Board Book June 25, 2015

Transcription

Chief Medical Officer
Julian Craig, MD
Board Report
June 2015
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MEDICAL STAFF SUMMARY
MEDICAL STAFF COMMITTEE MEETINGS
Medical Executive Committee Meeting, Dr. Victor Nelson, Chief of Staff
The Medical Staff Executive Committee (MEC) provides oversight of care, treatment,
and services provided by practitioners with privileges on the UMC medical staff. The
committee provides for a uniform quality of patient care, treatment, and services, and
reports to and is accountable to the Governing Board. The Medical Staff Executive
Committee acts as liaison between the Governing Board and Medical Staff.
Peer-Review Committee, Dr. Victor Nelson, Committee Chairman
The purpose of peer review is to promote continuous improvement of the quality of care
provided by the Medical Staff. The role of the Medical Staff is to provide evaluation of
performance to ensure the effective and efficient assessments and education of the
practitioner and to promote excellence in medical practices and procedures. The peer
review function applies to all practitioners holding independent clinical privileges.
Pharmacy and Therapeutics Committee, Dr. Mina Yacoub, Committee Chairman
The Pharmacy and Therapeutics Committee discusses all policies, procedures, and forms
regarding patient care, medication reconciliation, and formulary medications prior to
submitting to the Medical Executive Committee for approval.
Credentials Committee, Dr. Barry Smith, Committee Chairman
The Credentials Committee is comprised of physicians who review all credential files to
ensure all items such as applications, dues payment, etc. are appropriate. Once approved
through Credentials Committee, files are submitted to the Medical Executive Committee
and the Governing Board.
Medical Education Committee, Dr. David Reagin, Committee Chairman
The Medical Education Committee was formed to review all upcoming Grand Rounds
presentations. The committee discusses improvements and new ideas for education of
clinical staff.
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Performance Improvement Committee, Committee Chairman
The Performance Improvement Committee is comprised of 1-2 representatives from each
department who report monthly on the activity of each department based on standards
established by the Joint Commission, the Department of Health, and the Centers for
Medicare and Medicaid Services (CMS).
Bylaws Committee, Dr. David Reagin, Committee Chairman
Members include physicians who meet to discuss implementation of new policies and
procedures for bylaws, as it pertains to physician conduct.
The Medical Staff Bylaws, Rules and Regulations have been revised in preparation for
the upcoming Joint Commission inspection. The changes were reviewed, discussed and
approved by the Bylaws Committee and will be forwarded to the Medical Executive
Committee and then the Board of Directors for review and approval.
Physician IT Committee,
Members include physicians who meet to discuss the implementation of the new hospitalwide Meditech upgrade, as well as the physician documentation for ICD-10.
Physician Champions Meditech Program
Cyril Allen, MD
Julian Craig, MD
Mina Yacoub, MD
Russom Ghebrai, MD
Raymond Tu, MD
Cynthia Morgan, MD
Gilbert Daniel, MD
Deborah Wilder, MD
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DEPARTMENT CHAIRPERSONS
Anesthesiology .............................................................. Dr. Amaechi Erondu (Medical Director)
Critical Care ........................................................................................................ Dr. Mina Yacoub
Emergency Medicine ..................................................................................... Dr. Mehdi Sattarian
Medicine .............................................................................................................. Dr. Musa Momoh
Obstetrics and Gynecology................................................................................ Dr. Victor Nelson
Pathology .............................................................................................................Dr. David Reagin
Pediatrics ....................................................................................Dr. Marilyn McPherson-Corder
Psychiatry ............................................................................................................. Dr. Lisa Gordon
Radiology ............................................................................................................. Dr. Raymond Tu
Surgery .......................................................................................................... Dr. Gregory Morrow
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DEPARTMENTAL REPORTS
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ANESTHESIOLOGY
Dr. Amaechi Erondu
The overall census for the month of May 2015 declined slightly to184 procedures including
emergency intubations for code calls and OB cases, when compared to 202 for April 2015. We
have noticed a downward trend in the OB volume for the past few months.
We continue to work with the surgeons to increase the volume of surgical cases here at UMC.
CRITICAL CARE MEDICINE
Dr. Mina Yacoub
For May 2015, the ICU had 263 patient days, 76 admissions and 73 discharges. The ICU
managed a total of 82 patients in May. Admissions increased slowly, starting the second half of
May. We hope to see a continued increase in admissions.
For Q1 2015 and for the months of April and May 2015, ICU had no ventilator associated
pneumonias (VAPs), no catheter associated blood stream infections (CLABSIs), and no catheter
associated urinary tract infections (CAUTIs). ICU continues to maintain very low complication
rates with day to day operations. ICU infection control data is reported to the National
Healthcare Safety Network (NHSN). Our infection control data is also being validated by the
national Clinical Data Abstraction Center (CDAC).
ICU is partnering with UMC Quality Department which is performing concurrent reviews of our
quality indicator of Venous Thromboembolism (VTE) prophylaxis. Quality Department is
reporting ICU is meeting Quality Department goals with 100 % compliance for Q1 2015. April
and May data are pending reporting by Quality Department.
Average Length of Stay (ALOS) in May continues to show a low trend with an ALOS of 3.5
days. ICU is working to keep ALOS low, improving on cost-savings.
For May, there have been no readmissions to the ICU within 72 hours of ICU discharge.
ICU had 5 deaths for May 2015 with a mortality rate of 6%. Mortality rate continues to be
below national averages. All ICU deaths are reviewed and reported to the Critical Care
Committee.
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Critical Care Committee is reviewing and updating all critical care policies to update and align
with UMC CPOE practices. We plan to complete all policy review this calendar year.
ICU has been tasked by MEC to work to improve UMC pneumonia DRG core measures and
quality indicators. Pneumonia order set compliant with core measures requirements is built into
Meditech and is available for use by all UMC physicians.
ICU is awaiting implementation of plans to install doors on six patient rooms that still lack
doors. ICU is working with Building Services Department to convert a back room to an on-call
physician room. This is expected to improve intensivist availability to ICU patients and staff.
The current ICU on-call room is on the 3rd floor while the ICU is on the 4th.
EMERGENCY MEDICINE
Dr. Mehdi Sattarian
On May 15th 2015, Emergency Medicine Associates took over the operation of the emergency
department at United Medical Center. As Medical Director, I spent significant time meeting
with all department chairs to evaluate the room for process improvement through our
interactions.
We had very strong performance during the Month of May. ED saw 5,156 patients that has been
the highest census in 2015 and equal to the 2014 census. In the emergency department we had a
strong PR campaign during EMS week. We met with DC EMS leaders that resulted in
significant increase in our EMS traffic. ED had major improvements in almost all throughput
measures and most importantly LWBS. Other obvious change was increasing our admission rate.
May 2015 department metrics:
May Patient Volumes:
5,155
% Change from April 2014:
12% increase
Ambulance Volume:
1,381
Median Left without Treatment:
3.3 %
Admission Rate:
10.8% or 487 admissions
Transfers:
1%
Turn Around Time for D/C Patients: 169 minutes
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New Initiatives
1. Provider’s credential, orientation, and schedule: EMA will continue working with
medical staff office to have our providers ready for our start date of August 1. The
department schedule for May and June 2015 is available.
2. QI and Core Measures: Worked with ICU, Behavioral Health Director and IT
department, ED implemented all order sets including the top four “chest pain, CHF,
Pneumonia, and Psychosis”.
3. IT Department: Working with IT department, ED continued improvement in Meditech
documentation, order entry, and reporting capability.
4. ED dashboard: ED dashboard is functional; more items will be added in the future.
5. Scribes implementation: One of our biggest new initiatives is to implement the scribes
program. Scribes will help the providers function more productively and allow them to
spend more time with patients.
6. Super Tracker: With one provider and one nurse, Super tracker is functional on busy
days.
7. Clinical Guideline: With the goal of implementing the best clinical practice, we will
work closely with all other department chairs and IT department to implement the clinical
guideline and order set.
8. EMS relationship: ED continued its interaction with DC and PG EMS that has increased
our EMS traffic.
MEDICINE
Dr. Musa Momoh
Admissions/Discharges
For the month of May 2015, there were 370 admissions and 372 discharges. The average length
of stay was 5.8 days. The hospital length of stay was 5.2 days.
Procedures by Staff
EGD’s and Colonoscopies:
Bronchoscopies:
59
03
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Code Blue and Rapid Response
There were seven rapid response incidents and one code blue.
Satisfaction Scores
The Press Ganey satisfaction scores were 85.5% (Eleven responders)
PATHOLOGY
Dr. David Reagin
The laboratory completed the installation of the Panther instrument by Gen-Probe for the
detection of Chlamydia Gonococcus organisms. Testing is processing as anticipated.
Implementation of I-STAT system is on track for mid-May completion. A new floor was
installed in the staff lounge by Building Services staff (great job). It was highly appreciated by
the laboratory staff.
PEDIATRICS
Dr. Marilyn McPherson-Corder
For the month of May the Department saw 31 newborn babies. As of this year 2015, the
departments Continuity of Care program will celebrate its 9th Anniversary. In this program Dr.
Corder continues to provide the care of the newborns within 2-3 days of discharge from UMC.
On August 8, 2015, Dr. Corder and the UMC staff will host and participate in an all-day Health
Fair which will also include participation from Amerihealth, MedStar and Trusted insurances.
Dr. Corder is in discussion with the UMC staff about the details.
A staff meeting was held on May 20, 2015. The agenda included SIDS prevention, strategies to
remain compliant with the department and hospital policies and procedures. Also during the
meeting emphasis was placed on breastfeeding support.
Dr. Corder, Council Woman Karen Toles, The Prince Georges’ Chapter of the Links and the
Honorable Gloria Lawlah participated in the community outreach IFit: Healthy Lifestyles at
Drew Freeman Middle School. This program promotes healthy lifestyles. On May 27, 2015, Dr.
Corder was also a guest speaker on WHUR’s Daily Drum. The topic discussed was the Increased
Suicide Rate in male youth.
The physicians and the nursery staff continue to educate the mothers on the importance of on
time vaccinations starting with the Hep B at birth here at UMC to prevent vaccine preventable
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illness.
The Department continues to reach its common core goals.
PSYCHIATRY
Dr. Lisa Gordon
For the month of May, the Behavioral Health Department admitted 106 patients (37 from the
UMC ED and the rest from CPEP and other referring hospitals) with an average length of stay of
6.60 days. We saw 31 consults, including residents of the Skilled Nursing Facility.
The BHU has seen an increase in its census, due in part to seasonal fluctuations in hospital
admissions. The increase may also be attributed to the end of the IMD program (Institutions for
Mental Diseases), resulting in fewer patients being admitted to PIW. Another issue, as has been
reported in the local news, is the increase in the use of synthetic hallucinogenic agents such as
K2, Bizarro, Scooby Snacks and the VA Pack. These substances can cause an intense and lasting
psychotic episode, requiring hospitalization for treatment of the psychotic symptoms and risk of
harm to one’s self and others due to psychotic agitation. We will continue to serve these patients
and ensure they are provided resources for substance abuse treatment upon discharge.
The BHU Administrators met with the new interim Security Director, Mr. Derrick Lockhart, to
introduce him to our department and ensure a smooth transition and continued strong and
positive working relationship with that department. We will also be meeting with the new
director of the ED, Dr. Sattarian, for the same purpose.
RADIOLOGY
Dr. Raymond Tu
Performance Summary:
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Quality Initiatives, Outcomes, etc.
1. Core Measures Performance
100% extra cranial carotid reporting using NASCET criteria
100% fluoroscopic time reporting
100% presence or absence hemorrhage, infarct, mass
100% reporting <10% BI RADS 3
2. Morbidity and Mortality Reviews: There was 1 departmental death which was not a
UMC patient but a patient from Hadley Bridgepoint who was waiting for a procedure.
This was referred to Risk Management.
3. Code Blue/Rapid Response Teams (“RRTs”) Outcomes: There were 1 code blue
intervention in radiology and the patient expired.
4. Care Coordination/Readmissions: N/A
5. Evidence-Based Practice (Protocols/Guidelines) We are looking into how to improve
patient transportation from the emergency department to the radiology department for CT
scanning. We are pursuing a monitor in the radiology department core to help direct the
radiology staff to return patients back to the correct location in the ED.
