Hospital trustees shift their focus to medical safety
Hospitals increasingly are expecting volunteer trustees to go beyond the role of community boosters and tackle an imposing medical issue: preventing errors that lead to patient injuries and deaths.
Trustees traditionally have used their positions on hospital boards for social networking with other business executives and raising money through events such as fashion shows and golf tournaments. But expanding the scope of their responsibilities and time commitment is seen by hospital officials as key to improving patient safety because it would focus more attention on flawed policies and procedures that lead to mistakes.
Infections, prescription errors, mistaken identity, and a host of other problems lead to tens of thousands of needless deaths in hospitals nationwide. The federal Institute of Medicine estimated in 1999 that up to 98,000 Americans die annually because of medical errors in hospitals.
"Board seats in American hospitals have traditionally been relatively honorific positions," said Donald M. Berwick , chief executive of the Institute for Healthcare Improvement , a Cambridge nonprofit that is considered a leader in national efforts to reduce hospital errors. He said it is time for hospital boards of directors -- along with executives and physicians -- to "rise from slumber and view safety as an urgent matter."
Doctors caution against volunteer board members delving too deeply into areas that require medical expertise, but they generally support the increased focus on safety. Greater involvement can help board members recognize that safety improvements require more resources and better technology, they said.
"We don't want them micromanaging, but it promotes an interaction between the board and the medical staff that we would like to see happening," said Dr. Kenneth R. Peelle , president of the Massachusetts Medical Society , which represents 18,000 Massachusetts doctors.
Until the last several years, individual hospital boards in Massachusetts and other states had not paid much attention to the issue of preventable deaths, leaving oversight to doctors and administrators. Now, national and local conferences that encourage greater trustee involvement have been packed, healthcare executives say.
Katherine E. Putnam is among the new breed of hospital trustee that is being asked to investigate mistakes such as medication mix-ups or the amputation of the wrong limb. Putnam, chief executive of Package Machinery Co. Inc. , of West Springfield, is on the 22-member board of the Baystate Medical Center , in Springfield, and is chairwoman of the quality improvement committee. Her professional expertise is in manufacturing machines that wrap products such as frozen desserts, golf balls, and Q-tips .
In her role as a hospital volunteer, Putnam receives regular reports from doctors and administrators about medication errors, individual physician performance, and conditions that could pose risks to patients.
Massachusetts hospital officials say such communication is becoming more common at board meetings, although they don't have data to document the increase in board involvement.
The 653-bed Baystate hospital is among the state's leaders in establishing electronic medical records and computerized prescription systems that are designed to prevent dangerous drug interactions and other medication errors. Still, like any hospital, Baystate regularly has to plug gaps in its safety systems.
For instance, Putnam was recently briefed by doctors on a case in which two medications with similar names were stored side-by-side on an operating-room anesthesia cart, resulting in a nurse nearly giving a patient the wrong medication. To prevent a repeat of the "near miss," the hospital changed the color of the label on one of the medications and moved it to a different position on the cart.
During routine safety meetings with doctors and administrators, Putnam said, she holds them generally accountable for overall system performance, but does not blame them for specific errors when they admit making a mistake.
"We're not really focused on, as tragic as it was, a bad outcome. We're focused on making sure that outcome never happens again to somebody else," she said. "You're not going to get blamed if you can figure out a system that is going to prevent it from happening again."
Baystate executives say they have been working to encourage a culture where dialogue about safety and errors with board members is commonplace. But those kinds of conversations are not taking place regularly at most hospitals, said Dr. Lucian Leape , a prominent patient-safety advocate at the Harvard School of Public Health and a recent addition to the Cambridge Health Alliance board of trustees.
"The typical response in most hospitals is that it is not for the board to tell doctors how to practice medicine," Leape said.
Leonard Bicknell, chairman of the board at South Shore Hospital in Weymouth, and president of Alvin Hollis & Co., the South Shore's largest home heating oil delivery company, said he and other board members add something to the safety review process that medical professionals sometimes overlook.
"We bring a much more human concern," he said. "When a doctor mentions that there has been a patient affected [adversely] by something that was done in the hospital, the board is on pins and needles." In contrast, doctors tend to take such situations in stride, Bicknell said, because they "see things every day in the course of their work."
But some board members tend to be shy about voicing their opinions. A 2005 article in the quarterly academic journal Quality Management in Health Care said trustees who lack medical expertise tend to be afraid to challenge medical staffs, or second-guess how medical staffs discipline doctors for violating procedures or rules.
The Massachusetts Hospital Association , with financial help from Blue Cross Blue Shield of Massachusetts , is developing a curriculum designed to teach board members to speak up more. Classes will include instruction on how to ask executives difficult questions about safety, and how to demand that serious errors are brought to a board's attention.
The challenges for the medical establishment in dealing with boards involve translating complex medical issues into plain English, avoiding medical jargon, and "demystifying medicine," said Dr. Ronald B. Goodspeed , president of Southcoast Hospitals Group and chairman of the Massachusetts Coalition for the Prevention of Medical Errors .
Blue Cross Blue Shield of Massachusetts is considering other ways to accelerate the trend toward greater board participation, including denying an unspecified portion of reimbursement to hospitals unless board members receive training on how to question administrators and doctors on safety issues, chief executive Cleve Killingsworth said.
"This is not a witch hunt," Killingsworth said. "This is board members exercising their responsibility to ask questions about quality, in a way that compels the institution to respond."
Christopher Rowland can be reached at firstname.lastname@example.org.