“I believe one of the most underleveraged tools healthcare organizations have is their boards.” When I first heard those insightful words from Dr. Gary Kaplan, longtime CEO of Virginia Mason Medical Center, years ago, I immediately understood the depth of their meaning.
That statement also explains my relentless pursuit to learn all I could about the effectiveness of governing bodies in providing oversight and accelerating improvements in quality and safety at healthcare institutions.
Some 20 years ago, the Institute of Medicine sounded an alarm by alerting the nation of the unaddressed harm by our healthcare institutions documented in To Err is Human. Admittedly, since then, some progress in reducing harm in healthcare has been made. Data published by the Agency for Healthcare Research and Quality reports a 13% reduction in overall healthcare-acquired conditions from 2014 to 2017. At this pace, it would take an additional 30 years to eliminate harm. No high-reliability industry could survive today if it took three decades to become safe.
What role do governing bodies play in making healthcare safe? Do trustees view harm as part of the “cost of doing business” or rather as totally unacceptable and commit to its elimination? This shift in thinking is the transformational change leaders of commercial airlines, the nuclear power industry and other high-reliability industries had to embrace to ensure the viability of their businesses.
Common among all high-reliability industries is their reassurance to the public—that airplanes would fly and transport us safely and that a nuclear plant shouldn’t be a constant source of fear in its community. No such reassurance is commonplace in healthcare.
Regulators and the Joint Commission require hospitals to create a governing body and to hold this body accountable for quality of care within their organizations. In 1751, Pennsylvania Hospital, one of the nation’s first hospitals, established its first governing body. The original funding contributors, one of whom was Benjamin Franklin, drafted rules and regulations and established a 12-member board through an election process. Then, one more member, a treasurer, was added. Finance was the only competency that funding contributors ensured. The first governing body was composed of donors and members of the business community.
Today, the establishment and structure of most boards remains essentially the same. Over time, governance in healthcare has undergone little change even though the institutions they oversee have dramatically changed by becoming complex, high-risk and highly technical environments.
Studies rely on an organization’s governance structure and practices as a surrogate for performance in quality and safety. An example is the assumption that if a board retains a quality committee, there is oversight of these functions. The reality is, if members of a committee are not onboarded and educated appropriately in the area of safety and quality improvement, then they cannot competently provide oversight.
Boards are in a unique position to drive healthcare toward becoming safe and highly reliable. Governing bodies should build their capability to properly oversee their healthcare organizations’ quality and safety by using the selection process to ensure some board members are skilled in quality improvement and safety science.
Boards should also ensure full transparency of all quality and safety matters with their leadership team. These individuals can include former chief medical officers, chief nursing officers or even safety specialists in a highly reliable industry outside of healthcare. Healthcare organizations’ boards also should commit to beginning a journey to achieve zero harm and supporting the organization’s leadership during this effort.
The alternative is continuing on our current path and waiting those 30 years to eliminate harm by continuing the complacency present in many boardrooms today. Trustees with visions of eliminating harm in healthcare, along with a bit of impatience and a lot of courage, can make a big difference in leading the way to zero.