Service (HCAHPS Performance/Doctor Communication)
June was osteoarthritis awareness month and Dr. Tu recorded a radio spot on Radio One which
was played during the month highlighting the services of radiology and the hospital.
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Growth/Volumes
There is growth in use of the interventional radiology suite between radiology and cardiology.
There have been some scheduling challenges with concurrent requests to use the suite. The
addition of the second suite will be very helpful.
Stewardship Dr. Tu continues to strongly recommend clinical decision support at the point of
order entry to reduce unnecessary examinations and to aid in practitioners to order the right test,
the right time for the right patient.
Financials
Active Steps to Improve Performance: The ultrasound department passed ACR accreditation;
full accreditation is necessary for our image of quality as measured by third parties. The
radiology department had a full meeting on May 27th and we reviewed cases, discussed practice
growth opportunities and prudent use of radiation emitting procedures. We discussed gadolinium
based contrast media for safety in Trans-metalation.
SURGERY
Dr. Gregory Morrow
For the month of May 2015, the Surgery Department performed a total of 160 surgical
procedures. The department has met its quality measures with 100% compliance. Current
projects that are under way in the department are as follows;
•
Implementation of an Enhanced Recovery After Surgery (ERAS) protocol for Major
Abdominal Surgery.
Table: Typical Elements in an Enhanced Recovery Protocol
Preoperative
Identify patients
Education about program
Screen for malnutrition
Carbohydrate drink
Selective bowel preparation
Smoking cessation
Intraoperative
Minimally invasive surgery
Goal-directed fluid therapy
Regional anesthesia
PONV prophylaxis
Antibiotics before incision
Thromboprophylaxis
Postoperative
Early feeding
Early mobilization
Optimize fluid regimen
Optimize analgesic regiment
No NG tube or urinary catheter
Multimodal analgesia
•
Establish best practices for Major Joint Replacement (Hip and Knee) to include
postoperative physical therapy initiatives.
•
Establish best practices for Major Vascular/Revascularization Procedures including
standardized preoperative assessments, operative procedures, and postoperative
management.
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The department is actively recruiting physicians with special emphasis on Orthopedic,
Plastics/Reconstructive and General Surgery in order to enhance our service lines and also
increase our outpatient surgical volumes.
CARE MANAGEMENT
Darlene M. Taylor RN, BSN, MBA, CCM
AVERAGE LENGTH OF STAY (ALOS)
(Based on acute care discharges and does not include BHU or SNF)
7.0
6.0
5.0
6.6
6.2
5.7
5.3
5.7
5.6
Oct
Nov
5.4
6.0
5.5
5.6
5.2
4.7
4.0
3.0
2.0
1.0
0.0
June July
Aug
Sept
Dec
Jan
Feb March April May
Median LOS: 3.0 days
Goal LOS- 4.5 days
(metric takes into consideration outlier)
DEPARTMENT HIGHLIGHTS
1. ALOS for May, 2015 == 5.2 days (May 2014 was 5.7 days)
2. Inpatient volume - May 462 down from April 609
3. Case Mix Index (CMI) all payor decreased from April to May (1.10->0.98)
Strategy / Initiatives –
- Hospitalist and Nursing Rounds- Re-evaluation of process to streamline activity and
ensure consistent activity.
-
CM staff and Physician Advisor Dr. Morgan conducting daily LOS report out. Activity
conducted to identify barriers to discharge process and facilitate a proactive approach.
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MEDICAL AFFAIRS
Sarah Davis, BSHA, CPMSM
UMC Medical Affairs Monthly Report
June 2015
APPLICATIONS IN PROCESS
(Applications received through May 31, 2015)
Department
Anesthesiology
Behavioral Health
Emergency Medicine
Medicine
Obstetrics & Gynecology
Pathology
Pediatrics/Neonatology
Radiology
Surgery
TOTAL
# of Application in Process
1
2
16
12
0
0
2
0
5
38
DEPARTMENT HIGHLIGHTS
•
Effective May 17, 2015, Ms. Makyshia Abbott assumed the role of Credentialing Assistant.
Ms. Abbott joined the Medical Affairs Department in 2014 as the Administrative Assistant.
She is instrumental in the continued accreditation and success of the Grand Rounds program
at United Medical Center. Ms. Abbott plays a vital role in the day-to-day operations of the
Medical Affairs Department as she expands her role in the credentialing process.
•
Ms. Cheron Rust has accepted the position of Administrative Assistant in the Medical Affairs
Department beginning May 17, 2015. Although Ms. Rust is new to the Medical Affairs
Department, she has worked in various areas within United Medical Center to include
Radiology, Operating Room, and 8th Floor. She will be assuming coordination of the Grand
Rounds program, as well as day-to-day operational support to the department.
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ANNOUNCEMENTS
Medical Staff Meetings July
July 9, 2015 at 1:00 pm
Credentials Committee
July 13, 2015 at 12:00 pm
Critical Care Committee
July 14, 2015 at 12:30 pm
Prevention & Control of Infections
Committee Meeting
July 14, 2015 at 2:00 pm
Pharmacy & Therapeutics Committee
Meeting
July 15, 2015 at 2:00 pm
Health Information Management Committee
July 20, 2015 at 12:00 pm
Medical Executive Committee Meeting
July 22, 2015 at 12:00 pm
Performance Improvement Committee
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MEDICAL STAFF ACTIVITY
REAPPOINTMENTS
David Boyd, MD (Radiology)
Frederick Corder, MD (Pediatrics/Neonatology)
William Kelson, MD (Surgery/Oral Surgery)
Umar Rahman, MD (Psychiatry)
NEW APPOINTMENTS
Bryan Williams, MD (Medicine) Rehabilitation Medicine/Pain Management
Gregory Kennyherz, MD (Radiology) Teleradiology
Thomas Osborne, MD (Radiology) Teleradiology
JaNa Holyfield, PA-C (Medicine) Allied Health
Adrian Ahmadzai, PA-C (Emergency Medicine) Allied Health
Medina Salami, PA-C (Emergency Medicine) Allied Health
CHANGES IN STAFF CATEGORY
Kamron Izadi, MD (Radiology) Provisional to Courtesy
Albert Klekers, MD (Radiology) Provisional to Courtesy
Jacqueline Newsome-Williams, FNP (Medicine) Provisional to Allied Health
RSIGNATIONS IN GOOD STANDING
Roosevelt Brandly, Jr., MD (Emergency Medicine)
Lisa Brown, PA-C (Emergency Medicine/Allied Health)
Norman Brown, MD (Emergency Medicine)
David Clark, MD (Emergency Medicine)
Andrew Couchara, PA-C (Emergency Medicine/Allied Health)
Pamela Herbert, MD (Emergency Medicine)
Seife Kassa, PA-C (Emergency Medicine/Allied Health)
Steven Katz, MD (Emergency Medicine)
Renee May, PA-C (Emergency Medicine/Allied Health)
Darpan Parekh, PA-C (Emergency Medicine/Allied Health)
Michael Shuster, MD (Emergency Medicine)
Brandon Soule, PA-C (Emergency Medicine/Allied Health)
Michael Tesfazion, PA-C (Emergency Medicine/Allied Health)
Jean Williams, MD (Emergency Medicine)
Information Technology and Systems
Board Report – May 2015
Current or Completed Initiatives:
•
ICD-10 The committee to meet these requirements was suspended in 2014 when the regulations
were pushed back for one year by the Federal government, after having completed much of the
necessary work. With the new start date of 10/01/2015, the committee has restarted and is
creating the final work plan. The main areas of work now are testing of MEDITECH updates,
testing of ICD-10 claims to payors, developing in-house training expertise, training clinical staff
and setting up reports to forecast possible payment changes and monitor closely after 10/01/2015.
•
Meaningful Use (MU) Stage 1 numbers are being tracked for the full year for 2015 and are all
being met. We plan to receive the second year Stage 1 incentives valued at $830,00 at the start of
FY2016. Stage 2 items are all being tracked and updated as required. A team has been started to
add new processes and an advertising campaign to increase the Patient Portal level usage to the
required 5% of patients. We are very confident in meeting the Stage 2 requirements in FY2016
and receiving the estimated $500,000 in incentives for 2016.
•
Paperless Pay This system will allow us to have all pay stubs online only, saving printing and
distribution expenses. This system has gone live and is working as planned. We will print the
statements for one more pay period while we have all users set up their accounts to access their
records online.
•
New/Upgraded PACS System The PACS system upgrade team has had it’s first meeting and is
beginning to set the timelines and goals for the 6 month project to completely upgrade all aspects
of the current PACS system.
•
Security Updates We have sent updates to the Office of Civil Rights on our security progress
since our assessment in 2014. They have accepted our plan and closed our file. We plan to
perform a complete risk assessment in June.
•
Outpatient EMR We have finalized the selection and are beginning the contract negotiations for
our outpatient electronic medical record to be implemented at all of the outpatient clinics. We
expect to begin implementation immediately upon contract completion, in June 2015.
The total cost of the currently underway IT related projects is approximately $2.5 million.
The Application Support, Help Desk, and Infrastructure teams continue to provide ongoing operational
support of UMC’s systems. The team had 535 help desk requests and closed 513 in May 2015.
Business Development & Physician Recruiting
Board Report – June 2015
AREAS OF FOCUS OVERVIEW AND RESULTS
Physician Development /Recruiting Plan:
•
•
The board approved plan called for an expansion of services to meet the disparate and unmet health needs in UMCs PSA.
Physicians are at the core of developing and expanding services. Additionally, adding physicians for growth will enable an
increase in the commercial payor mix. Each of the contracts includes specific performance parameters. A quarterly review will
be conducted regarding the parameters and the individual business plan to be developed for each physician. A copy of an
executed agreement is attached (Attachment A); in order to demonstrate an example of how monitoring and performance
parameters will be utilized. With the guidance and assistance of counsel, the physician agreements have been standardized.
The chart below provides an update regarding physician recruiting based on the board approved plan.
Physician Recruiting Update – the following list indicates the priority physician recruiting targets. Attached is the board approved
recruiting plan.
Specialty
Status
Internal Medicine
-Contract Executed
$250,000
$1,562,500
-Joins staff July 2015
Internal Medicine
(Geriatrics)
-Contract Executed
$250,000
$1,562,500
Neurology
-Accepted (Contract in final stage)
$275,000
$1,750,000
General Surgery
-Contract Executed
$350,000
$2,875,000
Gastroenterology
-Interviewed candidate 5/15
-Contract sent – will join July 2016
-Interviewed candidate 5/26
-Awaiting response from candidate
(attempting to link spouse to
position in DC)
-Adam Bier, MD joined the medical staff for
an initial 2 months Locum Tenens
engagement
- Initial meeting with local area physician
-There is a need, as there is for any
community hospital, to provide access to
general orthopedic services
-A contract for orthopedic services was not
renewed because the amounts expended
were not justified.
-Should a contract be structured, it will have
specific performance parameters including
quality, outreach and program development
-Discussions – ongoing for long
term relationship
-Physician applying for DC License
Orthopedics
*Committed
**Expected Rev.
Next actions________
* Committed - $ Commitment
** Expected Revenue – Facility and professional fees
(facility fees based on annual national survey.
Professional fees based on data projecting visits,
procedures and average charge per procedure and visits
Next Focus Areas of Recruiting
ENT, Urology, Hematology/Oncology, Orthopedics, Endocrinology, Internal Medicine, Family Practice
Grants
• The board approved strategic plan included the objective of building capabilities to pursue grants. The table details the current
status of grants.
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2|Page
3|Page
Grant Name
Amount
*Equiv. Gross
Revenue
Ryan White
Year 2 - $703,000
$93.5M
Part A HIV
Year 3 - $703,000
$93.5M
Ryan White
-Award Increase
$92,500
$12M
Gilead (Focus)
$287,406
$38M
Diffusion
$148,750
$20M
Expand PCC hours, increase linkage
capacity
Ongoing
$22M
Supports rapid test HIV testing and
linkage to care within the emergency
room and the Care Center. In
addition, it supports the position of
reimbursement specialist.
