The Role for Boards in Quality/Patient Safety 1 Carol Wagner Vice - - PowerPoint PPT Presentation

1

Carol Wagner

Vice President Patient Safety Washington State Hospital Association

Judi Brenes

Board Member Southwest Washington Medical Center and Health System

The Role for Boards in Quality/Patient Safety

January 26, 2010

Presenters

2

• Judie Brenes, Board Member, SW

Washington Medical Center

• Carol Wagner, VP, Patient Safety

Program, WSHA

Boards Oversees Quality and Safety,

• n the Owner’s Behalf…

Board oversight of quality and safety is a legal, regulatory, moral, and financial mandate.

Quality oversight can not be delegated

It is what the public expects the Board to do!

Boards Legal and Regulatory

 The Code of Hammurabi (CIRCA 2,000 B.C.)

“If the surgeon has made a deep incision in the body of a free man and has caused the man’s death or has

• pened the carbuncle in the eye and so destroys the

man’s eye, they shall cut off his forehand.”

 Darling v. Charleston Memorial Hospital Case - 1965

4

Reinertsen and Orlikoff

5

Focu

• cus

s on

• n Quality

Quality and and Sa Safety: ety: Impr Improvement ement Needed Needed

• 1999 IOM report To Err is Human

 IHI initiatives-100,000 Lives and 5 Million Lives campaigns

6

Payment of Quality of Care

 Heart Attack

 Aspirin at Arrival  Aspirin at Discharge  ACE/ARB for LVSD  Smoking Cessation Advice  Beta Blocker at Discharge  Fibrinolytic at Arrival  PCI at Arrival

 Heart Failure

 Discharge Instructions  ACE/ARB for LVSD  Smoking Cessation Advice

 Pneumonia

 Pneumococcal Vaccination  Culture before Antibiotic  Smoking Cessation Advice  Appropriate Antibiotic Given  Influenza Vaccination

 Surgical Care

 Antibiotic Before Incision  Antibiotics Stopped After Surgery

 Mortality

 30-day Heart Attack  30-day Heart Failure

 HCAHPS

 10 Patient Satisfaction Measures

Media Attention on Health Care

7

Questions to Ask

 Why does your hospital/system do quality

improvement?

 Does your hospital provide significantly better care

this year as compared to last year?

8

Boards Oversees Quality and Safety,

• n the Owner’s Behalf…

Impact that boards can have in improving quality and safety.

The Power of Leadership

10

A A Cultu Culture of e of Saf Safety ety

 Requires teamwork, a focus on relationships rather

than resources

 A model for how to improve (going outside)  A focus on systems and processes rather than

individuals

11

A A Cult Cultur ure of e of Saf Safety ety

 Increased emphasis on

standardization to reduce variability

 Humans will make errors –

systems and processes must prevent those errors from reaching the patient

 A focus on reporting

errors

Southwest’s online patient safety event reporting

12

Le Lead ader ership fr ship from

• m the

the T Top

• p

Public and consistent leadership from the CEO/ET, Nursing that Patient Safety and Quality is the first priority

• National Patient Safety Foundation

 A high demand for Executive team visibility in leading the

culture change and directing Quality improvements

 A goal of empowering all levels off staff, patients  A commitment to education and training

13

Cha Chang nging ing Roles

• les for
• r

Ph Phys ysician icians s an and d th the e Ho Hosp spita ital

For physicians:

 A move from quality of

care for individual patients to all patients across the system

 Change must come from

an effective medical staff structure

 The physician as team

leader rather than commander

14

Cha Chang nging ing Roles

• les for
• r

Phy Physician sicians s an and d th the e Hos Hospita pital

For the Hospital:

 Our understanding/

action on what the physicians think is important

 Supporting quality

champions

 Decreasing time -

wasting frustrations to improve physician effectiveness

Physician Leaders

15

Whe here the the Boar Board d Fits in Fits in

Our fiduciary accountability: Stewardship of the mission, representation of our community, financial management, strategic vision and responsibility for the Quality and Safety of the care we provide

16

Whe here the the Boar Board d Fits in Fits in

 Don Berwick, CEO of IHI, “American healthcare is

unsafe, unreliable and wasteful at a level the Boards don’t seem to understand”

 Paul O’Neill, former Secretary of the Treasury and

health care leader, “The Board is personally accountable for everything that happens, especially what goes wrong.”

17

Se Seven en Cr Criter iteria ia for

• r Ho

How w w we e as as a Bo a Boar ard d ar are e Do Doing ing?

• 1. A definition of

what Quality means to us

18

• 2. Quality/Patient Safety’s integration with the rest
• f our Strategic Planning process?

 People- From orientation through day to day

work experience to performance evaluation

 Service-Service and quality of care are all in the

eye of the patient

 Financial- Linking our clinical performance to

• ur financials so that we really understand what

harm and waste in the system are costing us

Integration With Strategic Planning

19

Under Understanding standing Patient tient Saf Safety ety Issues Issues

• 3. An understanding of overarching Quality/Patient

Safety issues that go beyond just those reported on the dashboard? Our responsibility:

 To educate ourselves and understand our current

performance

 To be familiar with the definitions/elements of care in

• ur hospital

 To understand what the leading hospitals in our

industry are doing in patient safety and quality

 To speak up about what we don’t understand

20

Quality Measur Quality Measuremen ement

• 4. Quality measures that are relevant in which the

Board understands

 The dashboard  Level six harm reports  Trends they are seeing

21

Lea Leader dership ship Compen Compensa sation tion

• 5. Leadership compensation linked to

quality/service metrics?

SCALE % WT

1 2

Target

3 4 5

Time- frame Current Status

Quality

Reduce HAC C-difficile 10%

>=176 <=175 165-124 123-84 <=83

Monthly + Last Qtr.

5

Public Rpt HQA

(AMI, SCIP, PN, CHF)

10%

<85% 85- 86.9% 87- 91.9% 92- 94.9% >95%

3rd Qtr ‘09

3

22

Ef Effectiv ective e Quality Quality Com Committe mittee

• 6. An effective Quality committee made up of Board, ET,

Physicians and staff

 Guide, encourage and hold accountable  Moving the big issues up to the full Board  Vetting issues and framing questions that the

whole Board has to answer

23

Patient tient Par articipa ticipation tion

• 7. Is the patient at the center of our work?

Putting a human face on the graphs and numbers

24

Rec ecomme

• mmend

ndations tions

 Mentor/education program for non-clinical Board

members

 All Board members to serve at some point on the Quality

Committee

 Quality/Patient Safety are a part of all Board meetings and

a portion of all retreat agendas

 Increase opportunities for Board interaction with the

people who do the work at hospital

 Including quality and safety into the executives

compensation

 Increase outside education for the Board

25

Rec ecomme

• mmend

ndations tions

 Set the annual board agenda for quality with medical staff

input – set aim.

 Spend 25% of board time on quality and patient safety.  Regularly receive and discuss a formal quality performance

update, including measurement.

 Review patient satisfaction scores and any adverse events.  Put a quality expert on the Board.  Don’t be a rubber stamp. Actively participate in the

• versight of the medical staff credentialing process,

including involvement in the development of criteria.

WSHA Opportunities for Continued Education

 CEO and Trustee Summit

 April 13th repeated on 14th

“This is a must-attend event for all hospital board members and CEOs.”

John Fletcher VP and Chief executive WA/MT Region Providence Health System

 Annual Meetings  Rural Conference (Lake Chelan)

26

Questions?

Contact Information: Carol Wagner Vice President Patient Safety Washington State Hospital Association (206) 577-1831 CarolW@wsha.org

27