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Have We Not Been Looking at Things We Should Have Seen?

A remarkable aspect of the Parkland Memorial Hospital saga was the degree to which the hospital’s Board was not given information by senior management about the clinical outcomes in their hospital.  The lack of transparency, in other words, even went to management’s relationship with its fiduciary board.

A recent article by the Dallas Morning News outlines some of these points:

On August 19, the hospital’s seven-member board of directors got its first chance to read the full report by the U.S. Centers for Medicare & Medicaid Services.  Almost 10 days had passed since [the CEO] first received the findings.  As members began leafing through pages of the report, surprise, even shock, began to register.

The Chair of the board said, “We had direct culpability, but none of us even knew we were in the report.”

Earlier in the year:

Board members became increasingly alarmed that [the CEO] and his staff weren’t acknowledging the problems, even in closed meetings.  When they sought more information, [he] warned them against micromanaging the hospital.  Board members said he frequently told them in private, “If you don’t trust my decisions, you need to replace me.”

So, they resorted to their own methods.

Some visited the hospital alone to check on operations.

[One] board member . . . stopped patients as they left the hospital and asked how they had been treated by staff.  The member heard many complaints about a lack of civility.

[One] wanted to see patient-care findings that he thought Parkland was collecting from industry groups.  [The management team] wouldn’t make that information available to the board.   On his own, [he] began searching in June on [federal] websites for patient-satisfaction information.  He found that Parkland’s scores trailed national and Texas averages in seven of 10 categories for what HHS describes as “important measures of patients’ perspectives of care.”

“I wonder now:  Have we not been looking at things we should have seen?”

Lest you think this is an extreme example, please understand that a significant percentage of US hospitals do not compile quality and safety information, even for the senior clinical and administrative leaders.  How can a person serve on the board of a hospital in this country and not demand that such information be collected and shared with the governing body?

A colleague wrote me the other day:

Why is there PhysicianCompare and HospitalCompare but not HospitalCEOCompare?

Think that might make more CEOs consider patient safety and outcomes as their primary mission?

Indeed.  But it is ultimately up to the board to make this happen.

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.

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Lynn in SC
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Lynn in SC

Once Medicare’s death penalty is one the table it’s a little late for the governing board to say, “we should’ve known.” Why does Parkland’s CEO and senior management team still have their jobs?