Effective 3/1/2015
$66M
Diabetic Management- "Meeting
those living with diabetes where
they are;, improving health status
Not Funded
Not Funded
Not Funded
CDC HIV Testing
Innovation
$185,000
$495,200
Purpose
Supports the operations of the Care
Center which primarily provides HIV
clinical care and psychosocial
support.
Supports a program within the Care
Center to improve retention of
patients in care
Supports HIV and Hepatitis C testing
and linkage to care within the
emergency room and outpatient
primary care clinic and other parts of
the hospital.
Build Health Challenge
$250,000
$ TBD
Advisory board, RWJ, Kresge-Planning and implementation grants75K/100K, 250K -focus on population
health
Million Hearts Strategy
Grant Program
$102,000
$ TBD
Hypertension and BP management
Status
Ongoing
Ongoing
Ongoing
4|Page
Value Based Care
The transition from a fee – for – service (FFS) reimbursement system to one based on value is one of the
greatest financial changes to be faced. Value based payment contracts are in their infancy and most are
structured based to a shared saving model. Shared savings arrangements differ, but in general they incentivize
providers to reduce spending for a defined population by offering them a percentage of any net savings they
realize.
Attached is an article regarding value based care titled “From Volume to Value – Ready or Not” (Attachment B)
Physician Models
Physician Models are rapidly changing. The Advisory Board, a Washington based research and consulting
company, has looked at recent trends in physician employment and integration. The 4 slides give a high level
overview of the rapidly changing environment. This research helps to inform us of our future challenges and
potential courses of action. The following areas are covered:
•
•
•
•
Practice acquisitions increase
Tomorrow imperative – (tightly integrated physician base)
Employing sporadically – acquiring to scale
15 attributes of effective physician networks
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6|Page
7|Page
White Paper
Value-based Network Management
From Volume to Value – Ready or Not
A Research-based Report on Value-based Care
Trends and Physician Readiness
Forming or Joining an ACO
The Question isn’t “Should you?” but
“How should you?”
With the growing movement away from a
fee-for-service model, talk to any physician
these days and the subject of Accountable
Care Organizations (ACOs) will come
up. These organizations are designed to
manage the full continuum of care for
defined populations, and make physicians
and other providers accountable for the
quality, as well as the cost-effectiveness,
of care.
Through an ACO, healthcare leaders
negotiate contracts with multiple payers
to manage a given patient population.
These include both private and commercial
payer arrangements, whose terms can vary
by ACO and/or payer. Under those terms,
ACOs are reimbursed according to
value-based incentives, which are
designed to encourage cost-effective,
high-quality care for patients.
From a care perspective, ACOs that
participate in the Medicare Shared Savings
Program, for example, have a set of 33
measures of quality defined by the Centers
for Medicare & Medicaid Services (CMS) in
the areas of Patient/Caregiver Experience,
Care Coordination/Patient Safety,
Preventative Health, and care standards for
specific, at-risk populations (e.g., diabetes,
hypertension, etc.)
Many Questions Surround ACOs
As with most any proposed model for
business, the concept of ACOs and valuebased reimbursement raises a variety
of uncertainties. Bring up the subject in
most any healthcare setting and plenty of
questions will surface, for instance:
•
How aggressively is the industry
moving in this value-based
reimbursement direction?
•
Will practices have to transition
completely to the new model or do so
while still maintaining elements of the
fee-for-service model?
•
Who should take the lead and form
a new ACO, and who should join an
existing organization?
•
What critical success factors must
providers pursue to thrive within a
value-based model?
Keep the discussion going long enough and
there will be as many opinions as there are
healthcare experts. McKesson conducted
two key research studies to go beyond
anecdotal evidence and explore attitudes
and experiences surrounding the shift to
value-based reimbursement. One was a
national survey of payers and providers;1
the other was a more focused ACO
readiness study of health systems, as well as
independent and owned medical practices.2
Most physicians understand the need to adapt
to a value-based model, with just over 50%
having at least begun discussions about the
requirements and needs of becoming an ACO.
Research Results and Implications
Value-based Reimbursement is Real –
How Prepared are You?
The first and most striking trend to emerge
from McKesson’s national study of
payers and providers is that value-based
reimbursement and the ACO model are
coming – sooner rather than later. With
only 3% of payers exclusively using a
fee-for-service model, 90% have already
transitioned to some form of value-based
reimbursement – and that number is on
the rise.
More than 66% of payers are currently
using one or more of the prevalent value–
based reimbursement models, with the
most widely used models being pay-forperformance (used by 65% of payers)
and capitation, global payment, or total
cost of care payment (used by 64% of
payers) according to the national study.
Additionally, projections indicate that the
proportion of the healthcare businesses
aligned with a pay-for-performance model
is expected to nearly double within five
years, with fee-for-service payments
shrinking by about 33%.
Reflective of the survey results, in July 2014,
Cigna announced that it had met a goal to
cover one million healthcare consumers
under its value-based reimbursement
model, which includes 100 ACO-style
arrangements with large physicians groups
in 27 states. Likewise, UnitedHealthcare
announced that it expects to more than
double by 2018 the annual reimbursements
to physicians and hospitals tied to
accountable care and performance-based
programs.
2
Most Healthcare Providers are
Unprepared to Succeed as ACOs
The ACO Readiness study results indicate
that even though most respondents have
begun discussions about the development
of a formal ACO structure, overall readiness
to shift to that model is low. Only some
systems are in place to coordinate care
across care settings, with more work
necessary to complete the process. Only
limited patient data is available. Only
limited data analytics capabilities are in
place. And most providers believe that their
ability to negotiate and manage shared risk
is below average.
Even though payers appear to be leading
the charge to make the transition to
value-based reimbursement models,
research shows that both payers and
providers expect to have difficulty actually
implementing pay-for-performance models.
There are many reasons for this issue:
•
episodic care to managing a defined
patient population
•
The reason why payers are moving toward
the ACO model faster than providers may
have to do with a perception indicated in
the national survey: 60% of payers said that
they believe value-based reimbursement
models will have a positive financial impact
on their organizations. By contrast, only
35% of healthcare providers believe that
value-based models will deliver a positive
financial impact – and that number
was even lower for providers in smaller
sized practices. Additionally, a small but
significant percentage of providers state
that they already have been forced to
reduce their pricing to payers by more than
20% in the past year.
Limited physician engagement across
the network
•
Results of the ACO Readiness study show
that most physicians understand the need
to adapt to a value-based model, with just
over 50% having at least begun discussions
about the requirements and needs of
becoming an ACO.
Difficulty in transforming from
Inability to capture data across
multiple systems
•
Lack of measurement and analysis
data across multiple systems
The key to ensuring that value-based
reimbursement measures provide financial
value to the provider is the implementation
of cost-efficiency measures (e.g., reducing
overall costs, streamlining and improving
processes, reducing hospital emergency
readmissions). However, research
shows that only 37% of providers have
implemented these measures.
The Value-based Model is Coming,
Ready or Not
Providers’ reluctance to embrace the ACO
model does not change the fact that a
combined fee-for-service and value-based
reimbursement model is likely to prevail,
at least in the short-term, as value-based
reimbursement gains momentum.
Practices, therefore, will have to work
toward a transition to either building an
ACO-type model or participating in one,
while still maintaining elements of their
fee-for-service model.
Advantages and Drawbacks
Who Should Create New ACOs and Who Should Join Them
Once the decision has been made to adopt the ACO model, a decision needs to be made about whether to join an existing ACO or build one
from the ground up. There are, of course, key advantages and potential drawbacks to either approach:
Accountable Care Organization Advantages
BUILD
JOIN
•
•
•
•
•
You can provide leadership as new model is established.
You can create new governance and management standards.
You can impact network cost and clinical care quality.
You’re building for the future.
•
•
•
You may gain access to shared savings through improved
efficiencies.
You may gain access to an expanded referral network.
You may gain access to defined patient population(s).
You may gain access to resources and additional support.
Accountable Care Organization Challenges
BUILD
JOIN
•
•
•
•
•
•
•
•
•
A large and intensive capital investment is usually required to
create an ACO, especially on the front end.
Numerous legal barriers exist without sufficient guidance.
Clinical and operational infrastructure must be established.
If incentives are not based on the right criteria, there could be a
temptation to curtail necessary care.
Consolidation of market power could increase healthcare costs.
•
Time must be invested to become oriented to the network.
Participation requirements may be complicated.
Referral patterns may differ from current practice.
Without support, data reporting requirements may lead to
information overload.
Policies and procedures will need to be adapted to address the
process of managing a defined patient population
Ultimately, the factors that determine whether a practice should join an existing ACO organization or venture ahead to create a new one
center largely around recognition of the critical factors that ensure success, as well as the organization’s readiness and ability to drive forward.
Either way, it is important to begin with the understanding that transforming a practice to support or lead an ACO is a complicated process.
Practice leaders can take steps to ensure that they establish relationships with experts who are experienced in both building and evaluating
ACOs. Such partners are essential to help identify and address potential issues before they become damaging problems.
Critical Success Factors
•
The Key Elements of Effective ACOs
According to CMS, nearly half of the 2012
ACOs — 54 out of 114 — successfully
reduced spending for attributed
beneficiaries below their expenditure
target. However, only 29 of the ACOs
generated enough savings to qualify
for shared savings bonuses. These topperforming ACOs earned $126 million in
shared savings payments.
•
Strategic Management and Analytics
The cornerstone of any ACO organization
is its strategic and operational road
map to navigate the local landscape
of providers, facilities and payers,
and to develop a clear path to success.
Development of a strong infrastructure
is a complex process and includes
deep attention to issues ranging from
the organization’s driving vision
to its organizational governance,
technological infrastructure and
financial strategy.
Network Development
A successful ACO must be able to
identify, integrate and develop a
clinically integrated network of
primary care and specialty physicians,
along with high-quality, low-cost
facilities to actively participate in a
streamlined care delivery model.
A clinically integrated network is
commonly defined as a health network
working together, using proven
protocols and measures, to improve
patient care, decrease cost and
demonstrate value to the market.
•
Practice Transformation
Most practices will require many
changes – in everything from patient
flow to delivery of care to compliance
and communications practices – to
enable doctors and staff to manage a
combined fee-for-service and valuebased reimbursement environment.
Identifying the right changes to make
and how to make them with the least
possible disruption is critical.
•
Care Coordination
The ability to track and communicate
patient care across the care continuum,
including transitions, is one of the
defining elements of the accountable
care model. Employing managers,
registered nurses and nursing
assistants for care coordination,
oversight and utilization management
is therefore a vital component for fully
transforming a practice.
It is also important that practice leaders
recognize the degree to which clinical
and financial success will be dependent
on the ability to collect disparate data
and turn it into useful information
via data management and analytics
capabilities. It is therefore important
to ensure that technology decisions –
including identification, development,
implementation, and measurement of
necessary support systems – are interwoven
through all four elements.
Accountable Care is Coming and
You Can Be Successful
The research is clear: Value-based
healthcare and the ACO model are
becoming a significant part of healthcare
delivery and will most likely continue
to grow. The questions remain about
how and when to develop the necessary
organizational, legal and information
technology infrastructure. Fortunately,
experts who are experienced in both
building and evaluating ACOs and other
risk-bearing healthcare networks can work
with healthcare organizations to help them
achieve better financial success.
Hospitals, health systems, physicians
and other healthcare providers should
therefore seek the expertise of partners with
experience in the areas of administrative
infrastructure, network development,
practice transformation and care
coordination – as well as data management
and analytics knowledge. With these
capabilities in place, organizations will
have an opportunity to set a clear path to
achieve the full advantages of a value-based
reimbursement model, both immediately
and as Accountable Care expands across
more patient populations.
McKesson Business Performance Services
has extensive experience working with
accountable care organizations and
clinically integrated healthcare networks to
help them navigate the road to value-based
care, build for a sustainable future and
achieve financial success.
McKesson Business Performance Services
McKesson
5995 Windward Parkway
Alpharetta, GA 30005
www.mckesson.com/aco
[email protected]
1.877.528.9750
Copyright © 2015 McKesson Corporation and/or one of
its subsidiaries. All rights reserved. All other product or
com-pany names mentioned may be trademarks, service
marks or registered trademarks of their respective
companies.
