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Getting Boards on Board

Getting Boards on Board. Eric W Dickson MD, MHCM Senior Medical Director UMass Memorial Medical Group Professor of Emergency Medicine UMass Medical School Eric.dickson@umassmemorial.org. Disclosures. I have nothing to disclose. Today's focus. Highlight some key points from Jim’s lecture

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Getting Boards on Board

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  1. Getting Boards on Board Eric W Dickson MD, MHCM Senior Medical Director UMass Memorial Medical Group Professor of Emergency Medicine UMass Medical School Eric.dickson@umassmemorial.org

  2. Disclosures • I have nothing to disclose

  3. Today's focus • Highlight some key points from Jim’s lecture • Few additional pearls • Focus on a few specific actionable items • Shared Learning

  4. Why Do Boards Exist? To represent the owners

  5. Boards Oversee, on the Owner’s Behalf… • Mission • Strategy • Executive leadership • Financial stewardship • Quality of care and service

  6. Lead don’t just represent To Lead is to Serve

  7. A problem can only be solved where it exists Genchi Genbutsu Action item 1 Go to a rapid cycle improvement event at your hospital and make sure that front line staff is present and candid about the problem

  8. Gaps in PerceptionsView of One State

  9. Help your doctors see the profound benefit of standardization “It is impossible to improve any process until it is standardized. If the process is shifting from here to there than any improvement will just be one more variation that is occasionally used and mostly ignored. One must standardize the process before improvements can be made.” Masaaki Imai

  10. Action item 2 • Ask your doctors about the use of guidelines, protocols, checklist and other standardized processes • Encourage them to help develop and follow standard work Perfect care can only be achieved through perfect standard work

  11. Better Outcomes Are Associated With Hospitals in Which . . . • The board spends more than 25% of its time on quality issues. • The board receives a formal quality performance measurement report. • There is a high level of interaction between the board and the medical staff on quality strategy. • The senior executives’ compensation is based in part on QI performance. • The CEO is identified as the person with the greatest impact on QI, especially when so identified by the QI Executive. Vaughn T, Koepke M, Kroch et. al. 2006

  12. Action item 3, go to Hospital Compare and compare your hospitals results to those of your competitors.

  13. Safety Behavior Training Begins Employee Training Ends Medical Staff Training Ends Serious Safety Event Rate: One View Rolling 12-month Serious Safety Events expressed per 10,000 adjusted patient days SSER August 2008: 0.41 Average Days between events: 14 days (CY08 Sept YTD) 19 days (CY07) 37 days (CY06)

  14. Another look at the same data for the past 9 months Hollie C. 9/10/2008 Fall Jane E. 9/27/2008 Wrong Site Surgery Frances H. 7/15/2008 Delay in Tx Robert B. 9/16/2008 Delay in Dx Wayne W. 7/06/2008 Delay in Tx John L. 3/20/2008 HAI John R. 9/18/2008 Delay in Dx. Jimmy P. 7/07/2008 Fall Baby Boy H. 8/10/2008 Wrong Pt. Procedure Sharon R. 3/10/2008 Post Procedure Death Baby Girl C. 5/02/2008 Delay in Tx Nancy S. 1/14/2008 Delay in Dx Inga H. 2/18/2008 Fall John W. 8/25/2008 Fall Helen D. 2/07/2008 Retained Foreign Obj. Albert G. 8/17/2008 Fall Tom C. 1/09/08 Delay in Tx Robert S. 10/2/2008 Fall Mandy B. 1/13/2008 Delay in Tx

  15. Put a face to harm • Action item 4 begin a board meeting with a brief story of a negative patient experience • How many board members in the audience hear RCAs? • How many have had a patient come and tell a story about a bad event that occurred ? Reinertsen, Conway, others

  16. Making the future attractive Changing the old Framework: Leadership for Improvement Setting Direction: Mission, Vision and Strategy PULL PUSH Ideas Execution Will Establish the Foundation

  17. OIG and AHLAKey Questions for Hospital Board • What are the goals of the organization’s quality improvement program? • What metrics and benchmarks are used to measure progress towards each of these performance goals? • How is each goal specifically linked to management accountability? • How does the organization measure and improve the quality of patient care? • Does the board have a formal orientation and continuing education process that helps members appreciate external quality and patient safety requirements? • Does the board include members with expertise in patient safety and quality improvement issues? • What information is essential to the board’s ability to understand and evaluate the organization’s quality assessment and performance improvement programs? • Once these performance metrics and benchmarks are established, how frequently does the board receive reports about the quality improvement efforts?

  18. To Lead is to Serve

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