Leadership for Healthcare Excellence The Power of Boards Healthcare Trustees of Montana Mountain –...
-
Upload
charla-sims -
Category
Documents
-
view
217 -
download
0
Transcript of Leadership for Healthcare Excellence The Power of Boards Healthcare Trustees of Montana Mountain –...
Leadership for Healthcare Excellence
The Power of Boards Healthcare Trustees of MontanaMountain – Pacific Quality Health
Barbara Balik, RN, EdDMay 25, 2010
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
Board Accountability
• Understand the role and accountability of healthcare boards in creating a culture of quality and safety– Accountability in action
Board Accountability
To represent the community – • Mission• Strategy• Executive leadership• Quality of care and service• Financial stewardship
IHI Boards on Board6 Things All Boards Should Do1. Set aims
– Set specific aims to reduce harm this year.
– Make an explicit, public commitment to measurable quality improvement.
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
IHI Boards on Board 6 Things All Boards Should Do3. 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.
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.
IHI Boards on Board 6 Things All Boards Should Do5. 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.
IHI Boards on Board 6 Things All Boards Should Do6. 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.
The Power of Boards for GoodBoards 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
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]
Partnerships with Medical Staff• Describe the board’s role in
developing and sustaining effective partnerships with physicians– And the challenges in small
hospitals
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
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
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
Partnership Principles
• When courage is required– Disruptive behavior
• Any behavior that interferes with the team achieving its intended outcome
» Gerald Hickson, MD
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
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
Partnership Principles
• Addressing tough issues:– Assure continual improvement
for safe, reliable processes• Begin with the hospital
processes not the physician’s processes
Partnership Principles
• Be clear on what conversation you want to have:– Why did he/she leave?– Why didn’t you prevent
this?
June Call
• What topics do we need to address?
• What requires more conversation?
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)