01/2015-FVTV
Sources:
1.
McKesson Health Solutions, The State of Value-based Reimbursement and the
Transition from Volume to Value in 2014 (2014), MHSvbrstudy.com
2.
McKesson Corporation, McKesson ACO Readiness Survey (2014).
Not-for-Profit Hospital Corporation
HUMAN RESOURCES
REPORT TO
Board of Directors
Submitted By:
Jackie W. Johnson
Executive Vice President Human Resources
June 2015
UMC Career page
Link: http://www.united-medicalcenter.com/careers/
As we continue to incorporate / adopt cutting-edge technologies, we are also continually
analyzing existing systems and processes for enhancement/development opportunities. One such
enhancement / development is the creation of the UMC Career page. The Career Page is a portal
to current Clinical, e.g. Nursing, Technician, etc., and Non-Clinical, e.g. EVS, Dietary, SPO, etc.,
Career Opportunities within the Hospital, Current Events, e.g. Career Fairs, Public Engagements,
etc., and Employment Benefits. The development of the Career page plays an integral part in the
Hospital’s overall Branding and Social Media development strategy.
2015 Employee Engagement Survey
The 2015 Employee Engagement Survey began on May 26th of this year with an initial end date
of June 14th. The purpose of the Survey is to provide UMC employees with an opportunity to
give Hospital Leadership input and insight with respect to their opinions of the current working
environments as well as possible opportunities for overall improvements to current processes,
procedures and conditions. To date, we have only garnered a total of 97 responses against a goal
of 311, i.e. 30% of Hospital population. In an effort to increase the number of respondents, we
have incorporated a number of innovative approaches, e.g. the engagement of the Employee
Advisory Committee, a two week extension to the Survey period, direct Management
encouragement, Pointed Employee Messaging, both electronic and posted messaging boards, as
well as centralized survey locations and employee encouragement initiatives. The overall
objective is to exceed the 30% prescribed target. The next steps in the process are centeredaround the definition and analysis of issues identified through the survey as well as the potential
corrective actions associated with each.
•
June 1st was the beginning of the 2015 Performance Appraisal process. An enhancement for the
2015 Performance Evaluation process is the digitization of the Performance Evaluation form.
This enhancement will allow Managers the opportunity to capture / produce the overall Employee
Evaluation electronically, thus enhancing storage, tracking and delivery capabilities.
o
UMC has a total of 1,042 performance evaluations due June 1st – September 30th. We are
striving for a 95% compliance rate.
•
SWANK – we are now entering the second phase of our SWANK Learning Management System
roll-out. In the second phase, we will be focusing on the empowerment of the Group
Administrators through the following focused efforts:
o Intermediate level Group Administrator Training – The Intermediate training will focus
on department specific curriculum development, delivery and timing. This advanced
level training will allow the Group Administrators to strategically align training efforts
and requirements with the overall Learning Goals and Objectives of the Department.
o Integration of the Safety Storm Training Curriculum – Safety Storm is a 3-part program
that covers a variety of the fundamental components of key Safety concerns common in
healthcare organizations. Fourth Quarter Integration focus:
1. Group Administrators and Senior Leadership will define Learning Goals and
objectives for their Departments.
2. Group Administrators will customize the Training Modules, 18 customizable
modules, specific to their Departments and / or Functional areas.
3. Group Administrators will develop and integrate a training schedule for their
Departments. The Training Schedule will include the identification and
scheduling of training equipment, i.e. Computer / Kiosk access, Video Projectors,
etc., training locations and timing.
•
In an effort to enhance the caliber of on-going hires, UMC is in the process of evaluating Preassessment testing vendors. The pre-assessment test will evaluate both an applicant’s Behavioral
and Technical fit with respect to all levels of Career Opportunities within UMC. At present, we
are currently evaluating three (3) Vendors, e.g. ProveIt, Employ Test and Wonderlic in an effort
to identify the Vendor of Choice. We will identify the chosen Vendor and implement Assessment
testing by the end of the 4th Quarter 2015.
•
The Worker’s Compensation team, on Tuesday, June 9th, addressed the follow-up Risk Control
Assessment review by AIG conducted April 24, 2015. The survey was to evaluate and review
policy/procedure, physical hazard survey and claims management review. AIG identified five
areas of exposure for UMC. These areas ranged from accuracy of OSHA 300 compliance to
additional training and education for Fraud Prevention. Our next steps, over the next 30 days, is
to provide AIG with a plan of action with specific timeframes to accomplish our identified areas
of exposure.
o The Worker’s Compensation team is multi-disciplined and comprised of Charletta
Washington, VP Ambulatory & Ancillary Services, Derrick Lockhart, Director Safety &
Security, Peggy Fender, Director Risk Management, Mary Quirk, Occupational Health
RN and myself.
New Hires / Terminations
•
•
•
•
A significant amount of the Recruiting volume for May was driven by the Clinical disciplines.
We have experienced steady increase in recruitment since the month of January.
35% of the Hires for May were Registered Nurses.
The Termination Trend from January to present is statistically proportional between both Clinical
and Non-Clinical functions.
Nursing Recruitment
Total Number of Open RN Positions
19
7.1%
Vacancy Rate
Targeted Nursing Recruitment
•
•
•
•
•
Director of Perioperative
Services
Nursing Educators
Administrative
Supervisors
Clinical Manager
Registered Nurses
Recruitment Plan
•
Development of a Nursing / UMC recruitment brochure that will include testimonials
from patients and UMC employees from various departments – Draft is in review Anticipated date – June 18, 2015.
•
Upcoming Recruitment Fairs and Classroom Engagements for Nursing students.
o
June 13, Temple of Praise Spring Job Fair
o
June 18, Montgomery College – Career Fair
o
June 24, Prince George’s Community College - Meet and Greet
o
TBD, Coppin State University – Meet and Greet
o
June 25th – University of District of Columbia – Meet and Greet
•
Social Media – Secured a Face-book partnership with Coppin State University and Prince
George’s Community College. We also have a sponsor page inviting people to visit our
website on our Facebook page and Twitter.
•
Advertisement – The Washington Post, Healthjobsnationwide.com, Zip Recruiter,
Networking, UMC Website for the following positions:
Director of Perioperative Services
Administrative Supervisor
Clinical Manager
Clinical Informatics Coordinator
Systems Analyst
Financial Analyst
Labor Relations
Employees of all position levels at United Medical Center are taking our patient experience mission
seriously. Although employee suspensions have affected 7.2% of our workforce (78 employees) year to
date, only 2% of this number moved on to the termination stage between January 1st and June 1st of 2015.
Management and staff are demonstrating their commitment to hold each other accountable for improving
the overall patient experience. Employees value their positions with United Medical Center and positive
changes in work behavior and work ethics are evident as management continues to counsel, retrain,
reinforce, and reinvent a workforce that recognizes the mutual benefits of committing to a patient-focused
strategic turnaround. Of the 78 employees who received suspensions the majority did not grieve the
disciplinary decision. Less than 20% of the suspended employees felt management’s decision was unjust.
The grievance hearings held over this period resulted in all disciplines being upheld without progressing
to arbitration.
Governing Board Report
Hospital Operations / Quality & Compliance
June 25, 2015
Quality Management
Positive strides continue to be made with refining the hospital’s quality management program
and improving publicly reported metrics. Analysis of 2nd quarter (calendar year) preliminary
abstracted data reveals 85% of core measure results met or exceeded national averages. Quality,
IT, clinical and medical staff continue to work collaboratively on initiatives aimed at improving
clinical care impacted by core measures compliance. See Governing Board Patient Safety &
Quality meeting minutes and dashboard.
Evidence-Based Medicine (“EBM”)
Medical staff department chairpersons continue to work towards developing guidelines that
incorporate evidence-based medicine (the process of systematically reviewing, appraising and
using clinical research findings to aid the delivery of optimum clinical care to patients) into
clinical practice. An analysis of the hospital’s top Diagnosis-Related Groups (“DRGs”) was
done to determine where to target and prioritize EBM efforts. Based on diagnostic prevalence
and impact among the hospital’s patient population, psychosis, heart failure, chest pain and
pneumonia DRGs were chosen to incorporate evidence-based medicine interventions. The
guidelines will be selected, approved and incorporated into policy and practice requirements.
Utilization will be measured, monitored, reported and improved upon. See Governing Board
Patient Safety & Quality Committee meeting minutes and EBM documents.
Regulatory Compliance
The hospital received its official Department of Health report from its annual licensure survey
conducted April 7-9, 2015. Medical record reviews, environmental tours, staff interviews and
patient care observations were conducted to assess the hospital’s performance against
Department of Health licensure regulations. A plan of correction (“POC”) was submitted June
10th addressing identified opportunities to improve the following processes:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Quality control testing of newly opened urine pregnancy and occult blood kits
Specimen labeling in the presence of the patient
Expired specimen collection tubes observed in the ED
Documentation of controlled substances
Blood glucose monitoring and intervention
Removal of remains from the morgue
Respiratory treatment intervention and documentation
Correction of medical record entries
Timeliness of assessments and reassessments
1
10. Documentation of patient home medications (medication reconciliation)
11. Timeliness of new hire evaluations and annual employee health screenings
12. Facility repairs (damaged thresholds, marred doors, missing and soiled ceiling tiles, unflushed shower heads etc.)
13. Soiled air supply vents, stained floor surfaces, damaged or soiled baseboards, detached
privacy curtain hooks, etc.)
14. Other
The anticipated completion date for fully addressing the aforementioned is July 9, 2015.
High Reliability Organization (“HRO”)
Hospital leaders continue to work toward achieving success among the established 2015 quality
and performance improvement priorities. Eliminating potential patient harm, while working
towards becoming an HRO is one such priority. Among necessary steps that must be taken,
initiatives involving the following are being planned to lay the foundation for moving towards an
organization of high reliability:





Organizational trust/intimidating behaviors
Accountability & blame
Widespread adoption of performance improvement
Physician leadership in quality
Use of information technology to improve performance
See the attached article (High-Reliability Health Care: Getting There From Here) that will be
referenced during the upcoming education session of the next Governing Board meeting.
Hospital Operations
1. “April Madness” Hospital Cleanliness Competition—Staff concluded the organization-wide
cleaning competition as part of the hospital’s 2015 Quality & Performance Improvement
“Top 10 Priorities” initiative which includes the aim to “Adopt an ‘all hands on deck’ or the
‘UMC family-home’ approach to maintaining a clean, clutter-free and well-maintained
hospital environment.”
In recognition of unit or department uniqueness, complexity and variability of operational
activities, three-winner categories were established to recognize winning departments/units—
patient care, clinical and non-clinical. 8 West won first place as a patient care unit, the
Diabetes Center won 2nd place as a clinical department, while Accounts Payable / Payroll
received recognition for the cleanest and most clutter-free non-clinical department.
2. Energy Savings—The hospital received a $17,195 check for participating in an energy
curtailment program last fall. Efforts continue to be made to identify and capitalize on other
energy saving initiatives.
3. The hospitals agreement with MedAssets is approaching expiration.
Rather than
automatically renewing the agreement, due diligence of four Group Purchasing
Organizations (GPOs) including the incumbent (MedAssets), was done to determine whether
or not a better option exists that would bring about cost savings to the hospital. An RFP was
issued. A multidisciplinary evaluation committee including Finance, IT, Purchasing,
2
Contracts and Operations evaluated bidder responses of four GPOs—MedAssets, Amerinet,
Greater New York Hospital Association (“GNYHA or Premier”), and HealthTrust. Initially,
MedAssets was selected as the best solution for the hospital. However, during the
negotiations process MedAssets determined that it could not accept UMC/District required
contract language. As a result, the hospital moved on to the next most appropriate bid
responder (GNYHA) and is in the process of executing a contract. The base year cost of
partnering with GNYHA is $1.00 so long as the contract term of one year is met. Otherwise,
for the first year, $65,000 must be reimbursed to GNYHA if the contract is terminated
prematurely. The anticipated savings of contracting with GNYHA and having access to a
large contract portfolio is approximately 20%, versus not partnering with a GPO and
spending approximately 20% on medical supplies and other goods.
