As CEO of Virginia Mason Health System, Dr. Gary Kaplan sees it as his responsibility to ensure the organization’s board of directors is in-the-know on matters of safety and quality.
Members on the board’s quality committee are notified every time the most serious safety events occur, with what are called red alerts.
Additionally, each board meeting starts with a patient sharing their experiences at the organization, positive or negative. Kaplan, who attends all seven board meetings held annually, said quality concerns are discussed just as much as financial issues at the sessions.
This is a well-established culture of the board since Seattle-based Virginia Mason implemented its management system nearly 20 years ago. Kaplan said he’s perplexed why more institutions haven’t adopted something similar.
“I think it’s interesting that many boards don’t fully appreciate that they are ultimately responsible for the safety and quality of care within the institution they govern,” he said. “Traditionally the thinking has been we delegate quality to the medical staff. That is sort of true, but ultimately the board is accountable.”
While there are some indications governing boards are changing their ways, hurdles remain in getting members more involved in quality issues at health systems and hospitals. For starters, because board members at not-for-profit hospitals and health systems typically aren’t paid, they have less motivation to become deeply engaged, some experts claim.
Another obstacle could be found in the knowledge gap board members have regarding clinical problems. Board members are often part of the business or finance community, so they’re more comfortable discussing revenue, investments and the bottom line.
But perhaps the biggest influence on the board’s investment in quality is the CEO, who sets the culture and expectations. Some CEOs don’t fully appreciate the oversight responsibility that boards have on quality, don’t present information well or aren’t fully honest about quality challenges facing the organization.
“Sometimes the CEO and the C-suite aren’t really transparent and don’t make (quality) a priority for the board agenda or the board’s work,” Kaplan said.
“It’s up to the CEO’s discretion what to present to board,” added Beth Daley Ullem, faculty lead at the Institute for Healthcare Improvement. “There are certain boards that aren’t as motivated (to focus on quality) and it’s up to the CEO and the rest of the C-suite to engage them to select board members who will prioritize quality.”