Bringing the Board table closer to the bedside

The role of the Board of Directors at the Mater Hospital, Dublin in overseeing and contributing to the improvement of the quality of care provided at the critical front line had been enhanced as a result of a new governance programme which had been introduced, Prof. Mary Day, Group CEO, Ireland East Hospital Group told the Conference.

Prof. Mary Day
Prof. Mary Day

She said that as a result of the new programme, quality had moved from being a single item to becoming interspersed throughout the agenda of Board meetings (25% of board time was now devoted to quality) and the Board was better able to hold the executive to account.

I was looking at how we developed a culture of safety, openness and innovation not only at executive level but to bring it up to Board level.

The programme had been introduced following the outcomes of a pilot programme introduced by the Mater Hospital and the Quality Improvement Division of the HSE, led by Dr. Philip Crowley.

It was driven by the MMUH Board of Directors and was a collaboration between MMUH/HSE and Scottish Patient Safety Fellowship Programme.

Prof. Day said that we heard much about governance. It could take different forms in different settings and probably most pertinent to her was the inter-relationship between governance, quality and accountability.

“The journey of the Mater programme was to learn how the Board of an acute hospital could drive quality and to bring the Board table closer to the bedside. At that time in the Mater they were focusing on becoming a safe hospital. I was looking at how we developed a culture of safety, openness and innovation not only at executive level but to bring it up to Board level.”

The Board was now making key recommendations back to the executive and the executive felt challenged because the Board now had greater knowledge and understanding.

Members of the Board of the Mater are invited for membership by the Sisters of Mercy and they have fiduciary responsibility for quality of care and financial control of the hospital. There were seven non executive directors and four members.

The aim of the project was that by November 2014, the Board of Directors, individually and collectively would get a comprehensive picture of the quality of clinical care, have an understanding of this and act to hold the hospital accountable on the quality of clinical care (QCC) delivered.

The baseline was established through a review of Board minutes and agenda in the six months prior to the project beginning and interviews with the Board of Directors to establish what quality of care meant to them. “I am very much an advocate of data and believe we can only make decisions when we have clear data. We arranged a workshop for the Board. In addition to executive material they got targeted information on how they could hold the executive to account. We wanted to get their feedback and their engagement. They met the people who delivered the care and quality walk arounds enabled them to have meaningful conversation about care delivery at the coalface.”

Improvement actions included selecting quality indicators, developing a dashboard, targeted reading for Board members, shared learning with Sir Stephen Moss and the ISBAR communications tool.

Prof. Day said a Quality Dashboard on how to measure quality of care was a key part of the discussion and was introduced to the Board on a monthly basis. They developed a summary report for each indicator using the ISBAR tool at Board meetings. Sir Stephen Moss, former Chairman of the Mid Staffordshire Hospital, shared learning with them and they were deeply indebted to him for his assistance.

The results of introducing the programme were dedicated time for the discussion of quality of clinical care at Board meeting, quality of clinical care indicators were analysed monthly by the Board and there was a 150% increase in the time spent discussing the quality of clinical care at Board meetings. The outcome was an improvement in the quality of discussion and the number of recommendations made by the Board in relation to quality of clinical care.

The Board was now making key recommendations back to the executive and the executive felt challenged because the Board now had greater knowledge and understanding. For example the Board had looked at how falls risk could be improved and given the green light to purchase some equipment. Positive and negative stories were brought to each Board meeting and going forward they should probably look at getting a patient on the Board.

Prof. Day said that indicator selection needed to be reviewed regularly to reflect hospital strategy and use of outcome measures at board level.

She said that this type of project must be sponsored at Board level, there must be regular interaction and feedback between Board and project group, there must be a focus on patient experiences and clinical practice audits and automation of data for sustainability.

The detailed report on “Board on Board with Quality of Clinical Care is available at: http://www.hse.ie/eng/about/Who/qualityandpatientsafety/Clinical_Governance/CG_docs/_Board_on_Board_with_Quality_of_Clinical_Care_Quality_Improvement_Project_Case_Study_Report.pdf