4. Facility enhancements continue to be made in accordance with the hospital’s strategic and
Master Facility Space Plan. Recent enhancements include the following:
Project
Status
1. Enhancement of the Surgeons’
Lounge
2. Concrete stair repair—University of
District of Columbia entrance
3. Power Plant concrete stair repairs
In process
4. Installation of Code Blue emergency
alert units throughout outside
hospital grounds
5. ED Nurse Station Renovation
In process
6. Parking lot re-striping
July 2015
7. City bus entrance repair
July 2015
8. Patient room enhancement
In process
9. Relocation and renovation of
Centralized Scheduling Offices
In process
10. New IT Training area
In process
11. Supply Processing Distribution
(“SPD”) Department expansion—
entrance vestibule & closet
In process
Complete
In process
In process
Benefit / Result
Anticipated project completion in 6
weeks.
Complete. Increased employee and
visitor safety.
Increased employee and visitor safety.
Increased patient, staff and visitor
safety. Units installed. Awaiting power
installation.
Phase I in process. Phase II with
infection control risk assessment
(ICRA) barrier placement beginning
June 23rd.
Improved patient and visitor experience.
Clear delineation of parking spaces.
Promotion of patient, visitor and staff
safety.
Tentative start date June 29th.
Necessary relocation to re-open the gift
shop within space currently occupied by
Centralized Scheduling. Anticipated
date of completion July 11, 2015.
Reconfiguration of space to facilitate
Master Facility Space Planning
activities. Improve efficiencies.
Reconfiguration of space to facilitate
Master Facility Space Planning
activities. Improve efficiencies.
Necessary to facilitate relocation of
Centralized Scheduling Department and
reopening of the gift shop.
3
Public Relations and Communications June Board Report
COMMUNITY OUTREACH:
United Medical Center has participated in and has planned a number of outreach events to educate
the community about the new physicians, services, and programs that are available to residents living
in Ward 7, Ward 8 and southern Prince George’s County.
•
On Wednesday, June 17, the Ward 8 Health Council held its monthly meeting at the hospital
with representatives in attendance from Amerihealth, Trusted Healthcare, Howard University
Hospital and other healthcare organizations from across the city. Dr. Barbara Bazron, Director
of the D.C.’s Department of Behavioral Health, provided the keynote remarks on behavioral
and mental health in Wards 7 and 8 and the programs her department manages to help
individuals and their families. UMC’s Dr. Lisa Gordon, Chair of the Psychiatry Department
spoke about how the hospital works with the patients it serves. Yvette Alexander, Chair of
City Council’s Health and Human Services Committee, UMC Board Chair C. Matthew Hudson Jr.,
and UMC CEO David Small also provided remarks. Over 75 people attended the event.
•
United Medical Center will host a lunch and learn for community and business leaders and
healthcare organizations on Friday, June 26, to provide an opportunity for individuals to learn
more about the positive changes at the hospital. Members of UMC’s Executive Team,
physicians, nurses and staff members will be present to provide short presentations, answer
questions and to get advice from hospital and on how the hospital can better serve the
community. Attendees will also be given a short tour of the facility to show them some of the
renovation and remodeling projects that have been completed.
•
United Medical Center will host a lunch and learn for community and business leaders,
politicians, and healthcare organizations in Oxon Hill, Temple Hill, Forest Heights and other
jurisdictions in southern Prince George’s County on Friday, July 10. The purpose of the session
will be to introduce UMC to the attendees, particularly since the mobile health clinic will be
regularly seen in Prince George’s County providing health screenings to residents in community.
Unlike Wards 7 and 8 in the District, many community leaders in southern Prince George’s
County are unfamiliar with the hospital and the high quality services that are provided to
patients. This will be the first in a series of events to acquaint southern Prince George’s
County residents and community leaders with UMC’s physicians and services.
•
UMC and Trusted Healthcare will host a Health Fair on August 8 in the hospital’s parking lot.
The purpose of event will be to provide immunizations and test children before the 2015 -2016
school year begins. Children will be tested by Children’s Hospital and other healthcare
providers. The parents and guardians of the children will also be screened and tested for
various medical conditions via UMC’s mobile health clinics.
ADVERTISING:
•
New radio and cable television spots featuring UMC physicians were recorded for WMMJ,
Magic 102.3 FM and the Office of D.C. Cable Television. Dr. Asmir Syed, an interventional
cardiologist, recorded spots about hypertension. Dr. Syed spoke about habits that can lead to
high blood pressure such as eating too much salt and smoking. He also spoke about how high
blood pressure can lead to stroke, heart attacks, kidney failure and require individuals to receive
dialysis treatments. In the commercial, Syed encourages people to come to UMC for blood
pressure screenings, treatments and to use other services at the hospital.
COLLATERAL/MARKETING MATERIALS:
•
Developing new UMC brochures on high blood pressure and diabetes for distribution on the
mobile health clinic and at the hospital. The brochures will include photographs of UMC
employees.
•
Photographed UMC employees who are superior performers. Their pictures will be displayed
on the white poles that support the blue awning in front of the hospital. Exceptional Care
Provided by Exceptional People will be displayed above the photos of UMC’s top performers.
REPORT TO THE BOARD OF DIRECTORS
PATIENT CARE SERVICES • MAY, 2015
Maribel A. Torres, MSM, RN-BC
Executive Vice President & Chief Nursing Officer
Emergency Department (ED) Updates
•
•
•
•
May was a very busy month in the ED. Although overall volume has decreased slightly compared
to the same period last year, with over 5,100 visits, May was the busiest month we have had
year-to-date. There was a 1.5% increase in patients that arrived by ambulance, and the
conversion rate of ambulance to admissions remained greater than 20%. Our left without being
seen (LWBS) rate decreased from the previous month, ending the month at 3.2%. This is almost
a 50% decrease in LWBS compared to May, 2014 (5.0%).
In collaboration with the new ED Provider group, EMA, during the 2nd half of May, we saw even
further improved performance indicators, reaffirming our belief that this new partnership will
be a valuable one in meeting our strategic goals and implementing best practices clinically and
operationally.
We celebrated EMS week in May, 2015. This was the first time in several years that UMC has
hosted a luncheon for EMS and was very well received. The festivities included representation
from both DC Fire and PG EMS. This celebration was a part of our collaborative relationshipbuilding strategy and was a great opportunity to establish contacts with key stakeholders in
both agencies.
A new LCD display in the waiting room displays to patients current wait times. This was
implemented as part of industry best practice and in an effort to improve patient satisfaction
related to communication. Thus far, it has been very well received. Times are updated at
regular intervals based on algorithms within our EMR that include volume and average wait
times.
2015 Emergency Department Key Performance Indicators (KPIs)
ED Metrics Empower Data
Visits
Change from Prior Year (Visits)
% Growth
LWBS
Ambulance Arrivals
Ambulance Patients Admission
Conversion
% of ED patients arrived by Ambulance
% of Ambulance Patients Admitted
Page 1 of 3
Jan-15
Feb-15
Mar-15
15-Apr
15-May
2015 YTD
Avg
4487
↓239
↓5.06%
4.6%
1221
3845
↓457
↓10.6%
3.7%
1092
4569
↓312
↓6.4%
3.4%
1232
4521
↓195
↓4.13%
3.3%
1137
5134
↓17
↓0.03%
3.2%
1372
4511
↓1220
↓26.13%
3.6%
1211
283
27.2%
23.2%
246
28.4%
22.5%
274
27.0%
22.2%
243
25.2%
21.4%
282
26.7%
20.6%
266
26.9%
22.0%
ED Ambulance Admissions with Conversion
Jan - May 2015
Ambulance Arrivals
Admission Conversion
1600
1372
1400
1232
1221
1200
1211
1137
1092
1000
800
600
400
283
274
246
243
282
266
200
0
Jan-15
Feb-15
Mar-15
Apr-15
May-15
2015 YTD
Average
ER LWBS Average for Jan - May 2015 Percentage
5.00%
4.6%
3.7%
4.00%
3.4%
3.3%
3.00%
3.5%
3.2%
2.5%
2.00%
1.00%
0.00%
ER LWBS
Average
for Jan May 2015
Page 2 of 3
Jan-15
Feb-15
Mar-15
Apr-15
May-15 Goal 2015
2015 YTD
Average
Other Nursing-Related Highlights
 We are happy to announce the below new additions to the PCS leadership team:
o Adam Winebarger, MSN, RN, CCM, has been promoted to Director of Nursing.
An experienced clinician and leader, Adam will have responsibility for all
inpatient care units as well as enterprise nursing practice, operations and
resource management. Previously, Adam served as the manager of UMC’s Care
Management department.
o Dr. Mary Horton Elliott, RN, joins UMC as our new manager of clinical
education and development. She has over 30 years of experience in nursing
leadership and education, and most recently served as dean of nursing in the
Chicago area.
o Natasha Olavarria, MSN, RN, MBA, joins the UMC family from Walter Reed
National Military Medical Center, where she most recently served as a trauma
nurse coordinator. She will be the new clinical manager for 5-West/PCU.
 To increase our commitment to patient throughput, in collaboration with Building
Services, a comprehensive bed management and repair process was implemented in an
effort to maintain a consistent level of hospital beds and streamline the repair and
tracking process.
 The Clinical Practice Committee continues to be a success with representatives from
each unit representing their peers and having a collective voice in decisions directly
related to nursing practice. Most recently, topics for discussion and action included
introduction of nursing “grand rounds”, standardization of the charge nurse role
hospital-wide, and developing a proposal for leadership to introduce a new IV catheter
that eliminates exposure to blood, thus greatly reducing the risk of accidental exposure.
Forthcoming projects include developing modules for our new online learning software,
SWANK, and developing an evidence-based research project that can be potentially
published in scientific literature, led by our new clinical educator, Dr. Mary Elliott.
 We are eagerly anticipating renovations to being on our patient care units in June and
are currently in the process of developing contingency plans related to accommodating
a surge in census during his period and ensuing optimal patient satisfaction during this
time.
Page 3 of 3
Division Ambulatory and Ancillary Services
June 2015
Goal 5: Contribute to overall health within the communities that UMC serves
Mobile Health
The UMC Mobile Health Unit continues to depict the commitment that United Medical Center
has made to positively impact the health of the community that UMC serves. In May, the mobile unit
screened approximately 150 people and was able to link 22% of those screened, to care at United
Medical Center or to another service provider.
The Mobile Unit also continues to strengthen partnerships with the District’s Managed Care
Organizations and other health services providers. UMC’s Mobile unit will be stationed, throughout the
upcoming months, at various payor wellness centers to provide physicals and to assist the payors in
capturing HEDIS (Healthcare Effectiveness Data and Information Set) data.
HEDIS measures address a broad range of important health issues. Among them are the
following:
Asthma Medication Use
Persistence of Beta-Blocker Treatment after a Heart Attack
Controlling High Blood Pressure
Comprehensive Diabetes Care
Breast Cancer Screening
Antidepressant Medication Management
Adult Immunization Status
Adult Weight/BMI Assessment
The second mobile unit will be making its debut in the community in July 2015. The installation
of the second unit will fulfill the requirements of District legislation (AL-14-661B). The second unit
will be 45 feet in length and will be comprised of 3 exam rooms and offer dental as well as some prenatal services.
Mobile Health Dates
June 6, 2015 – New United Baptist Church
June 10 – East over Shopping Center
June 13 – Health Services for Children with Special Needs
June 16, 17, 19 – Forest Heights Men’s Health Month Initiative
June 18 – Southern Ave Market
June 24 – Oxon Hill Run Park
June 25 – Langston Lane
June 26 – Lunch & Learn
June 27 – St. Marks
2
Radiology
Radiology continues to be the key diagnostic tool for many diseases and has an important role in
monitoring treatment and predicting outcome. Technological advances in digital imaging have also
enabled the images produced to be post-processed, manipulated and also transmitted rapidly to view
simultaneously with the transmitting center. The improved image clarity and tissue differentiation in a
number of situations has dramatically increased the range of diagnostic information and in many cases
the demonstration of pathology without the requirement of obtaining a tissue sample through biopsy.
