Best Practices Survey. The Governance Institute has taken a new tact in its just released 2003 survey of hospital and health system boards. Besides surveying tangible artifacts such as board structure, size, makeup, and meeting frequency, the new survey probed the extent to which boards are following widely recommended practices. Some best practices aren't in as wide use as they should be: 65% of boards don't require the CEO to have a current succession plan in the event of an unexpected vacancy; 49% don't adopt an annual education plan or have a budget line for board development; and 35% don't periodically commission a study of community needs. The 54-page, 2003 survey report is a good board development tool, and is available for $39 each by calling 858-909-0811 or online at www.governanceinstitute.com.
Quality Improvement Success Story. Looking for a good case study in quality improvement for board and physician education? The Institute for Healthcare Improvement reported recently on a successful initiative that reduced ICU mortality 32 percent at one facility. It's long been known that elevated blood sugar levels reduce the body's ability to fight infections and increase morbidity and mortality. At St. Joseph Health Center in St. Charles, MO, physicians agreed to institute and aggressively monitor a protocol to control the blood sugar level of all ICU patients, not just diabetics. Filippo Ferrigni, MD, FCCM, director of the Intensive Care Unit and vice president of clinical affairs, called his hospital's new insulin protocol a "no-brainer." But that doesn't mean it was eagerly embraced when first introduced two years ago. It took a concerted effort of using data to convince physicians and nurses the protocol was the right thing to do. St. Joseph is part of SSM Health Care, last year's winners of the Malcolm Baldrige National Quality Award. For the full story go to www.qualityhealthcare.org , and under Topics, click on Patient Safety, Medication Systems, Improvement Stories, and then on " Reducing Mortality Through Aggressive Blood Sugar Control at SSM Health Care."
Building a Quality Culture. Many hospitals are working hard to build a culture of quality and safety among their staff. In an article in the December issue of the Quality and Safety in Health Care journal, quality guru Donald Berwick recommends new strategies for developing the health care workforce that will accelerate improvement by harnessing the imagination of workers. This shift, he says, will require a high degree of trust, a bias toward teamwork, and a predilection toward shouldering the burden of improvement, rather than blaming external factors. Find the article at http://www.qualityhealthcare.org/NR/rdonlyres/D356BFDC-
F9FF-4581-83B8-59AC21846235/0/BerwickImpTrustHlth.pdf. The IHI web site also has some useful culture-building tools, such as a Safety Climate Survey and recommendations for conducting Patient Safety Leadership Rounds. Go to http://www.qualityhealthcare.org/QHC/Topics/
PatientSafety/
Time to Revisit Billing Policies. Hospitals have taken a beating in the media recently because many have billed uninsured patients – including those least able to pay – their highest charge rates while health plans and employers got generous discounts. Hospitals say they fear discounting charges to individuals could violate federal anti-kick back rules, and the American Hospital Association asked for clarification. Now, the federal government has responded and clarified its rules, paving the way for hospitals to assist patients in financial need. This is a high visibility issue with legislators and communities, and hospitals have a window of opportunity to improve their image. Boards and Finance Committees may want to look at their hospital's current practices and see if changes are in order. For more information, go the HHS statement at http://oig.hhs.gov/fraud/docs/alertsandbulletins/2004/
FA021904hospitaldiscounts.pdf, and to AHA's web site at http://www.hospitalconnect.com/aha/key_issues/bcp/.
Billing policies cost hospital its tax-exempt status. A large Catholic hospital in Illinois lost its tax-exempt status when local authorities concluded its aggressive collection practices, including suing patients who wouldn't pay, isn't consistent with being a charitable institution. Provena Covenant Medical Center, a 270-bed hospital in Urbana, will have to pay $1 million in property taxes. In defense, Provena says it provided $2.9 million in charity care last year and lost $700 million overall. With states and localities strapped for monies, it's likely other not-for-profits will face similar challenges. For more, read the Wall Street Journa's story at http://online.wsj.com/article/0,,SB10771414272793
3052,00.html
Anti-trust risk grows. Systems that resulted from local hospital mergers are carefully watching events in Illinois where the federal government has challenged a merger consummated in 2000. The Federal Trade Commission filed its first anti-trust challenge to a hospital merger in six years, charging that the union of three hospitals into Evanston Northwestern has, contrary to pre-merger promises, increased prices and restrained competition. FTC is also studying mergers in several more markets, and could re-open other mergers if it gets an early victory in court. For more on the issue, see http://www.ftc.gov/opa/2004/02/enh.htm .
GREAT BOARDS NEWSLETTER. The Winter 2004 issue of the Great Boards newsletter is available at www.GreatBoards.org . It includes in-depth reports on lessons learned from hospital board mergers and strategies for becoming an employer of choice by respecting and investing in employees. Go to http://www.greatboards.org/newsletter/2004/winter/
winter2004_greatboards.pdf.
For the next issue, we're working on stories about what's really behind the new JCAHO standards and how "one page business plans" allow organizations to align strategy and operations – plus a best practices checklist to assess your board's involvement in strategic planning.
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Barry S. Bader, Bader & Associates
12225 Seline Way, Potomac MD 20854, 301-340-0903
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