For $600,000 of annual CEO pay, a hospital could hire at least 8 licensed healthcare practitioners of traditional medicine who treat chronic conditions through acupuncture, herbal medicine, lifestyle medicine, dietary therapy, and movement and breathing practices. These skilled providers whose medical systems are based on lifestyle and prevention would boost productivity, health outcomes, and reduce re-admission rates far more than Western medicine physicians and nurses can do alone. Collaboration is key. Integration works.
1
What about just hirering nurses, nurse's aides or cleaning crews? We don't need more voodoo practitioners after a voodoo CEO!
1
One of the advantages of single-payer health insurance would be that it would encourage competition at the provider level. Without insurance networks, patients could go to the doctors and hospitals they choose, fostering competition for patients, unlike the current system, which fosters competition for insurance contracts. The way it is now, patients are stuck in networks where there is little competition based on quality of care. The incentives are for hospitals to consolidate in order to wrangle better deals from insurance companies and suppliers. It's no wonder that quality of care is secondary in the current system.
2
One of the reasons for higher cost is the price support that federal givernment sets through CMS for hospitals, & providers. Therefore, healthcare market in every corner of the country is distorted. There is economic gameplaying by hospital administrations & insurance carriers to maximize profits even as most of the industry is termed as nonprofit. hence, there is a case to be made for removal of federal price setting by medicare. Let the market function function as a freerer market.
2
It is as foolish to badger clinicians with 'No Margin, No Mission' as it is to ask MBAs to promote quality care.
Trying to link financial incentives to good care seems equally misguided. The driving force in MD & RN practice is a culture of excellence, an ethical/moral incentive established from a community of mentors, clinical team leaders and peers. The best incentives are to allow a hospital staff to do a good job. Professional pride & gratification is a tonic. Hospital adminsitration & Boards should have experts in quality care informing policy. Instead of an MD VP (often used to coerce MDs to shorten length of stay) hospitals should have an independent Quality VP--RN or MD--who can speak truth to dumb fiscal power.
Medical care is not like Toyota - despite some helpful manufacturing principles from industry. There is no 'product.' Standards of an assembly line do not apply even if check lists & care maps help.
There is no question that, utimately, good care is efficacious & cost efficient. A staff that is fulfilled by their jobs & treated well will yield the best bottom line.
And- unlike manufacturing - healthcare always includes caring for the hopelessly ill, suffering & dying. Cure is not the only outcome. Measures that ignore acuity, complexity & futility or that trivialize palliation are beyond faulty- they are toxic to a decent & humane healthcare system.
Trying to link financial incentives to good care seems equally misguided. The driving force in MD & RN practice is a culture of excellence, an ethical/moral incentive established from a community of mentors, clinical team leaders and peers. The best incentives are to allow a hospital staff to do a good job. Professional pride & gratification is a tonic. Hospital adminsitration & Boards should have experts in quality care informing policy. Instead of an MD VP (often used to coerce MDs to shorten length of stay) hospitals should have an independent Quality VP--RN or MD--who can speak truth to dumb fiscal power.
Medical care is not like Toyota - despite some helpful manufacturing principles from industry. There is no 'product.' Standards of an assembly line do not apply even if check lists & care maps help.
There is no question that, utimately, good care is efficacious & cost efficient. A staff that is fulfilled by their jobs & treated well will yield the best bottom line.
And- unlike manufacturing - healthcare always includes caring for the hopelessly ill, suffering & dying. Cure is not the only outcome. Measures that ignore acuity, complexity & futility or that trivialize palliation are beyond faulty- they are toxic to a decent & humane healthcare system.
1
The article underestimates the average hospital CEO's salary in the New York metropolitan area. The CEO of Stamford Hospital makes about 1.8 millions if I remember correctly. That might be the reason why the hospital charged uninsured patients outrageous amounts of money for minor emergency care according to the long Time magazine article last year and why they obviously save on lowly employees. As far as I can remember management and employees have been at loggerheads for years. Who wants to be a patient at an outfit like that?
1
Well Gee for any organization poor management with short term thinking will cause issues. Just at the VA bad management makes everything worse and giving such incentives just allows them to cheat more. Ethical and informed managers run great place to work.
