Monday, August 03, 2015

The board has to be on board

Those of us who have run hospitals where we've been serious about achieving improvements in quality and safety know that without a highly committed board of trustees, the results will never be sustainable. And so it is lovely to see documention of that premise in a new article by Thomas C. Tsai, Ashish K. Jha, Atul A. Gawande, Robert S. Huckman, Nicholas Bloom, and Raffaella Sadun in Health Affairs. I reprint the abstract:

National policies to improve health care quality have largely focused on clinical provider outcomes and, more recently, payment reform. Yet the association between hospital leadership and quality, although crucial to driving quality improvement, has not been explored in depth. We collected data from surveys of nationally representative groups of hospitals in the United States and England to examine the relationships among hospital boards, management practices of front-line managers, and the quality of care delivered.

First, we found that hospitals with more effective management practices provided higher-quality care. Second, higher-rated hospital boards had superior performance by hospital management staff. Finally, we identified two signatures of high-performing hospital boards and management practice. Hospitals with boards that paid greater attention to clinical quality had management that better monitored quality performance.

Similarly, we found that hospitals with boards that used clinical quality metrics more effectively had higher performance by hospital management staff on target setting and operations. These findings help increase understanding of the dynamics among boards, front-line management, and quality of care and could provide new targets for improving care delivery.


Anonymous said...

Good luck on that one. I have sent at least 2 messages to the Sentara board and risk management. They had to do with quality over the pages of suing people for money and lobbying efforts. Nothing. One of them they said they would read but never got back to me. If your motto is "improving health every day", where is the evidence in terms of working with, not lawyering against, harmed patients?

Neville Sarkari MD, FACP said...

The IHI has run a course for years called "Getting your Board on Board" or something similar. They know that quality has to be driven from the top down. Interestingly, they have data, I believe, that shows improved financial performance when quality is the first priority.

Barry Carol said...

As hospitals continue to consolidate into larger systems and control more of the continuum of care, it seems that more and more board members should be chosen for the skill sets from both the medical field and from other fields that can contribute to the management and oversight of the hospital system including improving both care quality and patient safety. Social prominence and the ability to contribute money to the hospital or help raise funds from others should count for less in the future. Indeed, strong support for quality improvement and patient safety should probably be prerequisites for future board members.

From a patient’s perspective, it would also be useful if hospitals and doctors could develop metrics to help us assess quality and safety vs. peers. In terms of pricing, restaurant listings often show relative cost as one, two, three or four dollar signs with four dollar signs being the most expensive. If providers could tell us whether their fees are in the first, second, third or fourth quartile, that would also be helpful whether or not they’re in our insurer’s network.