Is there evidence that getting the board on board will make a difference in the quality and safety of care?

Even as committed as physicians are to improving the quality and safety of care, it is perfectly logical for them to ask whether it is really “worth it” for them to help get their institutions’ boards on board to promote the quality and safety of care.  A recent landmark study may provide at least an early answer to this important question.

Researchers from the University of Iowa, the Center for Medicare and Medicaid Services (CMS), Care Science, Inc. and the Wharton School of the University of Pennsylvania administered a short Web-based survey of hospital leaders in 2005. The group also consulted with Solucient, the National Committee for Quality Healthcare and eight hospital associations in the preparation and administration of this Executive Quality Improvement (QI) survey.

In particular, the survey examined hospital QI drivers and impediments, quality reporting methods, board and physician participation in QI and the use of senior executive incentives to support QI. A total of 413 hospitals from eight states including Arizona, Colorado, Illinois, Iowa, New Jersey, New York, Pennsylvania and Wisconsin completed the survey. Among other things, the study examined whether leadership involvement in QI (especially of the Board and CEO) was systematically related to observed hospital outcomes, as tracked by the Care Science Quality Index. This is an inpatient quality rating system based on compiling risk-adjusted measures of morbidity, mortality and medical complications into one overall index score. Professionals from Penn’s Medical and Wharton Schools spent many years developing this index with leading hospitals.

Results showed that better quality index scores are associated with hospitals where the board:

(1)     Spends more than 25 percent of its time on quality issues;           

(2)     Receives a formal quality performance measurement report;

(3)     Bases the senior executives’ compensation in part on QI performance; and

(4)     Engages in a high level of interaction with the medical staff on quality strategy.

Better quality index scores were also associated with the chief executive officer being identified as the person with the greatest impact on QI, especially when identified as such by the top hospital QI executive.  Those hospitals are more than three times as likely to be in the top third of the quality index distribution as in the bottom third. Vaughn, T, Koepke, M, Kroch, E, Lehrman, W, Sunil, S, Levey, S, Engagement of Leadership in Quality Improvement Initiatives:  Executive Quality Improvement Survey Results; Journal of Patient Safety. 2(1): 2-9; March, 2006

Although this is only one study, it is a significant one. Its results are based on the strong systematic associations found between boards taking the leadership on safety and quality and actual, measurable improvements in patient outcomes. In the brave new world of value-driven health care (see the previous issue of Risk Review), such differences in quality index scores may well mean the difference between future success and failure (for hospitals and their staff physicians). This greater financial success will be in addition to the decreases in potentially compensable events from a medical liability perspective likely to occur in these hospitals whose boards drive safety and quality.