Excerpt from the Compass Clinical Profile in Healthcare Leadership “Building a Will to Quality,” featuring Maureen Bisognano, CEO of The Institute for Healthcare Improvement (IHI).

Compass Clinical Consulting(CCC): Is there a role for the Board to initiate higher emphasis on clinical quality – or is it strictly the CEOs role to lead on this issue?

Maureen Bisognano (MB): Absolutely. The Board can help initiate a higher emphasis. A lot of it is having this conversation in a non-blaming context. When Board members talk to me, they often say—when they are at social even their towns or cities—they hear all of the negative stories. All of their neighbors and the people at the cocktail parties will come up and say,
 
“I couldn’t get access to the Emergency Department in less than four hours.”
or…
“I had a complication after my surgery.”
 The Board tends to feel in a very defensive mode when trying to protect the hospital’s reputation in the community. At the next Board meeting, instead of coming from a defensive mode asking the CEO,

“How could you have disappointed me in this way?”

… the Board should try a more inquisitive, non-blaming approach.

 “How can I support the CEO in making the needed improvements, or in declaring that we have vulnerabilities?

It’s only when that happens—changing the context of the conversation—that the kind of process changes we’re talking about can really happen.

CCC: If I am an active Board member, how do I make sure that we balance the quality agenda? To make sure quality is considered just as important as other different priorities within the organization? How do I push the organization to get the right kind of indicators in front of the Board to make sure that we are monitoring the things we do?

MB: You raise an important question. It can be difficult sometimes because it makes people get out of their comfort zone. Here’s an example of how one organization did it.

I was working with a hospital that had been focusing on decreasing birth trauma in newborns. What they found is that there were still some obstetricians who were delivering women electively before 39 weeks, which can produce greater harm for infants. The physicians all had good reasons why they were doing it, and they just kept pushing everybody away who was trying to create a solid line at 39 weeks.

The CEO knew he was in a precarious spot. When he put a firm line down and said, “We won’t do elective C-sections before 39 weeks,” he knew that some physicians were going to walk out and go to another hospital, which in this case they did. That meant that the hospital’s volume of deliveries was going to drop and that there was going to be discontent in the OB unit.

So the CEO and the Chief of Obstetrics went to the Board and talked about what they thought needed to happen.

They had to really get deep into the clinical aspects of why you don’t deliver before 39 weeks, because it’s a change in practice. Many of the Board members had elective caesarian sections or were married to someone who had. So, they walked them through a clinical conversation about what we’ve learned about the issue. And then they stated their position to the Board. It was a change that had to be made. They needed to stand up for what was right even if it meant some physicians would leave.

 That approach turned out very well. The Board eagerly leaned into the conversation to learn more. They had to make a value judgment about what was right and what was wrong. Were they going to accept substandard clinical performance, which was risky for patients? Or were they going to say, “Well, that’s not my job; that’s your job to decide?”

In the end, they all came together in support of the CEO and said,

“We’re going to do this. It’s the right thing to do.”

And it was. And is.

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