As a physician in private practice, I am constantly amazed by the notion of pay for performance in healthcare. There are two major components to the healthcare paradigm. The first is the patient. The second is the physician. While others have input at various levels, only physicians have the training and licensure that gives them the legal and moral authority to truly manage healthcare. If you doubt that concept, please consider any malpractice case where all the parties ultimately blame the physician of record as the responsible party regardless of the alleged event. Therefore, if care is to be relegated to payment for outcomes, then, assuming the competence of most physicians, the patient has an equal role to play in the outcome. For example, an overweight smoking diabetic patient with no family support will generally have a poorer outcome from a complex medical intervention and a greater risk of complications such as wound breakdown or infection. How do we as physicians, let alone large hospital entities, change that patient's lifetime of bad practices in one hospital stay? The concept is akin to filling the tank of your car and cleaning the windshield and then holding the gas station responsible if you have an auto accident 5 miles down the road. It defies logic. Until all parties agree that the real cost of healthcare is related to patients and their diseases, there is room for improvement only on the margins.
1
My hospital's board starts every meeting with a review of our quality measures, which are also posted on our website for all to see! Each division is expected to present their outcomes to the board on a rotating basis. I'm so lucky to be somewhere that is the opposite of what this article describes.
2
I spent over twenty years in a private emergency medicine group, and much of the last seven or eight at one particular hospital in the D.C. metro area. At the time, I thought that the hospital (which was a very difficult place to work) was suffering from a poor patient population and an aging physical plant. I have since then come to feel that the hospital suffered more than anything else from incompetent management. It is not easy to deal with an impoverished and very ill group of patients, but the extraordinary incompetence and deceit of the management easily eclipsed the patients poverty. I finally left, in despair, feeling that in the last several years of my career I owed it to myself to do more than tilt at windmills. I have never regretted the decision.
4
Heath care in America is so much about promoting PR..It seems to be just as much about perception as anything else..Unfortunately,it is our culture. Those Big heads that sit in their big chairs in those nicely designed rooms far away from the real nature of health care are caught up in the Business of Heath care. When confronted on their personal profits of gain,or whatever,they go into their defensive denial mode...
3
The esteemed writer is spot on. However , The economist knows that what keeps the doors open is financial ! No matter how good are the quality indicators the prosperous hospital will remain the hospital . In his essay he is poignant to ask how informed Hospital Boards are about quality , and do they have providers to advise them on these matters . He also would like to see a selection process that includes elections.There i believe he fails to understand the Boards role which is governance and the operational role which is executive management . As a board member of a midsize system and a clinician, i would like the public to know that measured quality is not reflective of accurate care ! It is reflective of indices such as selection of antibiotics , or timeliness of an admission or proper processes during a stroke or a heart attack, etc ! Well, it is derived from bills that assumes correct diagnosis . Studies have shown discrepencies between reports and true clinical complications http://annals.org/article.aspx?articleid=1748841&resultClick=3 . Therefore the health industry developed @ cost data mining departments to meet the need of these indicators . How simple would it be if we were to choose access to care , proper vaccinations , mortality rate , complication rates as indices . The current indices have created a rise in MI diagnosis and treatment , increase in antibiotics resistance for fear of failure ito give the antibiotic in time , and a rise in C. Difficile .
3
Board rooms is not a place to concern quality healthcare, concern about running the hospital , just money.
In many hospitals, if you do not engage deeply to work, you cannot even understand what is wrong.
Over all , New York area hospitals are not managed well by their boards. Boards is in business of glamour to extract money from donors, If things doesn't go well, sell or close the hospital is easy for them, as closing subway during winter storm.
I saw in New York area , many hospitals closed just blink of an eye, the only reason is Board room was inept. because they do not have any interest in hospital other than money raising.
Ok Let say in another word, Your hospital is not running because you are paying your service or your insurance, It is running because of donors, who knows those donors will stop giving when and this will be the end your community hospital.
In many hospitals, if you do not engage deeply to work, you cannot even understand what is wrong.
Over all , New York area hospitals are not managed well by their boards. Boards is in business of glamour to extract money from donors, If things doesn't go well, sell or close the hospital is easy for them, as closing subway during winter storm.
I saw in New York area , many hospitals closed just blink of an eye, the only reason is Board room was inept. because they do not have any interest in hospital other than money raising.
Ok Let say in another word, Your hospital is not running because you are paying your service or your insurance, It is running because of donors, who knows those donors will stop giving when and this will be the end your community hospital.
The idea that any hospital is a non-profit entity is delusional. America has made illness into a business, with the making of money being the primary goal. Non profit hospital make lip service of indigent care, but mainly to keep their taxes low and the federal dollars rolling in.
Business men have turned the hospital where I work from one that had a stellar reputation for excellence of care and being a great place to work into one that recently received a "D" safety rating. We are a non-profit that makes quite a bit of money, which reflects in the million dollar bonuses to the CEO.