As Radiology services continues to be the key driver for diagnostics in healthcare UMC is
striving to stay ahead of the curve by installing new radiologic diagnostic equipment. Over the next two
quarters the Radiology Department will install:
Equipment
Target Date of Completion
Picture Archiving Communication System (PACS)
October 2015
MRI Magnetic Resonance Imaging System (MRI)
October 2015
Computed Tomography Scan (CAT Scan)
July 2015
Radiology Room (X-Ray)
July 2015
Ultrasound (Diagnostic/Cardiovascular)
July 2015
Nuclear Medicine Camera
August 2015
Mammography
September 2015
Interventional Suite
November 2015
This new equipment will improve both access and the quality of care received by the patients
that UMC serves and places the institution among one of the first organizations in the District with this
new technology.
Division of Ambulatory and Ancillary Services
Primary Care Center
October
November
December
January
February
March
April
May
PCC
531
493
538
608
473
525
437
387 1
ORTH OPEDICS
200
195
204
190
189
157
133
100 2
GI
60
31
12
28
33
35
49
41
UROLOGY
26
55
34
26
42
52
38
15 3
OB/GYN
329
281
293
279
267
287
276
293
CARDIOLOGY
29
37
12
29
37
53
46
34
CARE CENTER
106
107
124
139
121
175
140
116
MOBILE UNIT
0
7
0
0
0
46
0
143
OCCUPATIONAL
H EALTH
15
20
16
22
21
26
26
37
SURGICAL CLINIC
39
29
29
22
34
22
24
26
WOUND CARE
CLINIC
PRIMARY CARE
TOTAL
99
77
79
73
57
108
75
94
1434
1338
1341
1416
1274
1486
1244
1286
June
July
August
September
Ambulatory Clinics
The Primary Care and Specialty clinics were 18% above budget for the month of May and year to date the clinics are 73.2%
over budget. Ambulatory Services as a whole unit were 11.9% over budget year to date. In addition, the Primary Care and Specialty
Center scheduled 88 operating room procedures attributed to 10 births as a result of clinic activity. The Primary Care Clinic continues
to see growth based on community outreach activities, mobile health screenings, and the Patient Concierge Program.
1
The Primary Care Clinic was down a provider for 2 weeks;
Orthopedic Surgeon was away from the clinic last week of May
3
Urologist was on vacation for 3 weeks
2
4
NOT-FOR-PROFIT HOSPITAL CORPORATION
Executive Management Report
To
Not-For-Profit Hospital Corporation Board
June 25, 2015 Meeting
Submitted by
David R. Small, FACHE
(Interim) Chief Executive Officer
1|Page
OPERATIONS SUMMARY THROUGH MAY, 2015
For the month of May we saw our inpatient admissions within less than 1% of our budget; the
medical/surgical admissions still lagged behind budget with a very nice increase in ObGyn services and
Psychiatry. While it is from a service provision to our community perspective good to see the
increases in the month for OB and Psychiatry, unfortunately the actual reimbursement rates are
relatively low (given most of this business was Medicaid) thus the impact to the bottom line, while
positive, is limited. Case mix index measure for the month was well under budget of 1.00 (at .975)
which again indicates less patient severity and less reimbursement paid.
Unfortunately the long delay in the anticipated Ward 8 Ambulatory Health Center coming on-line has
had a continuing negative impact on hospital performance. The budget had predicted an opening
earlier in this fiscal year, with not only increases in Outpatient revenues from Primary Clinic visits, but
also related “downstream” impact on the hospital’s diagnostic, specialty clinic, and inpatient
admission volumes that have not been realized. See below on the latest information on the status of
this initiative.
Visits to our Emergency Room continued to trail budget by 4.5%, although EMS trips increased by
1.5%. The ER staff continues to work directly with EMS for DC and Prince George’s County to have
more patients brought to UMC. Patient service efficiency as measured by “through put times”
continue to improve with the successful on-boarding of the new ER Physician partners, EMA. Of
particular note, the “left without being seen” category has showed marked improvement with a level
of 3.2% achieved.
Even with the above comments, the Net Patient Service Revenue generated from the services
rendered was slightly ahead (1%) of budget for the month (this is also negatively impacted by the
Medicaid recoupment process, associated with the change in inpatient reimbursement rates, that is
artificially increasing deductions from gross patient revenue).
On the expense side of the equation, it will be noted that the combination of Salary and Wages
(below budget for the month by $722K), Benefits (below budget by $60K), and Contract labor (over
budget by $356K) yields a positive result against budget for the month of $426K; if we consider that
we have two outstanding collective bargaining agreements, the anticipated rate adjustments when
factored in would still result in a positive result of approximately $300K for the month for this
combination of expense. Medical supply costs both for the month and year to date are well above
budget and extensive review is underway at this time to identify and correct any issues to get us
operationally back in line. For example, some expenses such as HIV reagent costs are fully covered by
grant dollars that are reflected on the revenue side of the Income and Expense report. A much more
comprehensive review report will be ready by end of this week.
The hospital at this time is also paying additional unbudgeted expenses related to the due diligence
efforts associated with the signed Letter of Intent regarding the proposed partnership; these expenses
are largely within the purchased services expense category (for legal and financial modeling services).
As the CFO’s report indicates there was a $600K loss from operations, largely due to the changes in
Medicaid Inpatient reimbursement rates (and retroactive recoupment for the fiscal year to date by
2|Page
DHCF) and the unanticipated reduction (no further payments this fiscal year) in Disproportionate
Share (DSH) program dollars for the hospital.
OTHER INFORMATIONAL MATTERS OF NOTE:
SERVICE EXPANSION UPDATE:
Jonathan Kayne from the District’s Department of General Services (DGS) indicated to me via email
that his offices had heard from the building owner at the former Unity Congress Heights location and
that a property appraisal by the owner had been ordered. Once that is done and information shared
and potential negotiations to arrive at a final purchase price might be undertaken. He estimates given
the track record of “timeliness of response” to date, it could be 60-90 days to arrive at such an agreed
upon purchase price and perhaps 60 days at least to get the sale through the Council approval
process. Thus the soonest we might expect to occupy such a space for the planned Ward 8
Community-based Ambulatory Healthcare Center would be very late in the calendar year. We
continue to monitor this situation against the timeline of our CON exemption for this facility as well as
any other sites that might become available in the intervening period (although none have
materialized over the past 18 months). This Center and its potential of downstream financial impact
to the hospital are critical and built into the current draft of the FY16 Operating Budget. We will keep
the Finance Committee apprised of any changes in the status of this initiative but on the side of fiscal
conservatism, I would recommend we do not budget any expenses or revenues for this initiative for
the FY16 budget unless there is actual confirmation of building acquisition from DGS.
As you will see in Mr. Hobbs’ report, we have been successful in “signing up” Dr. Syed for not only
cardiac service line development but also for clinic and call coverage and Cath lab work. Additionally,
Dr. Byam, a new general surgeon (specializing in abdominal surgery) has agreed to begin full time
work at UMC on 7/15. Mr. Hobbs is closing in on several other important physician recruitments
including a second GI physician, a very critical need currently. Funds in support of these priority
physician recruitments were carried over from FY2014 from District capital subsidy dollars.
It should be also noted within Mr. Hobbs’ report that for each of these physician support recruitment
expenditure there is an independently determined amount of patient service revenue (gross) on
average we can expect for each physician coming on board. This goes a long way to “redirecting”
current community physician referral patterns to UMC.
LABOR RELATIONS:
In Ms. Johnson’s report you will note the updates on both of the outstanding Collective Bargaining
Agreements (SEIU and DCNA). The SEIU arbitration hearing commenced on 6/22 and is scheduled for
two days; a final award will be issued shortly thereafter.
REPORT ON HURON LABOR PROJECT (PHASE II):
Under the current UMC contract with Huron Consulting, Huron was asked to review additional
areas/departments of the hospital that were not part of the prior (priority) scope of work in this
3|Page
regard. During this second phase of the improvement initiative for Labor and Productivity, the
following departments were evaluated for minimum staffing needs and “staffing to demand:”
Ambulatory Clinics
Environmental Services
Patient Transport
Health Information Management
Ultrasound and CT Scan Services
Skilled Nursing Facility
These specific departments were chosen because of anticipated growth (ambulatory clinics),
opportunities to leverage call-back and on-call policies within support departments, and evaluate
staffing in traditionally “fixed” departments and create a plan to ensure flexibility responding more
appropriately to fluctuations in volume or net revenue thresholds.
This work has been completed and reported out to the responsible Executive Leadership members
with several items of note. First, the SNF level of staffing is appropriate to the patient census and
requirements under DOH regulations. Second, there is an opportunity to gain further flexibility and
those templates for change will be immediately implemented. Third, there is an opportunity to
consolidate patient transportation services in a manner that is in fact less expensive than proposed by
an outside Vendor; these changes will be built into the operating budget for the new fiscal year.
Fourth, there is an opportunity for reduction of several positions within the Health Information
Management department and redeployment to other areas of the hospital and/or reduction in that
department will be quickly implemented. Finally, it will be noted that with our growth over the past
year in on-campus clinic services we now find ourselves at capacity in terms of clinical providers and
support staff. Further growth in this area must be evaluated (against actual reimbursement and cost
of service); such evaluation will be done to inform the recommended FY16 budget for this service
area.
The Huron report is attached to this Executive Report for your review.
NURSE/PATIENT RATIO PROPOSED LEGISLATION:
As previously reported to the Board, legislation has been introduced (Patient Protection Act) which in
effect would mandate nurse to patient staffing ratios. This legislation is being sequentially reviewed
by two committees of the Council (Business, Consumer, and Regulatory Affairs chaired by CM Orange,
and Health and Human Services chaired by Alexander); CM Orange’s committee held its hearing and is
marking up the legislation and then it will be forwarded on to CM Alexander’s committee. This
legislation is similar to nurse staffing bills introduced over the past 15 years across the country and
not adopted anywhere except California in 2001; the legislation requires a set number of nursing staff
based upon “heads in beds.” The DC Hospital Association representing its member hospitals has been
fighting this type of legislation for a number of years and continues to represent our opposition to this
current iteration of the legislation. We have reviewed and confirmed that should the proposed
legislation be passed, the fiscal impact on UMC would be in excess of $6.5M in staffing salary costs
(not counting paid benefits). We will keep the Board informed as this legislation moves out of CM
Orange’s committee and on to CM Alexander’s.
