Tuesday, September 13, 2011

Have we not been looking at things we should have seen?

A remarkable aspect of the Parkland Memorial Hospital saga was the degree to which the hospital's Board was not given information by senior management about the clinical outcomes in their hospital.  The lack of transparency, in other words, even went to management's relationship with its fiduciary board.

A recent article by the Dallas Morning News outlines some of these points:

On August 19, the hospital's seven-member board of directors got its first chance to read the full report by the U.S. Centers for Medicare & Medicaid Services.  Almost 10 days had passed since [the CEO] first received the findings.  As members began leafing through pages of the report, surprise, even shock, began to register.

The Chair of the board said, "We had direct culpability, but none of us even knew we were in the report."

Earlier in the year:

Board members became increasingly alarmed that [the CEO] and his staff weren't acknowledging the problems, even in closed meetings.  When they sought more information, [he] warned them against micromanaging the hospital.  Board members said he frequently told them in private, "If you don't trust my decisions, you need to replace me."

So, they resorted to their own methods.

Some visited the hospital alone to check on operations.

[One] board member . . . stopped patients as they left the hospital and asked how they had been treated by staff.  The member heard many complaints about a lack of civility.

[One] wanted to see patient-care findings that he thought Parkland was collecting from industry groups.  [The management team] wouldn't make that information available to the board.   On his own, [he] began searching in June on [federal] websites for patient-satisfaction information.  He found that Parkland's scores trailed national and Texas averages in seven of 10 categories for what HHS describes as "important measures of patients' perspectives of care."

"I wonder now:  Have we not been looking at things we should have seen?"

Lest you think this is an extreme example, please understand that a significant percentage of US hospitals do not compile quality and safety information, even for the senior clinical and administrative leaders.  How can a person serve on the board of a hospital in this country and not demand that such information be collected and shared with the governing body?

A colleague wrote me the other day: 

Why is there PhysicianCompare and HospitalCompare but not HospitalCEOCompare?

Think that might make more CEOs consider patient safety and outcomes as their primary mission?

Indeed.  But it is ultimately up to the board to make this happen.


Keith said...

Boards are selected less for their oversight capabilities and understanding of the industry, and instead for the size of there bank accounts and potential donations to the hospital. Why else do we have so many people from the financial services industry serving on hospital boards?!

Anonymous said...

Although the newspaper has an irritating subscription-only policy, I found the entire story here:


It paints a picture of an M.D.-CEO who started out well, but apparently gradually succumbed to the I-alone-know-what's-best syndrome over many years. Not only that, he infected the medical staff with this complacent attitude.
It also paints a picture of a board who, although revamped to include experts in hospital administration, went along with CEO behavior that has to have violated every tenet of business practice as well as business and medical ethics - e.g. outright refusal to provide requested information to the board. Having to sneak into the hospital alone to find out information? Surfing HHS websites to compare their hospital to others? Incredible. They should have fired him for that alone, well before it was allowed to come to this.
So yes - IMO, the board, despite being kept in the dark, is ultimately responsible - for being willfully blind.

nonlocal MD

Barry Carol said...

It seems that too many hospital board members view their position as a way to enhance their social standing and prestige in the community and the region. While boards generally need to rely on senior management to provide whatever information the board needs to provide proper oversight, when it’s not forthcoming, a mentality of collegiality and conflict avoidance plus an inclination to give the CEO and senior management team the benefit of the doubt leads to situations like the apparent one at Parkland. Perhaps the hospital sector needs its own version of Sarbanes-Oxley to ensure that hospital boards have the information they need, which the CEO has certified as accurate and complete, to do their job.

Anonymous said...

Hospital board members face new challenges in this new day for medicine, and just like providers (and management), the choice is to catapult into 2012 (over old systems of governance and oversight) or hunker down and hope no one notices that you have poor information sharing systems (electronic and human), quality expertise, or ambition. Frankly, you've got to admit that you are now in the wrong business.

Or, crawl out, accept some humility, look for the ambitious (often suppressed) internal leaders at every level of the institution who actually know what is going on and are willing to say it. Develop mechanisms that infuse external innovation expertise, and recruit board members with the knowledge base to challenge every number on every spreadsheet. And ask for every number on every spreadsheet. Empower them all, make the entrenched stand aside (join the wave or leave), and start walking the halls. If nurses and housekeepers know you, you will know that you have arrived.