Business men have turned the hospital where I work from one that had a stellar reputation for excellence of care and being a great place to work into one that recently received a "D" safety rating. We are a non-profit that makes quite a bit of money, which reflects in the million dollar bonuses to the CEO.
12
As more physicians abandon private practice and become employees of hosptials ( and as the hosptials expand in response to the incentivers of the Affordable Care Act), decisions on care and quality will be made by those boards for the benefit of their shareholders (or, in the case of the laughible tax exemption of many hospitals, the management). Physicians will have less and less reputational risk associated with care and even less control. This piece should be read along side Mr. Rattners editorial today on the "success" of Obamacare in order to get a clearer picture of the overall "success" of the ACA.
3
I will never forget a Boca Raton, Florida hospital I was in in 1999. After a routine operation, I was discharged with a tear in my esophagus. The lapse nearly cost me my life, because of dilatory actions once I got to ER. The doctor in charge was also on the board of the hospital. He repeatedly insisted that any bleeding had stopped, and made excuses for the ER not being properly staffed. Finally, when it became apparent that my hemoglobin was fatally low, he had his staff shove something under my face and said "Sign this or you will die." Presumably, that was their idea of informed consent. I'll never forget his arrogance and disinterest. When I demanded someone talk with me about it, his response was that I should be grateful he saved my life. It took me over a decade to even consider returning to that hospital.
3
I can't agree more. So much avoidable harm happens in hospitals - a perverse situation if I ever saw one - and yet so many hospitals have management teams that continuously fail to adopt known improvement methods.
My hospital, Beth Israel Deaconess in Boston, is far from perfect, as their infection rates etc show, but they sure aren't in denial - they work at it. Some years back they invited me to be a patient participant in their Lean quality workshop(!). One of the leaders was Mark Graban, author of the book "Lean Hospitals," and seeing this column on Facebook today, he posted this, which everyone who ever intends to be hospitalized should think about:
"Quality starts in the board room" - W. Edwards Deming http://thinkexist.com/quotation/quality_starts_in_the_boardroom/330488.html
My hospital, Beth Israel Deaconess in Boston, is far from perfect, as their infection rates etc show, but they sure aren't in denial - they work at it. Some years back they invited me to be a patient participant in their Lean quality workshop(!). One of the leaders was Mark Graban, author of the book "Lean Hospitals," and seeing this column on Facebook today, he posted this, which everyone who ever intends to be hospitalized should think about:
"Quality starts in the board room" - W. Edwards Deming http://thinkexist.com/quotation/quality_starts_in_the_boardroom/330488.html
2
We can find a similar problem in many modern corporations. At the top, companies often focus their efforts on the benefit of stockholders rather than a balance of stockholders, customers, and employees. This is sometimes heightened by executive bonuses pegged to stock market performance rather than market performance, customer satisfaction, and employee engagement. As in hospitals, this distortion in goals and measurements leads to poor corporate performance (but greater benefit to a small number of influential investors).
1
It is as important for actual *patients* to be on hospital boards. Think of that as a Chief Patient Officer function - many of us (patients) have become science and medicine experts out of necessity and self-perservation.
8
I am a nurse who sits on the board of an 18-hospital network, and I chair the board’s Committee on Quality and Patient Safety, so I can testify to the fact that knowing how to improve quality has become as important as fiscal savvy in board selections. This has become particularly true now that quality outcomes make a difference in inpatient reimbursement. Insurers, like Anthem, already provide top reimbursement only for top quality. CMS-Medicare incentivizes better care and penalizes hospital-acquired conditions. Though pay-for-performance strategies have yielded mixed results, I think this growing outcomes orientation is here to stay, destined to get refined with experience rather than abandoned. And this means board membership has to change to include more expertise on how you foster a culture of quality, sustain desired behavioral changes, coordinate care, and develop systems that “catch” problems in the making.
8
Board members rarely include working nurses and other healthcare workers who work directly with patients. Board members should have some clinical experience and training...for example, have them take a nursing assistant course and go to the units and turn and bathe patients...then they would understand the reality of healthcare on the front lines and perhaps make their decisions accordingly. The recent NPR series on nursing injuries is just one example of bringing to light what happens in the process of delivering the services, and more light needs to be shed.
20
As Dr. Jha once told Forbes, “I haven’t heard of any hospital that went out of business because its care was unsafe. I also haven’t heard about any CEO who got fired because the hospital’s infection rate was too high. It doesn’t happen, and that’s telling… It’s not what keeps CEOs awake at night. And until we get CEOs losing sleep about unsafe care, we’re not going to make a big dent in the failures of our health care system.”
