Engaging your board is a must: Here's how

You know just how complex your job is. How can you get your board on board with quality and not overwhelm them?

Susan L. Cresswell, MHA, CPHQ, director, quality resources at Providence Medford Medical Center in Medford, OR, says she gives her a board a foundation. When new members come on board, she has an orientation for them in which she explains the various regulatory agencies and public reporting data sources. They might not understand, for instance, why the hospital is paying The Joint Commission for accreditation.

"We kind of give them the historical background so that they understand why we're using The Joint Commission and how that relates to our local state department of health and that they come in for surveys as well as for patient complaints," she says.

She also shows them where publicly reported data are shown. "I think the show and tell is really important. If they don't see it, they don't realize the impact of it actually being out there on the web," she says.

Then, once the board has that foundation, she tries to keep their reports at a higher level and classifies things as green, yellow, or red. So if the hospital is working on hand hygiene, green signifies that the hospital may not be at a 100% but there is an action plan in place, no barriers have been identified, and the initiative is progressing or the standard is being met. Yellow signifies that there is a problem and the QI team may have had to go back to the drawing board and rework its action plan. Red signals there are issues or barriers that have not been addressed yet.

She says the board is a community board that doesn't have much fiscal responsibility, so one of its main charges is quality. She sits on the board as a quality director and runs a monthly report. In that, she provides the national benchmark for the measure at hand and then the hospital's performance. "I think giving them the benchmark instead of just a target is very important because then they can relate our organization to other organizations, and once again, the more that they can put things into a more regional or national perspective, the more engaged they become," she says.

She doesn't include everything but focuses on the QI priorities. "We try to keep it focused on what our priorities are. We always keep them updated on grievances because. . . Medicare states, particularly in the Conditions of Participation, that the board has to have a role in that."

The board has delegated the responsibility to the quality improvement committee, which in turn produces a report that looks at the timeliness of response to grievances and how many grievances have been received within the median time rather than the average. "We produce the report for them that looks at timeliness of response to grievances and how many did we get within the median time. We look at the median time rather than the average because if you have one complaint that for some reason has a real long time frame to resolve and may go outside policy range etc., that one may skew the average. We tend to look at the median time to response and see if that's within the time frame that's required in our policy."

She also informs them about core measure performance. She tries to keep the level of data high. For instance, if she were reporting on throughput, she wouldn't include time frames such as from time of admit to time into the ED. "We're going to look at the total turnaround time," she says.

Avoid using acronyms

"I would say that I think the most critical thing in engaging your board is communication and it's an ability to take the scientific and put it into a layperson's language," she says. One thing she knows confuses her board is acronyms such as DRGs, AMIs, CoPs.

"Part of their orientation is we give them an Excel spreadsheet that's got over 300 acronyms that are commonly used in health care. They get a big laugh out of that. But whatever report we give them, we always make sure we give them the full name and then we'll put the acronym in parentheses so we can use it to refer to in the discussion," she says.

Kathy Helak, RN, MSN, administrator, clinical performance support at Henry Ford Wyandotte Hospital, finds that acronyms frustrate and confuse her board as well. "The first thing you have to do is be disciplined enough to get rid of the acronyms, get rid of the abbreviations, and put the information that you're sharing in terminology that others will understand. I think that's difficult oftentimes for the medical staff to do with the board, and so I think it becomes really critical that the people in my type of position who are actually providing the information and oftentimes generating the presentation for people to respond to. That's something you have to be very cognizant of."

The second most important thing, Helak says, is to "be very clear on whatever you're talking to the board, what is it in it for them, and what you expect them to do with the information. And sometimes it's informational and sometimes it's decision making that you need. So I try to go with some guidance from the board of trustees quality committee chair. What is it that they feel is important to report up to the full board? So that's always one thing I look at."

She also looks at what her CEO feels is important for the board to know, "especially if it relates to anything from a regulatory or governmental perspective. For example, things that are going on with the hospital's accreditation. It's coming up, they're here, here were the deficiencies, here's our action plan. So that's always something that's important."

A sentinel event signals the need for "an automatic report, and so we work together and complete our root-cause analysis and so forth in a timely manner so we can report that up. But that's another absolute that if that occurs, we report that."

Cresswell tries to give the board a synopsis in lay language of whatever issue is on the table. "They don't remember necessarily from month to month. So if we're looking at the AMI readmission rate we'll have a little paragraph that says we're looking at readmissions for patients who suffered a heart attack. We want to know if we gave them the appropriate discharge instructions, etc. So [the report tells them] here's what the issue is and here's why it's important to us in lay terms. And then that frames up for them the whole report about that particular item," she says.

One of the board members sits on the quality improvement committee and becomes a part of the discussion of prioritization of tasks. So that individual can speak up at the board meeting. "I come to the board with the report and I give the report but then that individual can chime in to say, 'Yes, that was a very lively discussion and here's my perspective on why the hospital chose this' or 'I feel comfortable that even though we aren't performing as well as we want to in this particular area, I actually heard that team report out and I think that where they're going is appropriate,'" Cresswell says.

Another thing she says is important is making the quality report interesting. "Sometimes that means kind of telling the story and explaining to the board members, if we're working on throughput, well what does that mean to an individual patient? Well, what that means is that if your mom comes in and we decide she needs to be admitted for observation that she's not going to be sitting down in the emergency department maybe not getting as much attention as she could or would if we got her right up to the floor. So sometimes it's personalizing it for them... I think that's really where you get your biggest bang for the buck with them is if you can connect with them on their level. "

You know you've got them if...

"Too many times, I've seen reports given and it's so high level, their eyes just glaze over. They're not paying any attention," Cresswell says. "So if I start getting questions from them then I know I've been successful. Because they aren't going to ask a question unless they feel somewhat comfortable that they aren't going to appear stupid. So if they ask me questions, that to me means they've got some basic level of understanding of what I've presented and they feel confident and comfortable enough to be able to ask me about it and to solicit more information. Where if I don't get any questions, sometimes I think I went over their head."