4|Page
Board Member Attendance 2015 - Prepared by: Donna M. Freeman, Corporate Secretary
General Board Meeting
Board Members
C. Matthew Hudson, Jr., (Chairman)
Chris Gardiner (Vice-Chair)
Steve Lyons (Treasurer)
Virgil McDonald
Maria Gomez
Dr. Cyril Allen
Girume Ashenafi
Dr. Ricardo Brown
Dr. Konrad Dawson
Robert Malson
Dr. Julianne Malveaux
David Small
Dr. Raymond Tu
January
February
March
April
May
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
EXCUSED
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
EXCUSED - Representative attended
X
Board Member Present
Board Member Absent
Board Member Inactive
June
July
August
September October November
Audit Committee
January February
Board Members
Chris Gardiner (Chair)
Girume Ashenafi
Maria Gomez
David Small
March
April
May
June
July
X
X
No Meeting
Audit committee
Board Member Absent
September October
November
Governance Committee
January February
Board Members
Virgil McDonald (Chair)
Steve Lyons (Treasurer)
Maria Gomez
David Small
X
X
X
X
X
X
X
X
X
X
March
X
X
X
X
X
April
May
June
July
September October November
X
X
X
X
No Meeting
Board Member Absent
Prepared by: Donna M. Freeman, Corporate Secretary
Finance Committee
January February
Board Members
Steve Lyons, (Chair)
Virgil McDonald
Dr. Konrad Dawson
David Small
X
X
X
X
X
X
X
X
X
March
April
May
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Board Member Absent
June
July
September
October November
Patient Safety & Quality Committee
January
Board Members
Maria Gomez (Chair)
Girume Ashenafi
David Small
Dr. Cyril Allen
X
X
X
X
X
February
March
April
May
X
X
X
X
X
X
X
X
X
X
X
X
X
June
No Meeting
Board Member Absent
July
September
October
November
Board Attendance 2015 - Prepared by: Donna M. Freeman, Corporate Secretary
Strategic Steering Committee
Board Members
January
February
March
April
May
Dr. Ricardo Brown (Chair)
Girume Ashenafi
David Small
X
No Meeting
Board Member Absent
June
July
September
October
November
2014
NATIONAL
HEALTH CARE
GOVERNANCE
SURVEY
REPORT
AHA Center for Healthcare Governance
155 North Wacker Drive, Suite 400
Chicago, IL 60606
Phone: (888) 540-6111
www.americangovernance.com
© 2014 AHA Center for Healthcare Governance
TABLE OF CONTENTS
EXECUTIVE SUMMARY............................................................................................. 5
SECTION 1:
INTRODUCTION........................................................................................................ 7
SECTION 2:
BOARD COMPOSITION AND THE COMMUNITY................................................ 9
Board Size........................................................................................................................ 9
Board Diversity.............................................................................................................. 10
SECTION 3:
BOARD STRUCTURE............................................................................................... 15
Term Limits.................................................................................................................... 15
Board Meeting Frequency.............................................................................................. 16
Board Compensation...................................................................................................... 16
Board Committees......................................................................................................... 17
SECTION 4:
BOARD SELECTION.................................................................................................. 22
Competencies Considered for Board Selection................................................................ 22
Board Member Replacement.......................................................................................... 24
SECTION 5:
BOARD ORIENTATION AND EDUCATION......................................................... 27
Charters and Job Descriptions......................................................................................... 27
New Board Member Orientation................................................................................... 28
Continuing Board Education.......................................................................................... 29
Briefings from Legal Counsel.......................................................................................... 29
SECTION 6:
BOARD EVALUATION............................................................................................... 31
Types of Board Evaluations............................................................................................. 31
Using Assessment Results................................................................................................ 31
Competency-Based Evaluations...................................................................................... 32
4
SECTION 7:
EXECUTIVE PERFORMANCE AND COMPENSATION....................................... 35
CEO Performance Evaluation........................................................................................ 35
CEO Compensation....................................................................................................... 35
CEO Retention and Succession Planning....................................................................... 36
SECTION 8:
QUALITY AND STRATEGY OVERSIGHT............................................................... 39
Use of Quality Objectives and Benchmarks.................................................................... 39
Board Engagement and Accountability for Quality.......................................................... 40
Tracking Strategic Performance...................................................................................... 40
SECTION 9:
INTERNAL AND EXTERNAL STAKEHOLDERS................................................... 43
Alignment with Physicians and Clinical Staff................................................................... 43
Understanding of Community Health Needs.................................................................. 43
Board Receipt of the IRS Form 990.............................................................................. 43
SECTION 10:
BOARD CULTURE..................................................................................................... 46
Executive Sessions.......................................................................................................... 46
Board Meeting Dialogue and Discussion......................................................................... 48
Electronic Board Portals.................................................................................................. 48
SECTION 11:
READINESS FOR HEALTH CARE TRANSFORMATION..................................... 51
Knowledge of Health Care Transformation..................................................................... 51
Engagement in Transformational Governance Practices................................................... 51
Information Technology Resources to Support Transformation....................................... 55
Progress in Transformation.............................................................................................. 55
Willingness to Give Up Some Autonomy....................................................................... 55
2014 National Health Care Governance Survey Report
EXECUTIVE SUMMARY
Health care is undergoing a complex, uncertain and
fast-paced transformation on many fronts. Hospitals
and health systems are adapting to shifts in health care
reimbursement that encourage greater provider
coordination and integration (mergers, acquisitions,
affiliations, joint ventures and other relationships) that
will radically change the organizational landscape.
In addition, evolving advances in information and
medical technology, an emphasis on population
health that requires organizations to reconsider how
and with whom they can partner to best achieve their
mission and vision, and a myriad of new laws and
regulations are compounding the growing need for
diligent, high-performance governance.
Despite the growth of increasingly diverse
populations in communities across the nation, survey
results indicate that little change in the racial and
ethnic composition of board members has taken
place. Gender and age gaps are not closing either;
trustees are generally older (in 2014, only two in 10
board members were under age 50), and nearly
three-quarters of board members are male. And while
clinical representation is essential as hospitals strive to
continually improve quality and patient safety, the
percentage of clinical board members has declined.
Despite this, board chairs and CEOs both report high
levels of alignment among boards, medical staffs and
nursing staffs.
This 2014 National Health Care Governance Survey
includes many questions from previous surveys that
allow insightful comparisons of governance evolution
over time. It also probes new areas to enable a better
understanding about how hospital and health system
boards are preparing for and responding to the
transforming health care environment. For the first
time, the survey examined the results of questions by
types of boards, including independent hospital boards,
subsidiary boards of health care systems and boards of
health care systems. The survey results confirm the
growing transition toward system boards holding
greater fiscal and strategic responsibility than their
subsidiary organizations; at the same time, however,
local boards continue to offer a valuable purpose and
essential connection and engagement link to local
communities. Independent hospitals typically utilize
more traditional board structures, including longer
board member terms and term limits and more
frequent meetings, while hospital systems and their
subsidiary boards typically have shorter terms and
term limits, and meet less frequently.
One of the challenges boards face as health care
experiences significant change is the need for greater
evolution in composition. Diversity of background,
life experience, gender and ethnicity are important
and must be factored into board composition. At the
same time, boards should have an intense focus on
ensuring that they possess the competencies needed
to lead their organizations successfully into the future.
Clearly defined skills and competencies are being
employed to a greater degree in new board member
selection; however, they are employed less frequently
for evaluations and re-nominations of existing
board members.
Ensuring purposeful and highly productive hospital
governance requires considering how leading
governance best practices are carried out. About one
half of hospitals reported conducting a full board
assessment in the past three years, a process that,
when used properly, has been shown to be a major
factor in continuous governance improvement.
5
When new trustees are selected for board service, a
clear role description and a robust trustee orientation
process can ensure that they have a deep leadership
understanding of the organization, the environment
in which it operates and the challenges and
opportunities that will define its success. The goal is
to enable board members to quickly become wellinformed, active participants in governance strategic
thinking, dialogue and debate. Currently, nearly
one-half of surveyed CEOs report that their
organizations do not have a role description for their
trustees, board chairs and committee chairs. And
while nearly all hospitals and health systems report
conducting some form of new trustee orientation,
they reportedly are primarily focused on educational
basics, with limited mentoring by more experienced
board members or “shadowing” of clinicians to gain
insights about care delivery, quality and patient safety.
The combination of limited-scope orientations and
the decline in board education indicated by survey
findings is concerning; now more than ever,
governance education focused on continual boardwide knowledge-building is essential to ensure that
boards are best prepared to make well-informed
strategic decisions that successfully shape the future
of their hospitals and the communities they serve.
While there is agreement by both CEOs and board
chairs that boards are highly engaged in quality and
patient safety, board chairs perceive greater levels of
CEO accountability for quality than do CEOs. In
addition, in the areas of executive performance and
compensation, CEOs’ perception of their
accountability was lower in nearly every area
compared to the views of board chairs. Futurefocused boards should view this as an opportunity to
enhance the board/CEO partnership through review
of the CEO evaluation process, but also strengthened
CEO retention and succession plans.
6
Boards have often struggled to find the balance
between the board’s role in affirming high-level
strategic direction and management’s role in plan
implementation. As many of the ideas in today’s
health care transformation move from concept to
reality, the concept of shared governance is gaining
traction, encouraging trustees, senior leaders, and
clinical leaders to challenge one another and
complement one another’s skills and roles in ways
that most benefit the organization. Boards must
continually focus on purposeful and productive
efforts to lead strategic direction to improve quality
and patient safety, strengthen financial viability, ensure
executive performance, respond to community health
needs and more. Just over 40 percent of hospital and
health system boards reported that more than onehalf of their governance time is spent in strategic,
active discussion, deliberation and debate. At the same
time, nearly one in five boards report spending less
than one-quarter of their meeting time engaging in
this manner.
Board chairs and CEOs are reportedly generally
knowledgeable about emerging trends in health care
as they prepare their organizations for success through
health care transformation. Board chairs reported
higher levels of engagement than did CEOs in
embracing new practices to prepare them to govern
successfully through transformation.
The dramatic transformation taking place in the way
in which health care is financed and delivered in
communities across the nation creates great challenge
and opportunity for governing boards. The 2014
National Health Care Governance Survey provides
unique insights that can assist boards, executive teams
and clinical leaders to govern together for success.
SECTION 1
INTRODUCTION
The 2014 National Health Care Governance Survey
was developed by the American Hospital Association’s
(AHA) Center for Healthcare Governance. Building
on the results of previous national governance surveys
conducted by the AHA in 2011 and 2005, the 2014
survey also includes many new questions about
different types of boards, board selection and
evaluation, board culture and readiness for health care
transformation.
Two survey instruments were developed, one
designed for hospital chief executive officers (CEOs)
to complete, and the other to be completed by
hospital board chairs. The surveys were sent via
electronic mail and postal mail to the CEOs of 4,806
nonfederal community hospitals and health systems in
the United States. Specialty hospitals, such as eyeand-ear and psychiatric hospitals were not included.
CEOs were requested to provide the appropriate
survey to their board chairs. Respondents were given
the option to respond to the survey online or to
complete the hard copy.
Survey responses were collected during spring 2014.
A total of 1,078 CEOs (a 22 percent response rate)
and 710 board chairs (a 15 percent response rate)
responded to the survey.
Overall, the respondents were generally representative
of hospital bed size distribution and geographic
distribution in the United States (see Figure 1.1).
Public hospitals and not-for-profit hospitals were
somewhat overrepresented in the survey results, as
were non-metro/rural hospitals. Metropolitan
hospitals and health systems and investor-owned
hospitals were somewhat underrepresented. AHA
non-member systems were somewhat overrepresented,
with less representation from AHA member hospitals.
The majority of the questions were asked of both
CEOs and board members, allowing comparisons
and contrasts throughout this report. Questions about
board composition and structure were only asked
of CEOs.
7
Figure 1.1 – Survey Respondents Versus All Hospitals
All Hospitals
CEO Respondents
Board Chair Respondents
< 100 Beds
52%
53%
47%
100-299 Beds
32%
30%
33%
>= 300 Beds
16%
17%
20%
Northeast
13%
16%
19%
Midwest
30%
37%
35%
South
39%
28%
28%
West
19%
19%
18%
Public
21%
27%
27%
Not-for-Profit
58%
64%
66%
Investor-Owned
21%
9%
7%
Metro
60%
53%
55%
Non-Metro
40%
47%
45%
Non-AHA Member
38%
50%
49%
AHA Member
62%
50%
51%
Size
Census Region
Ownership
Location
Multi-Hospital System
8
SECTION 2
BOARD COMPOSITION AND THE
COMMUNITY
Health care in America is transforming, and so are the communities that hospitals serve. As patients become
more diverse, the diversity of hospital caregivers, leaders and board members must evolve to reflect changing
community desires and needs. At the same time, the structure of America’s hospitals is changing. While
community hospitals remain the bedrock of most communities, hospitals and health systems are increasingly
forging partnerships and alliances to better serve their communities. This 2014 survey is the first examination
of the various types of boards, including freestanding hospital boards, hospital subsidiary boards and boards of
system headquarters.
Board Size
Over the past several decades, hospital boards have trended toward smaller sizes, which allow them greater
flexibility and enable more in-depth, robust discussions and decision-making. However, as health care transforms
and the complexity of the challenges faced by hospitals and health systems and their boards increases, board
sizes may be shifting again.
The survey results indicate a slight increase in average board size, from 12 board members in 2011 to 13 board
members in 2014 (see Figure 2.1). System boards typically had the largest boards, with an average of 16 board
members. System boards also had the least number of non-voting board members (on average less than one),
and the largest average number of members. Both freestanding hospital boards and hospital subsidiary boards
reported approximately one non-voting board member (see Figure 2.2).
