Center for Healthcare Governance - Monographs 2008

2008- Putting Quality First: How Boards Can Make Quality Improvement a Higher Priority

Overview:
Boards shape priorities in many ways, but primarily by telling the CEO what's most important.The formal process boards use for this is performance management-goal setting, feedback, performance appraisal, and pay-for-performance.The informal process includes a wide range of interactions, such as setting agendas for meetings, discussing priorities and performance in board and committee meetings, providing informal feedback, asking how performance can be improved, and questioning how proposed operational changes will affect performance.

Boards shape priorities both intentionally and unintentionally. If the first question about a proposed change is how it will affect financial performance, if the incentive plan pays awards only if the budget has been met, or if financial performance is weighted more heavily than other measures in the incentive plan, it signals an overriding concern about profitability. If instead, the first question about a proposed change is how it will affect quality, if board meetings devote as much time to patient safety and quality as to financial performance, and if pay-for-performance depends as much on quality as on financial performance, it signals an overriding concern about quality.

One of the best ways to put quality first is to build it into every facet of the formal performance management process-the job description, the performance appraisal, and the incentive plan. Most hospitals now tie a portion of incentive opportunity to quality improvement, and most job descriptions give lip service, at least, to the CEO's accountability for clinical quality improvement. But job descriptions, performance appraisal, and incentive plans rarely put as much emphasis on quality improvement as on financial performance.

This publication shows boards how to put quality first in all aspects of the performance management process. It gives practical tips on setting good goals for quality improvement, evaluating performance, and rewarding improvements in quality. It gives boards practical suggestions for promoting quality improvement, using processes boards have always used to shape priorities and guide performance. It also reminds boards to use informal approaches, as well, to making quality improvement a higher priority.This publication also includes several tools and resources, such as the box titled Quality Improvement in Action on pages 4-6, to help boards apply the ideas and suggestions included here to improving quality in their own organizations.

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