Setting the Stage for Governance by the Board of Directors

To help boards assume a major leadership role in the fiduciary responsibility for not only the financial success of the organization but also improving clinical quality and reducing harm, the Institute for Healthcare Improvement has identified six crucial activities for boards through its 5 Million Lives Campaign:

1.      Set Aims: Make an explicit, public commitment to measurable improvement.

2.      Seek Data and Personal Stories: Audit at least 20 randomly chosen patient charts for all types and levels of injury, and conduct a “deep dive” investigation of one major incident, including interviewing the affected patient, family, and staff.

3.      Establish and Monitor System-Level Measures: Track organization-wide progress by installing and overseeing crucial system-level metrics of clinical quality, such as medical harm per 1,000 patient days or risk-adjusted mortality rates over time.

4.      Change the Environment, Policies, and Culture: Require respect, communication, disclosure, transparency, resolution, and all the elements of an organization fully committed to quality and safety.

5.      Encourage Learning, Starting with Yourself: Identify the capabilities and achievements of the best hospital boards and apply that standard to yourself and all staff.

6.      Establish Accountability: Set the agenda for improvement by linking executive performance and compensation.

While hospital management continues to drive quality improvement throughout the organization in partnership with the medical staff, board members must also be encouraged to take as much responsibility for the quality of care in their hospital as they take for the financial health of their organization. Quality is becoming a part of the algorithm for calculating an organization’s financial stability. Both Moody’s and Standard and Poor’s have declared their intention to consider clinical performance as a key component of healthcare organizations’ investment-worthiness.

Board members, through training, must acquire the skills to oversee quality & safety endeavors, and learn the Coaching Metrics for Quality 10 – a coaching program of HealthYncubator. An important aspect of IHI’s initiatives is to get the boards to interact with their medical staff. Today only 24% of boards have any interaction with the medical staff when setting the health organizations quality strategy and only 27% of boards spend more than ¼ of their time on quality issues. Additionally, only 34% of hospital CEOs have compensation incentives based on measurable quality improvement.

As important to executives attaining goals is the responsibility of boards to actively work with their executives and medical staff to attain their fiduciary goals.

HealthYncubator can assist in this process through our Coaching Metrics for Quality program.