satisfaction" is unimportant, it's just that "we are on top of that and our patient surveys show that our patients are very happy."
So, if I were sitting in your seat, I would not list "patient safety" and "quality" as issues that are "confronting" me because we at BIDMC are so on top of this with an excellent "machinery" in place to keep us constantly improving.
Of course, working at BIDMC may give me a skewed view of what CEOs do and what they feel is important...