Involving the Board in Quality and Patient Safety

You’ve studied the new standards, updated policies, and conducted tracers to monitor compliance. What else can you do to strengthen your hospital in preparation for more rigorous regulatory surveys? Communicate with your board! The board should serve as a resource for the hospital and provide oversight, not just for financial performance, but for quality as well.

Currently, the Centers for Medicare and Medicaid Services (CMS) require hospitals to have a governing body (the board) that is legally responsible for the conduct of the hospital as an institution. The board of a hospital is required to hire the CEO, establish a competent medical staff, and oversee key aspects of the organization, such as the strategic plan and budget. However, it’s the governing body’s role in oversight of quality care that is most commonly cited during a complaint survey.

Rather than taking an active role in ensuring patient safety, most boards feel forced into a “rubber stamp” approach to quality oversight. This is often due to a combination of factors, including confusion about how the board oversees quality and lack of adequate knowledge about patient safety. But, clinical and quality leaders can support the board in fulfilling their responsibilities. Follow these guidelines to ensure that the board is an effective resource for your hospital.

Provide your board with an orientation. While not explicitly mentioned in the standard, board orientation has become an expectation for both CMS and The Joint Commission. Board members should receive an orientation to the hospital’s quality program, as well as opportunities for additional education, if needed. Orientation also provides a chance for quality directors to learn more about the needs and preferences of the board. What kinds of people make up the board? What are their professional backgrounds? What kinds of report formats would be best to convey information to them in a meaningful way?

Make quality information universally understandable. Hospital boards generally consist of people from a wide variety of professional backgrounds. For example, think of someone in your town who owns a furniture company. She is interested in providing health care to her employees, and as a result receives a seat on the board of the local hospital. While she may have some knowledge of basic quality control, she does not know very much about the hospital’s quality standards. Therefore, the hospital must inform this board member about quality care in a way that makes sense to her. Reports should be written for a lay (non-healthcare) audience and emphasize meaningful information over data.

Outline and document specific expectations for board members. In order for the board to effectively oversee quality (or operations in general), members must be engaged, interested, and willing to ask questions. Let your board know that you expect members to challenge old ideas, and encourage inquiry when appropriate.

Hold the board accountable for quality oversight. Boards receive quality reports for two reasons, to gain information and to direct action. Be clear when you want the board to take action on an identified issue. State your recommendations, then allow the board the opportunity to act. Merely approving a report is not meaningful action when there are problems. Once expectations have been established, follow up in subsequent meetings.

Maintain transparency. Keeping the board informed is extremely important, particularly if your hospital is facing adverse survey results like Immediate Jeopardy. This is the time when the board can provide the greatest assistance. A properly informed board can be the hospital’s greatest asset when it comes to communicating with the community and mitigating the impact of negative survey results. On the other hand, leaving the board in the dark about poor survey results can be disastrous, not only for reversing the findings, but in the loss of trust of the board members and the community they represent. For more information and the story of one hospital that learned this lesson the hard way, read “Hospital Near-Death Experience: How Medicare Termination Can Push Your Hospital to the Brink of Closing.”