I argue ("Mistaking Failure for Success") that hospitals need to fundamentally rethink how they look at admissions if we want to change the culture (http://kimbellardblog.blogspot.com/2014/05/mistaking-failure-for-success...
I argue ("Mistaking Failure for Success") that hospitals need to fundamentally rethink how they look at admissions if we want to change the culture (http://kimbellardblog.blogspot.com/2014/05/mistaking-failure-for-success...
14
The link didn’t work. Want to try again?
1
I'm curious. How many hospitals have CEOs that actually sit on the board and who are involved in hiring board members. That is the situation in our hospital.
2
I am a physician who left a hospital for several reasons, not least of which was that the board was appointed by the CEO. He made decisions, good and bad, and the board smiled and nodded. Not a good system in my experience.
Wouldn't be nice if all hospitals were non-profit and doctors that were willing to provide services in under-served areas like inner cities and rural areas were better compensated. As long as profit is the epicenter of the business model for major hospital chains patient safety will be far down the list. Like that old joke: I went in for a toothache and came out with my arm missing.
10
Big donors may be treated visibly different as Tom stated below, but as a colleague of mine often says, "even Bill Gates can't buy quality care". Quality is a lot more than the flashy room and filet mignon trays and pandering administrators. With 440,000 deaths per year due to healthcare errors it behooves all CEOs and Boards to be very knowledgeable about quality and safety and strive for high reliability organizations.
11
This discussion is incomplete and misleading. Despite the fact that in the market as we know it, any company that focused on quality at the expense of profit would be considered a failure. What company motivated by market forces is going to look for ways to decrease their income? And if providing quality increases their market share, then what do we make of attempts to limit a hospital's growth? At what point does their success become "too much"? Are we hoping to see the same kind of volatility with hospitals as in other sectors? Moreover, if competition is important for quality, what do we make of the fact that people looking for lower cost insurance should expect to be limited to using a narrower network of providers? How does restricting patients to subsets of providers and hospitals foster competition? In fact, doesn't it limit competition, and therefore, lower quality?
Despite the fact that attempts to align payment with performance at hospitals have yielded mixed results. Mr. Frakt does not choose to question the assumption that has been made in this country that we need to inject more market forces into healthcare.
How have other countries managed to deliver quality for lower cost? Why does Mr. Frakt think America needs to reinvent the wheel?
Despite the fact that attempts to align payment with performance at hospitals have yielded mixed results. Mr. Frakt does not choose to question the assumption that has been made in this country that we need to inject more market forces into healthcare.
How have other countries managed to deliver quality for lower cost? Why does Mr. Frakt think America needs to reinvent the wheel?
6
Some hospital boards have recognized that having nurses on the board will bring the patient's and family's perspectives into the room, as well as a commitment to quality and organizational mission. These are not nurses who work for the organization but come with substantial leadership experience in another system, academia, a business, or other setting. I know of several high-performing health systems that have nurses on their boards and sometimes have them chair the committee on quality. Of course, if a hospital CEO, as some have already noted in this comments section, really want a rubber stamp, then they won't want someone who brings a conscience into the deliberations. But as our health system and payers move towards outcomes- and quality-driven care, the hospital boards that include nurses will only benefit from more discussions of quality and safety.
11
This is both a timely article and one which contains important advice for every hospital board.
Unfortunately as more and more community hospitals fail or become part of large national chains, the individual physician or hospital board member has less and less to say about what contributes to the quality of medicine provided by a hospital. At some point regulation which more effectively deals with the challenges presented by the huge hospital chains will need to be developed. In the meantime quality will continue to be a lower priority than profit for the majority of boards.
Unfortunately as more and more community hospitals fail or become part of large national chains, the individual physician or hospital board member has less and less to say about what contributes to the quality of medicine provided by a hospital. At some point regulation which more effectively deals with the challenges presented by the huge hospital chains will need to be developed. In the meantime quality will continue to be a lower priority than profit for the majority of boards.
9
My experience with hospital boards was indirect (and anecdotal in that I only have had close observation of perhaps five) but I was always interested because it is a "system" that can be understood so I paid attention. The CEO tends to choose the board (perhaps indirectly by encouraging certain people to apply, perhaps more directly by nominating new members- but he or she makes the choice none-the-less). The result is that hospital boards, like corporate boards, tend to be rubber stampers. The CEO develops the meeting agenda and gives out the factual information he or she wishes the board to have to make decisions and the board members have been selected by the CEO for their reliable malleability (including the physicians who were asked on). That only makes sense- as noted the CEO is highly paid and wishes to keep the job.
