The Role for Boards in Quality/Patient Safety 1 Carol Wagner Vice - PowerPoint PPT Presentation

The Role for Boards in Quality/Patient Safety 1 Carol Wagner Vice President Patient Safety Washington State Hospital Association Judi Brenes Board Member Southwest Washington Medical Center and Health System January 26, 2010

Presenters 2 • Judie Brenes, Board Member, SW Washington Medical Center • Carol Wagner, VP, Patient Safety Program, WSHA

Boards Oversees Quality and Safety, on the Owner’s Behalf… Board oversight of quality and safety is a legal, regulatory, moral, and financial mandate. Quality oversight can not be delegated It is what the public expects the Board to do!

Boards Legal and Regulatory 4  The Code of Hammurabi (CIRCA 2,000 B.C.) “If the surgeon has made a deep incision in the body of a free man and has caused the man’s death or has opened the carbuncle in the eye and so destroys the man’s eye, they shall cut off his forehand.”  Darling v. Charleston Memorial Hospital Case - 1965 Reinertsen and Orlikoff

Focu ocus s on on Quality Quality and and Sa Safety: ety: Impr Improvement ement Needed Needed 5 • 1999 IOM report To Err is Human  IHI initiatives-100,000 Lives and 5 Million Lives campaigns

Payment of Quality of Care 6  Pneumonia  Heart Attack  Pneumococcal Vaccination  Aspirin at Arrival  Culture before Antibiotic  Aspirin at Discharge  Smoking Cessation Advice  ACE/ARB for LVSD  Appropriate Antibiotic Given  Smoking Cessation Advice  Influenza Vaccination  Beta Blocker at Discharge  Surgical Care  Fibrinolytic at Arrival  Antibiotic Before Incision  PCI at Arrival  Antibiotics Stopped After Surgery  Heart Failure  Mortality  Discharge Instructions  30-day Heart Attack  ACE/ARB for LVSD  30-day Heart Failure  Smoking Cessation Advice  HCAHPS  10 Patient Satisfaction Measures

Media Attention on Health Care 7

Questions to Ask 8  Why does your hospital/system do quality improvement?  Does your hospital provide significantly better care this year as compared to last year?

Boards Oversees Quality and Safety, on the Owner’s Behalf… Impact that boards can have in improving quality and safety. The Power of Leadership

A A Cultu Culture of e of Saf Safety ety 10  Requires teamwork, a focus on relationships rather than resources  A model for how to improve (going outside)  A focus on systems and processes rather than individuals

A A Cult Cultur ure of e of Saf Safety ety 11  Increased emphasis on standardization to reduce variability  Humans will make errors – systems and processes must prevent those errors from reaching the patient  A focus on reporting errors Southwest’s online patient safety event reporting

Le Lead ader ership fr ship from om the the T Top op 12 Public and consistent leadership from the CEO/ET, Nursing that Patient Safety and Quality is the first priority - National Patient Safety Foundation  A high demand for Executive team visibility in leading the culture change and directing Quality improvements  A goal of empowering all levels off staff, patients  A commitment to education and training

Chang Cha nging ing Roles oles for or Ph Phys ysician icians s an and d th the e Ho Hosp spita ital 13 For physicians:  A move from quality of care for individual patients to all patients across the system  Change must come from an effective medical staff structure  The physician as team leader rather than commander

Cha Chang nging ing Roles oles for or Phy Physician sicians s an and d th the e Hos Hospita pital 14 For the Hospital:  Our understanding/ action on what the physicians think is important  Supporting quality champions  Decreasing time - Physician Leaders wasting frustrations to improve physician effectiveness

Whe here the the Boar Board d Fits in Fits in 15 Our fiduciary accountability: Stewardship of the mission, representation of our community, financial management, strategic vision and responsibility for the Quality and Safety of the care we provide

Whe here the the Boar Board d Fits in Fits in 16  Don Berwick, CEO of IHI, “American healthcare is unsafe, unreliable and wasteful at a level the Boards don’t seem to understand”  Paul O’Neill, former Secretary of the Treasury and health care leader, “ The Board is personally accountable for everything that happens, especially what goes wrong.”

Se Seven en Cr Criter iteria ia for or Ho How w w we e as a Bo as a Boar ard d ar are e Do Doing ing? 17 1. A definition of what Quality means to us

Integration With Strategic Planning 18 2. Quality/Patient Safety’s integration with the rest of our Strategic Planning process?  People - From orientation through day to day work experience to performance evaluation  Service -Service and quality of care are all in the eye of the patient  Financial - Linking our clinical performance to our financials so that we really understand what harm and waste in the system are costing us

Under Understanding standing Patient tient Saf Safety ety Issues Issues 19 3. An understanding of overarching Quality/Patient Safety issues that go beyond just those reported on the dashboard? Our responsibility:  To educate ourselves and understand our current performance  To be familiar with the definitions/elements of care in our hospital  To understand what the leading hospitals in our industry are doing in patient safety and quality  To speak up about what we don’t understand

Quality Measur Quality Measuremen ement 20 4. Quality measures that are relevant in which the Board understands  The dashboard  Level six harm reports  Trends they are seeing

Leader Lea dership ship Compen Compensa sation tion 21 5. Leadership compensation linked to quality/service metrics? Target Current % Time- 1 2 3 4 5 Status SCALE WT frame Reduce HAC 5 Monthly + 10% >=176 <=175 165-124 123-84 <=83 C- difficile Last Qtr. Quality Public Rpt HQA 85- 87- 92- 3 10% 3 rd Qtr ‘ 09 <85% >95% 86.9% 91.9% 94.9% (AMI, SCIP, PN, CHF)

Ef Effectiv ective e Quality Quality Com Committe mittee 22 6. An effective Quality committee made up of Board, ET, Physicians and staff  Guide, encourage and hold accountable  Moving the big issues up to the full Board  Vetting issues and framing questions that the whole Board has to answer

Patient tient Par articipa ticipation tion 23 7. Is the patient at the center of our work? Putting a human face on the graphs and numbers

Rec ecomme ommend ndations tions 24  Mentor/education program for non-clinical Board members  All Board members to serve at some point on the Quality Committee  Quality/Patient Safety are a part of all Board meetings and a portion of all retreat agendas  Increase opportunities for Board interaction with the people who do the work at hospital  Including quality and safety into the executives compensation  Increase outside education for the Board

Rec ecomme ommend ndations tions 25  Set the annual board agenda for quality with medical staff input – set aim.  Spend 25% of board time on quality and patient safety.  Regularly receive and discuss a formal quality performance update, including measurement.  Review patient satisfaction scores and any adverse events.  Put a quality expert on the Board.  Don’t be a rubber stamp. Actively participate in the oversight of the medical staff credentialing process, including involvement in the development of criteria.

WSHA Opportunities for Continued Education 26  CEO and Trustee Summit  April 13 th repeated on 14 th “This is a must -attend event for all hospital board members and CEOs.” John Fletcher VP and Chief executive WA/MT Region Providence Health System  Annual Meetings  Rural Conference (Lake Chelan)

Questions? 27 Contact Information: Carol Wagner Vice President Patient Safety Washington State Hospital Association (206) 577-1831 CarolW@wsha.org