Getting Docs on Board

Carrie Vaughan, for HealthLeaders News

Traditionally, hospital quality and patient safety have been left in the hands of the clinical staff–board members and senior executives focused more on the strategic and financial goals of the organization. However, that dynamic is no longer the case. Hospital executives and community board members are taking an increasingly larger role in defining and monitoring the hospital’s quality goals. So how can senior leaders and trustees ensure that physicians are on board with their quality agenda?

1. Ask physicians how the hospital can improve quality, says Melissa Coleman, a board member at Delnor-Community Health System in Geneva, IL. The 128-staffed-bed hospital has several physicians on the hospital board as well as the quality committee. The physicians help the quality committee set agendas based on their daily interactions and observations, she says. “They are out there on the frontlines. They know what will improve quality. . .If you are initiating or implementing a quality initiative, get doctors involved and let them drive it.”
2. Have a sincere and intensive discussion with the medical staff at least once a year on what they are doing to improve quality, advises James A. Rice, PhD, vice chairman of The Governance Institute. For instance, physician leaders should inform the board what processes they are establishing to guard against medical errors, enforce hand washing, and handle credentialing and privileging issues.
3. Align the quality goals of the physicians and the hospital. Rather than asking, “Why can’t we get doctors engaged in our quality agenda?” senior leaders and board members should ask themselves, “How can we get engaged in the physicians’ quality agenda?” says James L. Reinertsen, MD, president of the Reinertsen Group and a senior fellow at the Institute for Healthcare Improvement. Physicians’ focus on quality usually relates to their patients’ outcomes and wasted time. So if the hospital’s quality goal is to look good on the Centers for Medicare & Medicaid Services’ core measures for evidence-based medicine, that probably won’t engage docs. But framing the organization’s goals around improving patient outcomes for specific disease states and basing the clinical indicators to monitor the organization’s progress on evidence-based medicine and CMS guidelines will more than likely get physicians on board, says Reinertsen. “Now you have a plan that is exactly the same plan, but it has been framed in a way that engages physicians.”
4. Establishing medical conference committees can also help align the quality agenda of the medical staff, board members and senior leadership. These committees are usually composed of three or four key physician leaders and three or four board members who come together two or three times a year to look at the quality agenda, monitor performance, and brainstorm on strategic initiatives, says Rice.
5. Include the medical staff in strategic discussions on technology trends that have the potential to improve clinical outcomes and patient safety. Board members, senior executives and medical staff leaders should look at the efficacy of the technology–both clinical and IT–as well as the capital consequences for the hospital, says Rice, adding that the discussion can take place two to three years in advance of those capital decisions. “That is another partnership or culture of respect that is important to build between the board, management and physician leaders,” he says.
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