The end result however it that the philosophy of the CEO is dispositive of the hospital's priorities. If the CEO aims first for quality indicators the hospital's performance will reflect that. If things like short length of stay and low resource utilization, and therefore profitability, are number one then quality will tend to correlate inversely. If fund raising for new and expensive specialty care areas is most important then overall care quality will be less correlated (though not necessarily negatively correlated) with CEO (and board) priorities.
The end result however it that the philosophy of the CEO is dispositive of the hospital's priorities. If the CEO aims first for quality indicators the hospital's performance will reflect that. If things like short length of stay and low resource utilization, and therefore profitability, are number one then quality will tend to correlate inversely. If fund raising for new and expensive specialty care areas is most important then overall care quality will be less correlated (though not necessarily negatively correlated) with CEO (and board) priorities.
16
What a valuable sentence Gregg: "The end result however is that the philosophy of the CEO is dispositive of the hospital's priorities." Whether a hospital is for profit or a not-for-profit, the priority of every CEO of the many hospitals with which I have had first hand knowledge is their salary-bottom line. Valuable community services which are clearly stated in the mission statement or mandated by county or city law are dumbed down, dismantled or basically ignored because they are not money makers and drain the bottom line of the hospital. Funding the salaries of highly paid specialists who are more richly reimbursed either by insurance or medicare, and funding the CEO's salary become the board's main concern. This is the tail that wags the dog. Money not health quality has consumed the boards, CEOs, and doctors.
Infectious disease departments, once a part of every good hospital, have been closed. Pediatric and neuropediatric services have been down-sized so that persons must travel to university hospitals in distant cities. Psychiatric services have been all but closed due to the drop in reimbursements. Board memberships are a plumb in the veritable cap of society, yet the experience of members is limited to law, fund-raising, and finance. They are run by the old adage: give, get or get off! Doctors serving on the boards are there to save their jobs and save the CEO's salary. And new buildings for administrative offices!
Really it is criminal.
Infectious disease departments, once a part of every good hospital, have been closed. Pediatric and neuropediatric services have been down-sized so that persons must travel to university hospitals in distant cities. Psychiatric services have been all but closed due to the drop in reimbursements. Board memberships are a plumb in the veritable cap of society, yet the experience of members is limited to law, fund-raising, and finance. They are run by the old adage: give, get or get off! Doctors serving on the boards are there to save their jobs and save the CEO's salary. And new buildings for administrative offices!
Really it is criminal.
1
A powerful commentary that those ultimately responsible for hospital care are so frequently disengaged from setting quality standards! Boards have an important fiduciary responsibility, but in health care, good stewardship of shoddy quality rather misses the point, doesn't it? Mr. Frakt makes a fine recommendation here:
"It might also help if more members of hospital boards were trained in clinical quality, as called for by prominent health care quality organizations."
Including health care quality experts on every board of directors is a critical step in assuring that quality is weighed appropriately with financial viability and sustainability. I agree with several others commenting that one powerful mechanism to advance that cause is the inclusion of professional Registered Nurses within every hospital and health system board. Nurses provide a bird's eye view of clinical care, including the element of transitions between providers and services. They have a unique perspective on mechanisms to prevent medical errors, reduce complications, and improve patient safety, as well as improving efficiencies that directly impact the bottom line.
"It might also help if more members of hospital boards were trained in clinical quality, as called for by prominent health care quality organizations."
Including health care quality experts on every board of directors is a critical step in assuring that quality is weighed appropriately with financial viability and sustainability. I agree with several others commenting that one powerful mechanism to advance that cause is the inclusion of professional Registered Nurses within every hospital and health system board. Nurses provide a bird's eye view of clinical care, including the element of transitions between providers and services. They have a unique perspective on mechanisms to prevent medical errors, reduce complications, and improve patient safety, as well as improving efficiencies that directly impact the bottom line.
9
All hospitals in New York are non-profits. The boards are mostly lapdogs for the CEOs, whose primary concerns are their own salary and perks, which in NYC are very high, sometimes $4-5 million. In terms of quality of care, the CEOs and boards talk the talk but don't walk the walk. Nearly anyone who has been a patient or has had a relative as a patient in these hospitals can testify to that. By the way, the big donors to these hospitals are treated visibly differently from the average patient. Not for nothing, the CEOs are often big donors to the political campaigns of the Governor and key state legislators. Quality of care? Somewhere down the list. Cost control? Not on the list.
