The hospital board of directors is an important constituency that physician executives need to bring on the bus to promote consistent quality improvement.
Indeed the board should be at the wheel, but that may mean physician leaders will have to give board members a few driving lessons, according to David Nash, M.D., chairman of the Department of Health Policy at Jefferson Medical College of Thomas Jefferson University, Philadelphia. "The current state of board readiness to engage this issue is all over the map," Nash told physician leaders last week at the American College of Physician Executives meeting in Las Vegas, part of a three-day program on advanced quality management.
Most board members are business and community leaders with a lot of experience in finance and business management but with little background in the tools and metrics of quality management.
The easy way, and the wrong way, according to Nash, for boards to address quality is to make it a staff function by fobbing off the duty to a designated quality control officer or committee.
In addition, mission statements aren't enough, Nash said. Board members need to set the quality priorities of their hospitals, including picking specific metrics to be met, and allocating the resources to both measure and achieve those goals.
Just as virtually every board meeting addresses financial concerns, a hospital should "never have a board meeting without talking about quality improvement," Nash said. Quality and safety should be on the agenda of every meeting, and physicians can help create quality and safety indicators for board members to review.
The board should link executive compensation in a meaningful way-say 30% of their annual bonus-to meeting specific, quantifiable quality and safety targets, Nash said. "Nothing gets the attention of hospital CEOs as this stuff (does)," he said.
Physicians, too, need to be educated about quality metrics. They need feedback about how they're doing, preferably coming from a respected clinical leader, and they need financial rewards tied to their performance.