The Board of Director's Role in Quality Improvement
Board members of healthcare organizations often struggle with the issue of their personal role in their organization's quality improvement efforts. Whether they are on the board of a small community action group or of a major medical center they feel unprepared to review and discuss the quality of care and the quality of service provided. It's easy to understand why a "lay" board member might turn to other "expert" board members like physicians, nurses or people with technical skills and say "you tell me about the quality of this organization." In fact, if that's the starting point for learning about quality, the "you tell me" approach may be appropriate. Unfortunately however, all too often it's the end point rather than the starting point and it seems that the board member is really saying something like "I'm not responsible for the level of quality here, you (the expert) are."
It's unlikely that that approach would work with any other board oversight function. While no one has to be an expert on every single issue that comes before the board, you don't generally hear things like "you know about money and budgets, you decide" or "I'll vote for whatever you come up with for the new building construction project" from board members. Of course board members are not expected to be quality experts, they need education and training and they need real, two-way conversations with other board members, executive management, physicians and others. They need to feel secure enough to be able to ask basic, "dumb" questions; they, like all the other board members, need to learn.
One way to encourage the learning process is to conduct a retreat where all board members can put today's quality of care requirements into both an industry-wide and organization specific context. Board members and organizational leaders need to learn about and discuss the two questions they must continually ask about their organization:
(1) Are we any good?
(2) Are we getting better?
No matter where you are in your personal, professional and organizational journey to improve quality, these two questions will serve you well.
The "are we any good" question can only be addressed by putting it in the context of "good compared to what?" This means regular comparisons to other organizations with similar missions, to top performing organizations, to world class providers of the services your organization undertakes. It is not enough to look at your nearest competitor (or worse, to say "we have no competitor") and make a blanket statement that we all know we're better than them. "Are we any good?" must be answered using hard data on a very regular basis.
At the same time you are benchmarking against top performers, you also need to ask: Are we getting better?" The way to address getting better is to compare, to measure against your own organization's past performance. Data must be assembled and tracked. It must be put into a visual format that tells the story of improvement or the lack of it. When undertaking quality assessment and improvement, data is your much needed best friend. It tells you how and where to prioritize; it shows trends; it turns the light on areas previously listed as top secret or unfathomable and data supports the logic chain that says "if we do this, we expect that to occur."
One last thing, I have attended hundreds of board meetings in hospitals, long term care facilities and other organizations. I have heard many, many financial presentations from accountants, managers, CFO's, outside auditors, bond experts, architects, consultants and others. I have never seen a patient or patient's family tell about their experience with the clinical and customer service aspects of their organizational encounter - never! Board members need to be reminded that a strong financial position, a new piece of equipment or a new wing on the building are not ends in themselves, rather they are the means to the end of caring for patients. Boards, administrators, even physicians can greatly benefit from two-way conversations with people who have used their organization's services. After all, they are much more than numbers; they are your mission.
High-level engagement on quality really does cascade down to frontline staff and cements care quality as an organization-wide priority. It is the board of director's ultimate responsibility to see that this is established, sustained and rewarded.