25
I sat, as chief of staff on a hospital board for four years while the hospital converted from a not for profit institution to a part of a national hospital chain. The nurses and community leaders and clerics that made up the old board were removed and replaced by business people, who although they understood quality in terms of their own business, strictly advocated for a good bottom line. The strings were pulled from hundreds of miles away. The community was rarely considered. How are you going to change that?
31
I have avoided hospital work for over half my nursing career, though initially I loved it. I found hospitals more willing to hire vice-presidents, with degrees in marketing and business, than nurses. There have been several comments about the importance of having nurses serve on boards, and I could not agree more with them. However, the other board members will have to be more willing to listen to the nurses than many doctors have proved interested in doing...
29
Nurses can make ideal board members when it comes to ensuring a strong quality agenda in a health care organization. They can serve as a reality check when important patient centered decisions are being made. Recently, 21 national nursing or health-related organizations have come together to launch the national Nurses on Boards Coalition, which has a goal to put 10,000 nurses on boards of corporate and non-profit health care organizations by 2020. The effort is a direct response to the Institute of Medicine’s (IOM) call in 2010 for nurses to play more pivotal decision-making roles on boards and commissions in improving the health of all Americans. The IOM’s landmark report, The Future of Nursing: Leading Change, Advancing Health, established that strong leadership from nurses is an essential element in transforming health care delivery and improving patient care.
15
Then again, both patients and hospitals(and their staff) have to deal with two elephants in the room, the insurance companies and lawyers. Out here, the big are gobbling up the small at a rapid pace, trying to create larger networks. An independent GP no longer exists as hospitals ensure that any doctor pays for the privilege by being forced to join a network to have any privileges. Hand in hand with this collusion is the state insurance commissioner who gets elected only with the support of big dollars from the insurance industry and makes the rules for their state. Insurers pressure hospitals and doctors, state insurance commissioners kowtow to insurers, and the patient's needs and health care for the public comes in last place. Too many blame the federal government when the real target of their ire should be the insurance industry and their state insurance commissioner.
19
However, in the new world of limited networks consumers don't have much leverage when it comes to the quality of the hospital or the doctors they can use unless they can afford to go out of network and pay the higher costs. In other words, single payer universal access. That would make it possible for hospitals in the United States to meet the same requirements in every state and locality. It might also stop the ridiculous advertising done by many hospitals because the real measurement of how good a hospital is has nothing to do with how well done the ads are: it's the quality of the care and quality and cost are not always related.
15
Our community hospital does have a community quality board, and when asked to join this board, not because of who I know, but as a very experienced registered nurse, because of what I know....and what I care about - quality - I was overjoyed.
I gave the address at my nursing graduation years ago, have a varied resume that many others wouldn't perhaps want, went back to school and drove on old rural two lane highways 40 miles one way in WI blizzards, years ago, with three daughters and a husband at home, and have done more...much more.
But, having been asked to serve on this hospital quality board is the highest honor I could ever expect. I sit with a variety of community leaders. I come out of the meetings feeling respected and encouraged that our board can truly make a difference for our community and other communities who take heed. The director of quality for the hospital is a top notch nurse who presents the good and the bad, detailed and succinct. The hospital CEO urges us to make recommendations to provide opportunities to improve. Together we can forge ahead to do what we can try to do to assure we have a safe hospital with high standards.
Hopefully more and more hospitals will attempt to make these possibilities realities - because you know, health care quality is about reality - real people who all deserve the best.
I gave the address at my nursing graduation years ago, have a varied resume that many others wouldn't perhaps want, went back to school and drove on old rural two lane highways 40 miles one way in WI blizzards, years ago, with three daughters and a husband at home, and have done more...much more.
But, having been asked to serve on this hospital quality board is the highest honor I could ever expect. I sit with a variety of community leaders. I come out of the meetings feeling respected and encouraged that our board can truly make a difference for our community and other communities who take heed. The director of quality for the hospital is a top notch nurse who presents the good and the bad, detailed and succinct. The hospital CEO urges us to make recommendations to provide opportunities to improve. Together we can forge ahead to do what we can try to do to assure we have a safe hospital with high standards.
Hopefully more and more hospitals will attempt to make these possibilities realities - because you know, health care quality is about reality - real people who all deserve the best.
13
Congratulations on this incredible honor. You sound like the perfect, compassionate candidate for the job.
