More than 2100 Boards of participating hospitals signed up for the Boards on Board intervention, thereby publicly embracing their responsibility for improving quality and patient safety. Across the nation they sent an increasingly strong and clear message: holding themselves accountable and committing themselves to continuous improvement.
As a result, IHI and partners at work on healthcare governance have been flooded with requests from board members for content, information, ideas, and help. And board members have made great personal investments of time and talent. Thousands of trustees and executives have gone to the classroom, studied hard, and demonstrated relentless resolve. (After one recent nine-hour training session with nearly 200 board members and other executive leaders, more than half of those attending remained afterward for further discussion. They continued at their tables, with their teams, solving problems for patients and staff.)
Why have hospital boards and executive teams together taken on this challenge, when it has not been their traditional role practice? In short, its because they must. Patients deserve it, standards-makers and regulators increasingly expect it, and they know medical errors can undermine the best-laid business plan. But, for the most progressive boards, a strong commitment to safety and quality also creates significant opportunitiesfor better patient outcomes, for managing costs (particularly with new Medicare reimbursement incentives), for gaining local market share, and particularly for bringing energy to professionals and staff who can reconnect to their own care-giving vocation.
Alongside executive leaders, the most progressive boards set clear organizationwide aims for quality that are transparent and that translate into clear action for every leader, clinician and staff member in the facility. Quality appears as the first agenda item in every meeting of the board and management. Quality meetingsonce held quarterly, if at allare now held monthly with a clear focus and priorities. Leaders are getting out on the floors, interviewing patients, families, and staff. They are observing barriers to progress and removing them. Expectations change, and a culture of quality and safety follows suit.
Promising examples are emerging in hospitals of all kinds:At the Henry Ford Health System in Detroit, Mich., the board and executive leaders set a goal to reduce hospital mortality by 25% over three years, and they achieved it. With the board and leadership together at every step, they created the will, brought together the ideas and the plan, and then assured relentless execution. At the 159-bed Delnor-Community Hospital in Geneva, Ill., a patient experience story has been presented at board meetings since January 2006. Each story is specifically selected and connected to highlight a Big Dot or Driver measure on the Clinical Dashboard (i.e., connecting the dots). The story is told by a patient, a medical staff member and/or senior management, at the start of the meeting and usually lasts about 30 minutes.At the 25-bed Hot Springs County Memorial Hospital in Thermopolis, Wyo., board members have attended quality conferences and national meetings on trusteeship. And, at board meetings, quality leaders are invited to make presentations, and educational materials are distributed. At one of the largest healthcare systems in the world, the New York Health and Hospitals Corporation, the board has set the goal of being the safest public hospital system by 2010 and has gone fully transparent on their key measures for every hospital.
Most of the hospitals that have adopted the Boards on Board intervention have not yet demonstrated this level of commitment, but a new trend is apparent. And, as a result of the 5 Million Lives Campaign and complementary governance initiatives, a permanent national learning network is now in place to help hospitals learn from and mentor one another on trustee accountability and additional important improvements.
This mobilization could not be more timely. Tense external pressuresterribly difficult economic constraints chief among themcan distract organizations if their leaders lose resolve or fail to see quality as a force for organizational progress and prosperity. Instead they must make sense of competing demands, and give everyone in their facilities a sense of purpose.
Hospital boards are now engaged as never before, and, more than ever, we need them to lead the way.
Joe McCannon is vice president of the Institute for Healthcare Improvement and campaign manager of the 5 Million Lives Campaign. James Conway is senior vice president of IHI and former chief operating officer of the Dana-Farber Cancer Institute.