Constant change, the increasing complexity of healthcare organizations, and the growing expectations for board effectiveness all demand that new board members get up to speed quickly. Many of our clients are refocusing their attention on the new member orientation process -- making it more structured, beefing up the content and extending it over the new director's first year.
What should go into an orientation process? We've added two new Best Board Practices Checklists to the Great Boards' website, one on the orientation process and a second on what goes into an orientation manual. See them both at http://www.greatboards.org/resources/.
Subtitled "The Truth Behind America's Terrifying Epidemic of Medical Mistakes," Internal Bleeding sounds like an uninformed polemic against hospitals' and doctors' negligence. Instead, it's thoughtful exploration by two emergency physicians from University of California, San Francisco, about why mistakes happen and what can be done to prevent them.
This book is an outstanding primer for non-clinicians, especially those serving on board quality committees, about how medical errors happen, the complexities of clinical care, and how the culture of hospitals and medical practice cast a net of secrecy that inhibits identification and frank exploration of how to prevent similar errors in the future. Physicians will learn as well what it takes to create a culture of safety and "hard wire" hospital systems to deliver safer care more consistently.
After reading case histories -- of the procedures done on wrong patients, the incorrectly marked drugs, the misdiagnoses, the ill-prepared medical students and residents, and the non-communication among caregivers -- board members will be better prepared to understand the quality and patient safety information they'll address.
Internal Bleeding is available for $19.97 at Amazon.com and other booksellers.
If you missed it, the Spring issue of Great Boards is online with articles on what boards need to know about the Joint Commission's shift to unannounced surveys and best practices for engaging a board in the strategic planning process. Download the entire issue at http://www.greatboards.org/newsletter/.
BUILDING BETTER BOARDS. A governing board can define its role according to one of five levels of engagement, ranging from passive oversight to active involvement in a company's strategic planning and operational decision making, says an article in this month's Harvard Business Review. David A. Nadler, chairman of the management consulting firm Mercer Delta, writes that boards benefit from a candid self-assessment in which they identify their current and desired levels of engagement, and then develop a plan to remedy any gaps.
Built on his firm's work with corporate boards such as Medtronic and Target, Nadler offers a board-building methodology and useful insights into what makes boards effective. For example, he discusses the value of a competency assessment to identify recruitment needs, and he describes how directors can get first-hand information, unfiltered by management, about company operations. (For example, GE and Target directors are required to periodically visit company facilities unaccompanied by senior executives.)
See the full story in the May issue of Harvard Business Review. HBR also has packaged the Nadler article with two others on board culture and stakeholder connectedness -- "What Makes Great Boards Great" by Jeff Sonnenfeld and "The Board's Missing Link," by Cynthia Mongomery and Rhonda Kaufman.
The article, or the set of all three, make for good reading before a board self assessment process or board retreat. To order, go to www.HBR.com and type "Better Boards" in the search box.
Another reminder of that came this month in Georgia, where the Atlanta Journal-Constitution used publicly available data from the Internal Revenue Service to publish the compensation of not-for-profit hospital and system executives in the area. Singled out by the story: one Atlanta CEO whose salary topped $965,000 plus a one-time bonus of $1 million. The bonus represented an accrual of payments over a number of years, a hospital spokesperson said, defending the amounts as "approved by a national compensation firm." No board representative was quoted, and the hospital's web site is silent on the subject.
Would your board be ready to defend your CEO's compensation?
For the story, go to http://www.healthleaders.com/news/newspage1.php?
contentid=54634.
For tips on board oversight of executive compensation, see the article by Dan Fairley of Clark Bardes in the August 2002 issue of Great Boards -- it's at http://www.greatboards.org/newsletter/2002/august/
GB_August_Good_Business.PDF.
We've been watching this issue because if the California law is perceived to work, other states may follow suit -- especially those with strong nursing unions. See the story at http://www.bizjournals.com/industries/health_care/industry
_regulation/2004/05/10/sacramento_story1.html.
If that's so, then some new planks on the platform were set afire last week.
A report released by the Robert Wood Johnson Foundation found that of the nearly 44 million uninsured Americans, 20 million have jobs but lack health coverage. The ranks of uninsured grow as premiums rise, more people have part-time jobs without health benefits, and small employers either drop costly coverage or boost what workers must contribute to insurance premiums. Data from the U.S. Labor Dept. show that in 1992-93, only 54% of employers required workers to contribute to single person coverage; in 2003, 90% required workers to contribute. Employees' share of premium costs rose 56%, while their average deductible jumped from $131 to $228 a month.
In six states, at least one in five working adults are uninsured, and in 38 other states, at least one working adult out of every 10 does not have health insurance. The study had broad support from a coalition of business, labor, and healthcare organizations including the AHA.
Another report from the Kaiser Family Foundation pegs the uncompensated costs of caring for the uninsured at $40.7 billion a year which must be absorbed by hospitals and physicians providing safety net care and is partially offset by public funds, including Medicare disproportionate share (DSH) payments. What would it cost to expand health care coverage to include the uninsured? Because the use of health services would increase, the foundation estimates it at $48 billion a year. That's a big number -- until it's put in perspective. It's 3% of total spending on personal health, 6.5% of current spending by Medicare and Medicaid plus current subsidies for private health insurance. And it would increase the share of the GDP going toward healthcare by 0.4%.
Both President George Bush (at http://www.georgewbush.com/HealthCare/Brief.aspx) and Sen. John Kerry have offered healthcare reform packages in recent weeks to expand coverage for the uninsured. The platform is heating up -- and trustees need to be involved in advocacy efforts.
To background your board, you'll find these reports and more at http://covertheuninsuredweek.org/.
Davidson urged hospitals to "talk more about the work we do than the business we're in...and follow up that talk with action." The message is important for boards because they are the formal connection between a hospital and its stakeholders. Hospitals need to be proactive in communicating their round-the-clock preparedness, uncompensated community services, and contributions to the local economy.
U.S. hospitals contribute more than $1.3 trillion to the nation's economy, according to a TrendWatch report released at the AHA meeting by the Lewin Group. Hospitals employ nearly five million people, rank second as a source of private sector jobs, and directly or indirectly support one of every nine jobs in the U.S., says the report, which details the economic and societal contributions hospitals make to communities and states.
At a press briefing on the report, West Virginia Gov. Bob Wise noted that 19 of the top 100 private employers in his state are hospitals, and Joe Krier, president of the San Antonio (TX) Chamber of Commerce, said one in every seven workers in that city is employed in health care. Sandra Bruce, president and CEO of Saint Alphonsus Regional Medical Center in Boise, ID, said her hospital contributed $53 million in community service benefits in the fiscal year ending last June 30, including patient care, patient and community health education, and other services.
"Hospitals are more than a place where you go to get well... Hospitals truly are the cornerstone of the community," said AHA Executive Vice President Rick Pollack. The report can be found at www.hospitalconnect.com/aha/press_room-
info/specialstudies.html.
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Barry S. Bader, Bader & Associates
12225 Seline Way, Potomac MD 20854, 301-340-0903
www.GreatBoards.org *** bbader@GreatBoards.org