By Ed Howe
Retired president and CEO, Aurora Health Care
This morning I read a shocking headline: “A new survey shows that half of hospital boards don’t rate quality as a top priority.” The survey is printed in Health Affairs, a leading journal regarding health policy.
I find it astonishing that so few of these board members consider quality of care one of their two top priorities. Also, only a handful had any training in quality.
My experience at Aurora Health Care showed how important board-approved goals are regarding quality.
At Aurora the quality committee and the finance committee were of equal importance. Each had both short-range and long-range goals with hard measures. No feel good and apple pie goals.
Executive compensation was tied equally to significant measurable improvement in each area. The results speak for themselves as Aurora improved from slightly above average quality to a model for national leadership as measured in the CMS/Premier Hospital Quality Incentive Demonstration project. Community costs also improved over time, once again demonstrating that good quality is also cost-effective care.
Too many hospital board members think profit is the reason to be in existence. They are comfortable measuring financial performance. BUT our not-for-investor-profit healthcare system was created to provide good care to the community. Yes, we must be fiscally competent, but quality, outreach, and service is where the core focus should be.
The survey suggests that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals. I agree.
Perhaps too many healthcare executives are in healthcare for the wrong reasons.
November 8th, 2009 at 8:57 am
I am shocked as well. Palmetto Health also had financial and quality goals of equal value. Compensation was also based on both measures. Community boards can represent local interests, but often are very political and can be weak. Also in a difficult financial period all the verbage about quality can quickly disappear. Finally the medical staff must be plugged in to really make it work. Another argument for consolidated payment.
November 9th, 2009 at 9:51 am
Ed, I agree and it is umbelievable that as long as we have been focusing on Quality and Safety that we hear this kind of information. If the results of this study are correct the leaders and board members have really let us down.
November 9th, 2009 at 11:21 am
Like my colleagues I am astonished at this report.At Baystate,quality improvement and financial performance were continuously monitored by the Board and one of our most active Board committees oversaw quality initiatives and performance in conjunction with the leadership of the medical staff.The incentive compensation program for both management and medical leaders weighted quality results equally with financial results and payouts could not be achieved unless goals were achieved in both areas.I sincerely hope this study is flawed in that I can’t imagine a Board acting in this fashion.
November 11th, 2009 at 1:34 pm
The connection between how the board oversees quality and patient safety and institutional performance has been firmly established in comprehensive studies conducted by the IHI, The Governance Institute, Solucient, Agency for Healthcare Research and Quality, and supported by Moody’s own research (among others). The specific board practices that are associated with better quality are generally agreed upon in these studies. The problem with this survey is that many of these other surveys contradict the conclusions reached by the researchers. In fact, the recently released 2009 Biennial Survey of hospitals and health systems (which surveyed the entire industry) conducted by The Governance Institute tells a different story. It appears that a significant majority of boards (small and large institutions) are “getting it” when it comes to driving the quality agenda for their institutions. The practices that are becoming standard at most institutions include things like: increasing the board’s quality literacy; adopting formal board quality oversight policies and processes; holding management accoutable and linking compensation to quality performance; engaging the medical staff heavily in quality improvement efforts; focusing more of the board’s time on quality matters; selecting a few macro-level measures and easy to understand dashboards (IHI’s “big dots”); and establishing an effective board level qualtiy oversight committee.
Yes, boards do and probably always will spend more time focusing on the financial side of the operation but that doesn’t necessarily mean they are giving short shrift to their quality oversight responsibility.
My sense is that the “sky is not falling” as the controversial article headline would suggest. To say that “hospital boards don’t value clinical quality” is an overreaching judgement that is not supported by the nature of the survey conducted. Nor is it supported by numerous other surveys as mentioned above.
I agree that boards can do a lot more to drive quality efforts in their institutions and so can CEOs and medical staff leaders.
Ed Kazemek