While we have spent a lot of time here and in the media in the last few days and weeks discussing the merits of public disclosure of hospital infection rates and other quality metrics, we have neglected discussion of the role of a hospital's governing body in holding the medical and administrative staff accountable for patient safety.
Back in February, I talked about the role of the hospital's board of trustees in governing safety and quality. The board does have final authority for these matters under state law. How it should do the job is not specifically set forth in the law. A lot of what I presented in my February posting was suggested by an external review committee we had retained for BIDMC to evaluate our safety and quality programs.
One member of that review committee was Jim Conway, former COO of Dana Farber Cancer Institute, and now working at the Institute for Healthcare Improvement and teaching part-time at the Harvard School of Public Health. Jim recently had an interview with an organization called Great Boards. It is well worth reading, and I link to it here.
As I read through his recommendations, I see that we have implemented some of them, but some items are left to be done. For example, over 25% of our board meetings are devoted to these topics, and we present specific cases of where we have done harm to patients and what we have learned and changed as a result. In October, we are holding a two-day board retreat focused solely on this topic. Our board members will participate in on-site visits of patient care areas -- talking with doctors, nurses, transporters, and others -- will review Jim's recommendations and others, and then they will decide how they want to govern quality and safety at BIDMC going forward. I know that similar discussions are taking place at several other hospitals in the region.
But here's a question for the public debate: Should the state DPH, which has authority over public health matters, or the Attorney General, who has supervisory authority over public charities, require some certification of board of trustee training in safety and quality matters? We could not imagine a doctor or nurse being permitted to serve the public without training. Should board members who have the statutory responsibility for patient welfare also be required to meet some minimum level of competence in this regard? I am not suggesting they would need to have the technical depth of MDs or RNs, but perhaps they should be required to have a working knowledge of the governance issue surrounding quality and safety.
What do you think?