6
Claire
Thanks! From public health visits in the boonies to case managing ICU's in WI largest hospital; from ER staff nursing to working in the schools/Head Start on an Indian reservation; from supervising Rehabs to riding with those afflicted with MS on a bus to advocate for decreasing pharmaceutical costs with state legislators in Madison; parish nursing to camp nursing with the Fresh Air Fund in NY - and even more - I've had so many opportunities and am so grateful. It's been a great ride and I challenge nurses to step out of the usual box, take risks, join a different rank once in awhile - but always, always, always, remember quality!
Thanks! From public health visits in the boonies to case managing ICU's in WI largest hospital; from ER staff nursing to working in the schools/Head Start on an Indian reservation; from supervising Rehabs to riding with those afflicted with MS on a bus to advocate for decreasing pharmaceutical costs with state legislators in Madison; parish nursing to camp nursing with the Fresh Air Fund in NY - and even more - I've had so many opportunities and am so grateful. It's been a great ride and I challenge nurses to step out of the usual box, take risks, join a different rank once in awhile - but always, always, always, remember quality!
8
Boards are ultimately accountable for the care delivered in the organization, and they should know about the institutional weaknesses as well as their strengths. Often board get sanitized reports from the hospital's executive staff. The information shared should be the good and the bad about the quality of care in the organization as well as opportunities to improve care. Too often the clinical side is not represented by nurses who are the people who deliver care and are accountable for that care. Let's put knowledgeable nurses on Boards where they belong with their physician colleagues as voting members.
11
A decade ago mergers and acquisitions were the prime work of hospital boards. Today it is reducing hospital re-admissions to avoid costly penalties. The drivers for reducing costs in health care today are quality and safety. Who better knows quality and safety in delivery of care than NURSES. A nurse should be present on every hospital board across the country to bring a unique and balanced perspective to the table.
37
Have you ever listened to how doctors treat nurses? Hospitals are more interested in keeping the number of registered nurses down because they cost too much. I doubt that the board of a hospital interested in having the latest and greatest technology is going to value the opinion of someone who didn't go to medical school no matter how valid their points are.
6
They certainly value the lowly MBA (two year degree) of the CEO and pay them huge salaries when many nurses also have Master's degrees in various fields (but pay is strictly on years of licensed experience.)
It is the easiest educational route to wealth and status to be a hospital CEO. The hard part is being tall enough, smooth enough and well connected enough to be selected for the role.
It is the easiest educational route to wealth and status to be a hospital CEO. The hard part is being tall enough, smooth enough and well connected enough to be selected for the role.
2
This article makes compelling points; however, it is important that nurses begin playing a larger role in the boardroom to ensure high-quality patient care is a priority. There are approximately 3 million nurses in the U.S. today with projections of continued growth over the next several years. In addition to growth in numbers, the nursing workforce is also experiencing a growth in responsibilities. Today, nurses are expanding their roles in the health care system by serving as partners on interdisciplinary health care teams, providing health promotion services, and helping patients transition out of hospitals. In addition, advanced practice registered nurses (APRNs) are providing primary care in nurse-led clinics, many without physician supervision. However, this growth and influence is not reflected among hospital boards. In order to ensure sustaining changes in healthcare, more nurse leaders must be brought to the table.
3
The shortage of nurses serving on boards contrasts the fact that nurses comprise the largest segment of the U.S. health care workforce—3 million strong. More than any other health care provider, nurses bring the perspective of the patient. They are on the frontlines in making sure care is delivered safely, effectively and compassionately. With federal health care reform, health care providers are in the midst of reworking care delivery to make it more accessible, accountable and affordable, while putting an emphasis on prevention and primary care. Nurses already play a huge role on the frontlines. It’s time they begin playing a role in the boardroom too, bringing both their practical sensibilities and view of patient care experiences to the table.
17
Frakt makes an excellent point in his piece on the responsibility that Boards have in the delivery of quality health care. The intentional inclusion of registered nurses on hospital boards would go a long way to creating a culture of quality. The largest health care workforce in the nation, registered professional nurses can add a perspective on quality that lay board members and other members of the health care team may not have. Over 3 million strong, we understand systems, quality processes and safety. Consumers who are looking at hospital boards to assure quality care would do well to seek those facilities that utilize registered nurses on their Boards.
8
There is a lot of blowback in these comments about more power for nurses. In the for profit corporation owned/run hospitals that I have worked in some nurses have plenty of power. Going from CNO, to COO, to CEO has not been uncommon. The CNO ran our hour long AM quarterly board meeting and ran thru an agenda herself that took up the whole hour. There was no time in the agenda for discussion, questions, or debate. The prominent business people and the physicians on the board sat and listened for an hour and rubber stamped everything. If you are a nurse and want more power, you can do it but you will have to be willing to pay only lip service to quality of patient care and play ball like everyone else running the hospital.
