Question

When a large regional medical center became part of an integrated delivery system that had a central board of directors, the medical center's board began to struggle with its revised role. The new organizational environment included several outpatient clinics, multispecialty physician practices, and an insurance entity. Many of the current board members had served the organization since the medical center was built, and board activities always had been performed in a certain way. The administration rigidly controlled board meetings. Board members did not ask questions and routinely approved committee reports. The reports covered topics such as the organization's financial status and future financial plans, physician credentialing, care quality monitoring, new policies, and plans for a new hospital.

A new board member with a healthcare background was appointed after extensive screening and a personal interview with the executive committee. She was not part of the local business power structure, and the administration was concerned that her appointment might not be a wise move. During her first board meeting, two very interesting reports were given. One report detailed some reengineering projects. One of these involved redesigning nursing staffing patterns. This redesign decreased the number of registered nurses (RNs), and replaced them with licensed practical nurses (LPNs) and certified nursing assistants (CNAs). The current quality report documented a very high quality of care and positive patient satisfaction surverys. Data excerpted from this report can be seen in the "1st Quarter" column of table 15.1 (found on page 402). Given that this was her first board meeting, the new board member remained silent and did not ask questions.

Within four months, the new nursing staffing pattern had been launched. Data excerpted from the quality indicators report presented to the board can be seen in the "2nd Quarter" column of table 15.1 (found on page 402). the new board member was very concerned and decided to ask the nurse administrator presenting the quality report the values, which show a negative trend, were for the nursing nits with the new nursing staffing patterns. the administrator reported that there was a direct correlation. This answer initiated discussion among other board members who were accustomed to using quality indicators in their businesses. This was the first substantive board-level discussion that the new board members had seen. One board member wanted to know whether any data had been gathered from patient focus groups. Another board member ask whether the average length-of-stay data had increased, and someone else asked about a cost-benefit analysis of the new staffing patterns. Following the usual process, the chair called for approval of the report and presentation of the next item on the agenda.

Case study questions

1. What changes or patterns do you see in the data? What remedies might be suggested for any problems?

2. Has the CEO carried out his or her responsibility for educating the board? Why or why not?

3. Depending on the answer to question 2, what strategies would you recommend at this point?

4. What quality data should be reported and utilized by this board of directors?

5. Given this administration's style and leadership approach, do you think the minutes of the board meeting reflect actual board meeting discussions?

Answer 1

1-The first report looked or showed a very high quality data which did not show any trend or initiate any discussions as it all seemed to be perfectly going well. When in next quarter the data collection method and variables were changed, the staff was into asking a bundle of questions which led to discussion as it seemed that their contribution to quality dipped. The difference was the way the report perceived. This attitude can be change in number of organizations if a same old traditional report is changed and a new trend with different quality variables are included every year.

2-The CEO was good in approval in changes of report but the education of the board members about the lack or changes or current trend was incomplete. Due to this the members were at shock when the changing variables brought out what seen as perfect in previous quarters.

3-A correct welcome and drill will help novel members:

-Take on their parts in the association both rapidly and securely.

-Sense more associated to one another.

-Sense more associated to the organization.

-Healthier understanding of their character on the Board as to why they were requested to joint, and what is predictable of them as memberships.

-Function from the similar writing that is, to comprehend the idea, assignment, and their parts in the association in the similar way.

-Sense more interested to do an improved job.

4-Relate to patient care or quality of upkeep.

Definitely influence health consequences.

Encounter or exceed rule and directive.

Can be precisely and willingly unhurried.

5-The MOM did not match what the discussion was about. The administrator does not seem to care much about others opinions and that’s what the MOM (minutes of meet) shows.