Leadership for Healthcare Excellence The Power of Boards Healthcare Trustees of Montana Mountain – Pacific Quality Health Barbara Balik, RN, EdD May 25, 2010 June 29, 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

Scenario The CEO/Board have the courage to articulate and enforce organizational values and evidence-based practices but the sole community surgeon threatens to leave the community if required to follow the expectations. This has significant financial and access implications for the hospital and community.

Scenario How do we evaluate processes to improve physician production while maintaining/promoting quality?

Scenario Tools for developing the relationship with a new and current physician to prevent/reduce disruptive behavior

Scenario Communication between board members and physicians – –When is it beneficial? –Can it be a positive tool? –How to avoid the pitfalls?

Scenario How do we separate the role of governance from operations? –How can the roles and boundaries of board members be reinforced?

Scenario What are ways to prepare physicians and the hospital to positively support board strategies to foster/develop patient/family councils – active participation of them in quality improvement?

Board Accountability To represent the community – Mission Strategy Executive leadership Quality of care and service –Creating a culture of quality and safety Financial stewardship

Principles into Action First – –Accountabilities –Principles Second – –Apply to scenarios

IHI Boards on Board 6 Things All Boards Should Do 1.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 Do 3.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 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.

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.

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?

Resources Getting Started: Governance Leadership “ Boards on Board ” How-to Guide; Insititute for Healthcare Improvement; (Available on 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; (Available on