Dysfunctional attempts to measure "quality" and "pay for performance" neglect the fact that what is "quality" to one person may not be "quality" to another - - what performance is better for any given individual patient depends on the patient. Hospital CEOs and Boards should never have responsibility for "quality" and never be paid more than the lowliest physician who actually sees patients is is responsible for quality.
9
Checkout the laws regarding hospitals in Georgia. Incomplete article. In Georgia, Hospital Authorities are the governing boards and there is a monopoly in any county. A waiver of that monopoly is granted only by state legislation. A couple of other other states have that methodology, Leads to non-competitiveness, nepotism, and just plain fraud. No one can just come into town and start a new hospital and compete. Unless it is owned by one physician. Hospital Boards often do stupid things. Never seen the need for them.
6
The board members also have a ethical and moral responsibility to regulate their chargemasters, the far too arbitrary pricing mechanisms each hospital creates to "fundraise" from their patients.
The #1 reason for personal bankruptcy in America is medical bill related, and out of those who filed the majority had insurance. "Fundraising" on the backs of the individuals hospitals are designed to serve tramples upon the notion of "First, do no harm."
The #1 reason for personal bankruptcy in America is medical bill related, and out of those who filed the majority had insurance. "Fundraising" on the backs of the individuals hospitals are designed to serve tramples upon the notion of "First, do no harm."
33
Indeed! In each of the three treasured Harvard hospitals, physicians have discriminated and retaliated against three prominent physicians. The activities were illegal and social, not medical. Yet, the boards believe the doctors must be right and don't recognize their ethical and moral responsibilities. The nasty and illegal behavior is hidden -- not unlike pedophilia in the Church -- trusted male, traditional male hierarchy, hidden evil, supported by the system.
The abdication of moral responsibility of hospital boards permits this violation of women's civil rights.
As Jimmy Carter says:
"The world’s discrimination and violence against women and girls is the most serious, pervasive, and ignored violation of basic human rights."
The abdication of moral responsibility of hospital boards permits this violation of women's civil rights.
As Jimmy Carter says:
"The world’s discrimination and violence against women and girls is the most serious, pervasive, and ignored violation of basic human rights."
1
I disagree with Ms O'Leary. What a hospital charges is so close to meaningless its amazing. If you have a high deductible insurance plan and therefore a large bill to pay, your responsibility is based upon your insurance contract, not the amount charged. The amount charged has all ready been discounted down to the insurance company's fee schedule. Everyone else is suppose to have Medicaid (and the patient will almost always owe zero) or Medicare, and the patient will once again be charged based upon the Medicare discounts - not the charges.
Almost all inpatient payment methodologies are all-inclusive. If the reimbursement contract calls for a payment of $2,300 then the charges can be $2,500 or $200K but the payment remains the same. Differences in how long you may stay (or if the treatment was actually effective) rarely matter at all. This is why the hospital is constantly pushing on the Doctor to discharge you no matter what. The best financial outcome for a hospital is when a patient is admitted for a complicated diagnosis and then dies quickly - before they've had a chance to expend resources. Medicare got this all started in the 80's.
The real issue about medical bankruptcy revolves around how a hospital collects self pay accounts and how it determines indigence. If a not-for-profit hospital isn't trying to qualify its needy (or near needy) for assistance from its donors then the IRS should have at them.
Almost all inpatient payment methodologies are all-inclusive. If the reimbursement contract calls for a payment of $2,300 then the charges can be $2,500 or $200K but the payment remains the same. Differences in how long you may stay (or if the treatment was actually effective) rarely matter at all. This is why the hospital is constantly pushing on the Doctor to discharge you no matter what. The best financial outcome for a hospital is when a patient is admitted for a complicated diagnosis and then dies quickly - before they've had a chance to expend resources. Medicare got this all started in the 80's.
The real issue about medical bankruptcy revolves around how a hospital collects self pay accounts and how it determines indigence. If a not-for-profit hospital isn't trying to qualify its needy (or near needy) for assistance from its donors then the IRS should have at them.
2
How can you live in Texas and make the statement "Everyone else is supposed to have Medicaid"? Gov. Abbott and the TX legislature are determined to allow no one in TX to have Medicaid.
5
Good article. And since quality goes hand in hand with public image it's not a leap to say boards should be stewards of the hospital brand as well. But many don't understand marketing or customer service to the degree they should.
6