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Emerging Health LeadersHealth 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
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Objectives
Describe the role of the governing body
for quality and safety
Learn about some leading governancepractices for quality and safety
Identify how management and staff can
support the board in carrying out its role
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Consider this Scenario
Board asks:
Why is it so difficult to get staff to wash
their hands?
Managements response:
There is no easy solution
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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 fullyengaged in the quality and patient safety
agenda
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The Changing Tide
Board involvement in quality and safety is
fundamental to the achievement of theorganizations mission
Carlow, Healthcare Quarterly, 2010
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Creating the Burning Platform
Research Studies
Best Practices Institute of Healthcare
Improvement and Health Quality Ontario
Accreditation Canada, Qmentum
Excellent Care for All Act
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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
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The Role of the Board in Improving
Quality
Boards with a quality committee can significatlyenhance 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
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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
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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 patientsatisfaction
Jiang J, Lockee C, Bass K, and Fraser I,Journal of Healthcare Management,
Jan/Feb 2009:15-28
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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 clinicalleaders. A culture of quality and safety.
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How does Sunnybrook Fair?
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How does Sunnybrook Fair?
Board wanted actionexpected an improvement in handhygiene compliance
MAC developed a plan
Physician Champions
Regular monitoring and reporting
Executive accountabilities
Recognition
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How does Sunnybrook Fair?
43%
62%
68% 69%72%
76%
82%79%
81%
86% 86%84%
86%
91%
0%
20%
40%
60%
80%
100%
Nov 07-
Feb 08
Aug-Oct
08
Nov 08 -
Mar 09
Q3 2009-
10
Q4 2009-
10
Q3 2010-
11
Q4 2010-
11
Q2 2011-
12
Q3 2011-
12
Q4 2011-
12
Q1 2012-
13
Q2 2012-
13
Q3 2012-
13
Q4 2012-
13
HHCompliance(%)
HH Trend
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How does Sunnybrook Fair?
0
10
20
30
40
50
60
70
80
90
100
Nursing Staff Medical Staff Allied Health Workers Suport Staff SB Average
HHCompliance(%
)
HH Trend by Profession
Nov 07- Feb 08 Aug - Oct 08 Nov 08- Mar 09 Q3 2009-10 Q4 2009-10 Q3 2010-11 Q4 2010-11
Q2 2011-12 Q3 2011-12 Q4 2011-12 Q1 2012-13 Q2 2012-13 Q3 2012-13 Q4 2012-13
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The Role of the Board in Improving
QualityThe Essential Questions
Strong Boards can live with the tension betweengovernance 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)
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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
