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Emerging Health Leaders Health Care Governance

The Role of the Board in Quality and Safety Ms. Marcia Visser, BSN, MHSA Chair, Quality Care Committee, Sunnybrook Health Sciences Centre Chair, Ontario Hospital Association May 23, 2013

Objectives
Describe the role of the governing body for quality and safety Learn about some leading governance practices for quality and safety Identify how management and staff can support the board in carrying out its role

Consider this Scenario

Board asks: Why is it so difficult to get staff to wash their hands? Managements response: There is no easy solution

The Challenges
Boards have typically focused on finance Board members typically do not have clinical backgrounds Board members may be confused or intimidated by quality and patient safety issues Board members and physicians are not fully engaged in the quality and patient safety agenda

The Changing Tide

Board involvement in quality and safety is fundamental to the achievement of the organizations mission

Carlow, Healthcare Quarterly, 2010

Creating the Burning Platform


Research Studies
Best Practices Institute of Healthcare Improvement and Health Quality Ontario Accreditation Canada, Qmentum

Excellent Care for All Act

The Role of the Board in Improving Quality


Board has a precise view of Quality and understands where Patient/Client safety fits Board works with management to develop and prioritize quality and safety indicators set targets - choose comparators Focus on monitoring and measurement Critical Incident Committee

Determines Quality and Safety priorities for CEO and links compensation to achievement of goals

The Role of the Board in Improving Quality


Boards with a quality committee can significatly enhance the Boards oversight function (Jiang 2008) Board ensures organizational/board structures are in place to achieve Quality and Safety goals

Support initiatives that support the development of a Quality and Safety culture
Quality Improvement Plan and Framework

The Power of an Engaged Board, Leadership and Health Care Staff


Outcomes are better in hospitals where: The Board spends > 25% of its time on quality and safety The Board receives a formal quality performance measurement report and monitors regularly There is a high level of interaction between the Board and medical staff on quality strategy Senior Executive compensation is based in part on quality and safety performance The CEO is identified as the person with the greatest impact on quality, especially when so identified by the executive in charge of quality
Vaughn T, Koepke M, Kroch E, et al. Journal of Patient Safety, 2006;2(1)2-9

Best Practices Associated with Better Performance


Board Quality Committee with CEO and Chief Medical Officer as members

Establish strategic goals for quality improvement


Include a specific item on quality in Board meetings

Use a dashboard with national benchmarks that includes indicators for clinical quality, patient safety and patient satisfaction
Jiang J, Lockee C, Bass K, and Fraser I, Journal of Healthcare Management, Jan/Feb 2009:15-28

Other Characteristics of a High Achieving Board


Sets goals for education of Board members about quality and safety Seeks regular input of patient, families and staff
Evaluates board performance Partners with executives, physicians, nurses and other clinical leaders. A culture of quality and safety.

How does Sunnybrook Fair?

How does Sunnybrook Fair?


Board wanted actionexpected an improvement in hand hygiene compliance MAC developed a plan Physician Champions Regular monitoring and reporting Executive accountabilities Recognition

How does Sunnybrook Fair?


HH Trend
100%
91% 86% 82% 80% 68% 62% HH Compliance (%) 69% 72% 76% 79% 81% 86% 84% 86%

60%

43% 40%

20%

0% Nov 07- Aug-Oct Nov 08 - Q3 2009- Q4 2009- Q3 2010- Q4 2010- Q2 2011- Q3 2011- Q4 2011- Q1 2012- Q2 2012- Q3 2012- Q4 2012Feb 08 08 Mar 09 10 10 11 11 12 12 12 13 13 13 13

How does Sunnybrook Fair?


HH Trend by Profession
100
90 80 70 HH Compliance (%) 60 50 40 30 20 10 0 Nursing Staff Nov 07- Feb 08 Q2 2011-12 Aug - Oct 08 Q3 2011-12 Medical Staff Nov 08- Mar 09 Q4 2011-12 Allied Health Workers Q3 2009-10 Q1 2012-13 Q4 2009-10 Q2 2012-13 Suport Staff Q3 2010-11 Q3 2012-13 SB Average Q4 2010-11 Q4 2012-13

The Role of the Board in Improving QualityThe Essential Questions


Strong Boards can live with the tension between governance and operations Two types of questions How good is our care?
How do we compare to others? Who is the best?

Is our care getting better?


Are we on track to achieve our key quality and safety objectives? If not why not? Is the strategy wrong, is it not being executed effectively ( J LReinersten)

Boards Do Make a Difference


an activated Board, in partnership with executive leadership, can provide the will and set system level expectations and accountability for high performance and the elimination of harm to dramatically and continuously improve the quality of care
Conway J, Journal on Quality and Patient Safety, 2008; 34(4):214-20

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