The trade groups certification launched in January 2008 and 150 trustees from 19 hospitals have earned the qualification. Given the states large number of rural hospitalsmore than 40% of Georgias community hospitals operate outside of major metropolitan areasthe association offers online training. Georgias certification requires, among other items, that trustees receive 12 hours of education, sign a conflict-of-interest policy; undergo evaluation once a year; and guarantee certain board standards, such as a standing place on agendas for quality and safety.
Harrell said that she expects to see initiatives spread from state to state, including the pay-for-good-governance effort under way in Massachusetts. Whatever happens there, it will probably come to all of us sooner or later, she said.
In Moultrie, Ga., veteran trustee Durwood Dominy is pushing for trustees to quickly seek certification. Trustee education is nowhere where it needs to be, he said. Dominy joined the board of 73-bed Colquitt Regional Medical Center 18 years ago and said education to keep up with such a complex industry is necessary and just good business. The medical centers nine board members finished the trustee certification, but are in the minority statewide, he said.
New board members need an introduction to healthcares technical and medical jargon, Dominy said. All trustees need to keep abreast of changing regulations, labor shortages and issues such as the uninsured. When you go in, you dont know what fully to expect, he said. It took me about two years to understand the language. Theres a learning curve all along. As I got into it, I said, This learning curve is not going to end.
Low public confidence in corporate oversight has made it increasingly important for boards to welcome improvement when the opportunities arise, Dominy said. The public needs to know were interested in the same things they are, he said: the best possible care at the lowest possible cost. Well-educated board members can help with Georgias push to become one of the top 10 states on certain quality measures, he added. Theyll have walking-around sense and know what questions to ask.
In Massachusetts, one major insurer has pushed quality education for boards in a bid to boost hospital performance. Blue Cross and Blue Shield of Massachusetts targeted trustees as part of a broad plan to improve quality and eliminate waste and errors that harm patients and drive up costs, said Fredi Shonkoff, senior vice president of corporate relations. The insurer backed a course on quality tailored for boards, jointly developed by the Massachusetts Hospital Association and the AHA.
Nine Massachusetts hospitals in late 2007 tested the course, and the results prompted the insurer to launch a speaker series on quality and two governance initiatives. One used the insurers leverage as a payer: the Blues plan is adding pay-for-performance measures for quality oversight by boards. The second created a one-year grant program to further trustee quality oversight. Five hospitals received $50,000 grants to bring in quality consultants for six months to draft a goal that will dramatically improve the hospitals quality and safety.
The pay-for-performance plan offers bonuses tied to governance, staggered over three years, Shonkoff said. Hospitals receive a bonus in year one if at least 75% of board members attend classes on quality improvement. Twenty-five hospitals have finished the course, she said. The number is expected to climb to about 50 by the end of the year and as the insurer negotiates new contracts with hospitals.
To earn a bonus in the second year, governing boards must create a quality improvement plan that identifies three quality or safety gaps. In the final year, the incentive is tied to a governance plan to eliminate five quality or safety gaps and the board must link the CEOs performance evaluation to quality improvement.
John Lowe, a healthcare management associate professor at Simmons College, Boston, and a trustee at 166-bed Emerson Hospital, Concord, Mass., said that expectations for board savvy has increased with insurers heightened focus on quality, citing the state Blues plan and Medicares move to halt pay for preventable illness or harm. When the people paying the money make it their business to get involved in this, then the people taking the money better pay attention, said Lowe, who joined Emersons board 13 years ago when he moved from Chicago to Boston to join Simmons Colleges faculty.
Emerson received one of the Blues five grants, which require hospitals to provide $25,000 in matching funds. The hospital was also among those to test the quality training for trustees, which prompted Emersons board to create a quality committee nine months ago.
Doctors and management can only take you so far, Emerson said. Trustees chose not to pick a doctor as chair of the newly created quality committee to increase its accountability to the hospitals patients, he said. You want the face of the effort to come from the community.
Seth Medalie became the chairman at Beth Israel Deaconess Hospital-Needham (Mass.) a little more than a year after joining the board and just as the community hospital decided to try to eliminate all preventable harm by January 1, 2012. Medalie said that trustees at the 33-bed hospital felt inspired by the aggressive goal and driven to succeed, but even as management pressed on, the board needed more education to understand its role.
I dont think we knew what we were getting into, Medalie said. The board, already grappling with the hospitals largest construction project, also had new members from outside healthcare who needed training and exposure to hospital operations to become more familiar with quality and safety issues. Without education, trustees struggle to hold executives accountable or know where to invest to best improve quality, he said.
Medalie, founder and president of financial firm the Bulfinch Group, was fully prepared to rebuff trustees who had approached him to take over as chairman, given the requirements of the job. His experience with healthcare is as an outsider. He agreed only after the outgoing chairman pledged to meet two hours each week before the transition.
The Needham hospital, an affiliate of 585-bed Beth Israel Deaconess Medical Center, Boston, also scored one of the Blues quality and governance grants. Medalie said working with a consultant will help the board establish its process for quality oversight. Our heart is in the right place, he said. Were totally committed to this. Now we need help with the steps.