Wednesday, March 07, 2007

While Hospital Board Members "Slumber"....

With some reading between the lines, a story in the Boston Globe by Christopher Rowland helps explain some of the problems that afflict the leadership of health care organizations. To summarize the story, in quotes,

Hospitals increasingly are expecting volunteer trustees to go beyond the role of community boosters and tackle an imposing medical issue: preventing errors that lead to patient injuries and deaths.

Trustees traditionally have used their positions on hospital boards for social networking with other business executives and raising money through events such as fashion shows and golf tournaments. But expanding the scope of their responsibilities and time commitment is seen by hospital officials as key to improving patient safety because it would focus more attention on flawed policies and procedures that lead to mistakes.

'Board seats in American hospitals have traditionally been relatively honorific positions,' said Donald M. Berwick , chief executive of the Institute for Healthcare Improvement , a Cambridge nonprofit that is considered a leader in national efforts to reduce hospital errors. He said it is time for hospital boards of directors -- along with executives and physicians -- to 'rise from slumber and view safety as an urgent matter.'

Doctors caution against volunteer board members delving too deeply into areas that require medical expertise, but they generally support the increased focus on safety. Greater involvement can help board members recognize that safety improvements require more resources and better technology, they said.

'We don't want them micromanaging, but it promotes an interaction between the board and the medical staff that we would like to see happening,' said Dr. Kenneth R. Peelle , president of the Massachusetts Medical Society , which represents 18,000 Massachusetts doctors.

Until the last several years, individual hospital boards in Massachusetts and other states had not paid much attention to the issue of preventable deaths, leaving oversight to doctors and administrators.

Not to minimize the issue of patient safety, I believe this article brings up a larger issue affecting hospital governance, and, more broadly, the governance of health care organizations. The issue is that the boards of many health care organizations have not taken their fiduciary responsibilities seriously. Boards of not-for-profit corporations or NGOs are responsible for keeping the organizations' activities focused on their missions. Instead, this article suggests that hospital boards are often peopled by local business-people interested in "social networking" and glitzy events. Boards need to arise from their "slumber," not just to worry about patient safety - although they surely should worry about that - but to make sure the organizations for which they are responsible are adhering to their missions.

On Health Care Renewal we have seen multiple cases of hospitals, academic medical centers, and health care systems whose managers have been mission-hostile, conflicted, or even corrupt. In many of these cases, there was little evidence that the organizations' boards were aware of the problem, or did much about it until it created headlines, if then. We need board members who can not only arise from their "slumber," but who are willing and able to make sure the hired management understands, respects, and operationalizes the mission.

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