Governing in the New Quality, Safety Landscape

By Jamie Orlikoff

Increased governmental and public pressures to improve healthcare quality and safety during the past decade have translated into reduced reimbursements for hospitals that fail to deliver. The Centers for Medicare and Medicaid Services (CMS) was in the vanguard when it announced hospitals that did not report performance results on specific quality measures would see a decrease in Medicare payments. CMS went further and identified eight never events—serious and costly errors that should never happen in the delivery of care—that it would not pay for if acquired by a patient during a hospital stay.

The list of never events is now at 11 and will continue to grow. Further, private payors are following CMS’ lead, refusing to pay hospitals for care associated with these and other never events. These trends signal a necessary shift for hospitals and their boards and indicate a rapidly rising bar for quality and safety. The level of hospital quality and safety that used to be acceptable will no longer pass muster, and the level of oversight for quality and safety that boards used to provide is, likewise, no longer acceptable. Hospital boards are usually comfortable overseeing financial, planning and other business functions.

Trustees often come from business backgrounds outside of healthcare and are familiar with performance measures such as days cash on hand or debt service coverage ratios, which are commonly used to evaluate financial performance across many industries. They are less confident, however, when asked to oversee healthcare quality and safety performance—a task that involves understanding and interpreting a host of measures and indicators specific to the delivery of clinical care and service, the core business of a complex industry about which most board members know relatively little.

Continual, in-depth education is needed for trustees and boards to effectively oversee hospital quality and safety in today’s environment. The American College of Healthcare Executives’ Policy Statement on “The Healthcare Executive’s Role in Ensuring Quality and Patient Safety” states that a critical step on an effective quality journey is for boards to be equipped with tools and information needed to provide appropriate oversight of patient safety and quality.

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