Leadership for Healthcare Excellence The Power of Boards

1. Leadership for Healthcare ExcellenceThe Power of Boards Healthcare Trustees of Montana Mountain – Pacific Quality Health Barbara Balik, RN, EdD May 25, 2010

2. Purpose • Understand the role and accountability of healthcare boards in creating a culture of quality and safety • Understand the accountability in action • Identify how the board’s expectations of respectful teamwork are essential to safe, effective care • Describe the board’s role in developing and sustaining effective partnerships with physicians • Understand the use of data-driven quality improvement in their governing role • Identify principles to solve tough issues

3. Board Accountability • Understand the role and accountability of healthcare boards in creating a culture of quality and safety • Accountability in action

4. Board Accountability To represent the community – • Mission • Strategy • Executive leadership • Quality of care and service • Financial stewardship

5. IHI Boards on Board6 Things All Boards Should Do • Set aims • Set specific aims to reduce harm this year. • Make an explicit, public commitment to measurable quality improvement.

6. IHI Boards on Board 6 Things All Boards Should Do 2. Get data and hear stories • First agenda item: Select and review progress toward safer care at every board meeting • Human face on harm data • Ground the work in transparency • Engage with patients and families • Stories of harm; case study of a specific case

7. IHI Boards on Board 6 Things All Boards Should Do • Establish and monitor system-level measures • Identify a small group of organization-wide measures of patient safety. • Continually update them. • Every board meeting • Make them transparent to the entire organization and all of its customers.

8. IHI Boards on Board 6 Things All Boards Should Do 4. Changing the environment, policies, and culture • Commit to establish and maintain an environment that is respectful, fair and just • Especially for all who experience the pain and loss as a result of avoidable harm and adverse outcomes: the patients, their families, and the staff at the sharp end of error.

9. IHI Boards on Board 6 Things All Boards Should Do 5. Learning • Starting with the board, develop your capability as a board. • Expect the executive and clinical leaders are continually learning • Set an expectation for similar levels of education and training for all staff.

10. IHI Boards on Board 6 Things All Boards Should Do 6. Establish executive accountability • Oversee the effective execution of a plan to achieve your aims to reduce harm. • Include executive team accountability for clear quality improvement targets.

11. The Power of Boards for Good Boards are powerful and make an enormous difference. • TGI/Solucient Top 100 • The CEO is held accountable for quality and safety goals. • The board participates in the development of explicit criteria to guide medical staff credentialing and privileging. • The Board Quality Committee reviews patient satisfaction scores. • The board sets the board agenda for quality. • The medical staff is involved in setting the agenda for the board’s discussion of quality. • Lockee, Kroom, Zablocki, Bader, 2006

12. Governance and Quality – A sobering survey • 20% of board chairs reported the board chair, board itself, or a subcommittee as one of the two most influential forces on quality. • Lake Woebegone Effect: • Among the low performing hospitals, no respondent reported their performance as worse than the typical US hospital. • A little over half identified clinical quality as one of the two top priorities for board oversight. • Fewer than one-third of nonprofit hospitals had formal board training programs that included quality. • Jha A, Epstein A. Health Aff (Millwood). 2010;29(1): published online 6 November 2009; 10.1377/hlthaff.2009.0297]

13. Partnerships with Medical Staff • Describe the board’s role in developing and sustaining effective partnerships with physicians • And the challenges in small hospitals

14. Partnership Principles • Seek Common Ground • Physicians as partners not customer • In all activities we strive to - • Advantage both partners • At minimum, provide benefit one partner and keep neutral for the other • Never advantage one to the disadvantage of the other partner • Learned from Vic Tschida, MD

15. Partnership Principles • Seek Common Ground • Mission • Care that is patient-centered, safe, effective, efficient, timely, equitable • Core Values – the ground we stand on • Respectful behavior • No waste - Efficient use of everyone’s time and resources

16. Partnership Principles • When courage is required • When autonomy conflicts with evidence based care • SCIP protocols • Surgical checklist • Use of Demerol or out-dated medication practices • Lack of patient/family partnership • Disruptive behavior

17. Partnership Principles • When courage is required • Disruptive behavior • Any behavior that interferes with the team achieving its intended outcome • Gerald Hickson, MD

18. Partnership Principles • Addressing tough issues • Assure the Board is doing the 6 Things All Boards Should Do • Data that are a select few, clear, reliable, over time • Stats and stories • Avoid death by data volume

19. Partnership Principles • Addressing tough issues: • Clear statement of Core Values • Systems to assure they are lived every day by everyone • Hire/recruit for values then talent • Assure executive & medical staff leadership have systems in place to honor core values • Medical staff by-laws clear and up-to-date • Standards of behavior • Consistent, fair process to address in: Credentialing, recredentialing, when disruptions occur

20. Partnership Principles • Addressing tough issues: • Assure continual improvement for safe, reliable processes • Begin with the hospital processes not the physician’s processes

21. Partnership Principles • Be clear on what conversation you want to have: • Why did he/she leave? • Why didn’t you prevent this?

22. June Call • What topics do we need to address? • What requires more conversation?

23. Resources • Getting Started: Governance Leadership “Boards on Board” How-to Guide; Insititute for Healthcare Improvement; 2008. (Available on www.IHI.org) • Reinertsen, J, Gosfield, A, Rupp, W, Whittington, J. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)