Figure 2.1 – Board Size
Figure 2.2 – Nonvoting Board Members
Average Numbers
of Board Members
Freestanding Hospital Board
12
Hospital Subsidiary Board
12
System Headquarters Board
16
2014 Average all respondents = 13
Average Numbers of
Nonvoting Board Members
Freestanding Hospital
Board
1
1
System Headquarters
Board
0.5
9
Board Diversity
For many hospitals across the country, the racial and
ethnic diversity of communities is changing and
cultural disparities in health care are becoming more
and more evident. It is trustees’ role and responsibility
to ensure that the hospital knows what the community’s health needs are, and how to best deliver care that
meets the needs of those served by the organization.
In 2011, the AHA, American College of Healthcare
Executives, Association of American Medical Colleges,
Catholic Health Association of the United States and
America’s Essential Hospitals stood together in a
national call to action to eliminate health care
disparities. The focus is threefold, including increasing
the collection of race, ethnicity and language
preference data; increasing cultural competency
training; and increasing diversity in governance and
leadership. The call to action for increased governance
and leadership diversity is focused on leadership that
is reflective of the communities served.
Despite this national call to action, the survey results
highlight a lack of progress in board diversity of race
or ethnicity, gender, age and clinical profession.
Race and Ethnicity
Minorities currently comprise 37 percent of the
U.S. population according to the U.S. Census Bureau.
In the coming years the U.S. population’s diversity
is expected to grow significantly, with minorities
comprising an estimated 57 percent of the population
in 2060.1 Despite this growing diversity, in most
communities hospital boards are predominantly
Caucasian.
The 2014 survey results indicate that little has
changed in the racial and ethnic composition of
hospital boards since 2011, with almost nine in 10
board members reportedly Caucasian (see Figure 2.3).
Slightly over half of all hospitals in the survey that
reported board composition had at least one
non-Caucasian board member; leaving 47 percent
Figure 2.3
2011 Board Member
Demographics
4%
4%
12%
4%
2%
1%
3%
2%
2014 Board Member
Demographics
10%
76%
88%
2011 Communities that
Responding Hospitals
Serve*
4%
2%
1%
19%
2%
9%
1%
1%
3%
1%
5%
76%
90%
Board Race/Ethnicity
2014 Communities that
Responding Hospitals
Serve*
Caucasian African American Hispanic/Latino Asian/Pacific Islander American Indian Other
*Community diversity as reported by responding hospitals, may not reflect the actual demographics of the community.
1 Source: https://www.census.gov/newsroom/releases/archives/population/cb12-243.html)
10
with no racial or ethnic minority representation
in 2014 (see Figure 2.4).
Gender
When asked whether their board’s composition reflects
the diversity of the community and stakeholders
served by the organization, the average score was 3.5
(using a scale of 1 – Not at All, to 5 – Completely).
Freestanding hospitals and hospital subsidiary boards
reported that their board composition was more
reflective of the community served, while system
boards were less confident (see Figure 2.5).
While the percentage of men and women is nearly
equal in the U.S., according to the U.S. Bureau of
Labor Statistics women comprise nearly 80 percent
of the health care workforce. In recent years, the
importance of women in leadership has been elevated,
but there has been little shift in hospital board
representation. In fact, the gender divide on hospital
boards remained the same in 2014 as it was in 2011
(see Figure 2.6). Just under three-quarters of all board
members were male, while 28 percent were female.
Figure 2.4
Figure 2.6 – Board Gender
Hospitals with At Least One
Non-Caucasian Board Member
100%
75%
50%
25%
47%
0%
53%
200520112014
Female Trustees23%28%28%
Male Trustees 77%72%72%
Hospitals with At Least One Non-Caucasian Board Member
Hospital Boards Comprised of All Caucasian Board Members
* Percent of all hospitals that reported board composition,
not the total of all survey respondents.
Figure 2.5 – Boards Reflective of
Community Diversity
Average Score
Freestanding Hospital Board
3.6
3.4
System Headquarters Board
2.9
Overall
3.5
Extent that the Composition Reflects Community Diversity
Scale of 1 (Not at All) to 5 (Completely)
* Community diversity as reported by hospital, may not reflect the actual
demographics of the community.
Age
Four generations are now represented in the
workforce, but not necessarily around the board
table. Boards missing the diversity of age may also be
missing the commitment, passion for service, and
fresh thinking of their community’s next generation
of leaders. In addition to the benefits younger leaders
can offer to boards, organizations may also be missing
an opportunity to offer their communities a valuable
leadership development experience for these
future leaders.
This year’s survey results reiterate that the governance
age gap is not narrowing. Hospital trustees are getting
older. Since 2005, the percentage of board members
under the age of 50 has continued to decline. In
2014, only two in 10 board members were under age
11
Figure 2.7 – Board Age
Figure 2.8
Clinical Professions Serving on Boards
100%
40%
75%
30%
50%
20%
25%
10%
0%
2005 20112014
<= 5029% 24% 21%
0%
200520112014
51-7062% 67% 68%
All Clinicians
>= 719% 9% 10%
Physicians20%20%20%
31%29%
Nurses 6%5%
Other Clinicians
50. The majority of hospital trustees were ages 51-70,
with the remainder over age 71 (see Figure 2.7).
5%
4%
*2011 was the first survey to ask about clinicians
other than physicians.
Clinical Representation
Expertise is required on hospital boards in a variety of
areas, but as hospitals and health systems continue to
strive for excellence in quality and patient safety the
need for a strong clinical voice on the board is
essential. Clinical expertise may come from a variety
of professions, including physicians, nurses, pharmacists,
and other clinical specialties. Despite their essential
perspective, the percentage of clinical board members
declined from 31 percent in 2011 to 29 percent in
2014 (see Figure 2.8). Overall, the percentage of
physician trustees remained the same from 2011 to
2014, but the percentage of board members that were
nurses or other clinicians declined.
Of all survey respondents, three-quarters had at least
one physician serving on their board. More than
one-third (37 percent) had at least one nurse on their
board, and 22 percent included at least one other
clinical profession as a board member (see Figure 2.9).
Diversity Varies by Board Type
There are sizeable differences in board composition
by type of board. System boards had slightly greater
African American representation, more males, and
more trustees in the 51–70 age range. System boards
12
Figure 2.9 – Percentage of Hospitals
with Nurses, Physicians and Other
Clinicians on the Board
Percentage
Physician
75%
Nurse
37%
Other clinician
(e.g., pharmacist, therapist)
22%
also tended to have greater physician representation.
Hospital subsidiary boards included more females and
a greater percentage of younger trustees. Freestanding
hospital boards had the highest percentage of
Caucasian board members. Freestanding hospital
boards also had the largest percentage of trustees over
age 71, more nurses and the smallest percentage of
physician representation (see Figure 2.10).
As health care organizations grow and evolve, the
various types of boards used throughout systems and
their subsidiaries serve a unique role. While system
boards are typically responsible for finance, strategic
Figure 2.10 – Board Composition by Type of Board
Freestanding Hospital
Board
Hospital Subsidiary
Board
System Headquarters
Board
Caucasian
90%
86%
86%
African American
4%
6%
7%
Hispanic/Latino
3%
3%
3%
Asian/Pacific Islander
1%
2%
2%
American Indian
1%
0%
1%
Other
1%
4%
1%
Unknown
0%
0%
0%
Male
72%
69%
76%
Female
28%
31%
24%
<=50
17%
19%
12%
51-70
63%
70%
81%
>=71
20%
11%
7%
Physician
17%
22%
26%
Nurse
4%
6%
4%
Other Clinician ( e.g., pharmacist,
therapist)
5%
3%
2%
Race/Ethnicity
Gender
Age
Clinical Background
13
direction and rigorous oversight of performance and
risk, local or subsidiary boards are responsible for
understanding community needs and perceptions and
relaying those needs to the system board, as well as
local quality, patient safety and physician credentialing.
Local boards should be more reflective of the
community served, while system boards may be more
focused on professional expertise and experience.
Section Highlights
• The average board size was 13 trustees
• 47 percent of all hospitals in the survey that
reported board composition had no racial
or ethnic minority representation in 2014
• No progress has been made since 2011
in gender diversity
• Hospital trustees are getting older
• The percentage of clinical board members
declined from 31 percent in 2011 to 29
percent in 2014
• There are sizeable differences in board
composition by type of board
14
SECTION 3
BOARD STRUCTURE
Highly effective boards ensure that their governance
structure and operational practices are designed for
maximum governance effectiveness and successful
achievement of the organization’s mission. When they
govern at peak performance, the board and individual
trustees play an important role in helping to ensure
that the organization gains strength and new capacity
to sustain success through the change ahead; doing so
requires a clear understanding of the requirements for
governing excellence.
Boards set the tone for successful governance by
ensuring that clear policies and procedures clarify
expectations for board term limits, board meeting
frequency, board committee roles and participation
requirements and board compensation.
Term Limits
Board term limits offer a formal process that enables
longtime board members to leave the board. Term
limits also provide a way for trustees to leave the
board who may no longer be a good fit for the
organization’s governing body. At the same time,
board terms ensure consistency of board composition
to prevent continuous turnover.
The complexity of health care brings unique
challenges to board term limits. Hospital and health
system boards must balance the value of experienced
board members with the opportunity to bring fresh
thinking and perspectives to governance dialogue and
strategic direction setting.
In 2014, the average board term was 3.9 years, up
slightly from the average of 3.5 years in 2011.
Freestanding hospital boards had longer board terms
(more than four years) than hospital subsidiary boards
or system boards (see Figure 3.1).
Figure 3.1 – Term Length
for Board Members
Average
Number of Years
Freestanding hospital board
4.4
Hospital subsidiary board
3.1
Local hospital board with limited
authority
2.9
Local hospital board with no
fiduciary duties
3.1
Local hospital board with
significant authority
3.4
System headquarters board
3.1
2014 Average all respondents = 3.9
2011 Average all respondents = 3.5
The maximum number of consecutive terms in 2014
averaged 3.3 terms. Like the average board term
length, the number of consecutive terms allowed was
highest for freestanding hospitals (3.5 terms), and
lower for hospital subsidiary boards and system boards
(see Figure 3.2).
When combined, if a board member served the
maximum number of consecutive terms, the average
length of board service would be nearly 13 years.
For freestanding hospital boards, the average
maximum length would be over 15 years, while the
average for hospital subsidiary boards would be
9 years and the average for system headquarters
boards would be nearly 10 years.
15
Figure 3.2 – Maximum Number
of Consecutive Terms
Figure 3.3 – Number of Regularly
Scheduled Board Meetings Annually
Average Number of
Consecutive Terms
3.5
11
3.0
8
limited authority
2.9
limited authority
7
fiduciary duties
2.9
fiduciary duties
8
3.1
9
3.2
8
Average all respondents = 3.3
Average all respondents = 9
Board Meeting Frequency
The frequency with which hospital and health system
governing boards meet varies depending on the scope
of the governing board’s responsibilities, board
composition, travel requirements and a variety of
other factors. Some system boards with wide-ranging
representation may only meet four times a year with
longer board meetings, while other boards may meet
more frequently but for a shorter duration.
As hospital trustee responsibilities grow, there is no
doubt that their expertise is valuable and their
personal and professional time is at a premium.
Compensation rewards trustees’ valuable contributions,
and some believe it may result in improved governing
performance, or may contribute to a better ability to
recruit future trustees. At the same time, compensating
trustees may raise questions about trustees’ motives
and incentives to serve and act on the board.
Compensation may also increase the board’s liability,
and may have the potential to hinder advocacy clout.
In 2014, boards reported holding an average of nine
board meetings annually. Freestanding hospital boards
averaged the highest frequency of board meetings,
with 11 meetings annually. Hospital subsidiary boards
and system headquarters boards met on average eight
times a year. Within hospital subsidiary boards,
governing bodies with limited authority met less
frequently, while governing bodies with significant
authority met more frequently (see Figure 3.3).
Board Compensation
Serving on a hospital or health system board is
increasingly complex, requiring a significant time
commitment and dedication from board members.
16
Average Number of
Board Meetings
While some believe that the growing complexity and
demands of not-for-profit trustees merits
compensation, others believe that trustees are
motivated by non-financial benefits, including the
opportunity to serve the local community and
provide value to the local hospital or health system.
Despite some debate, compensating trustees for their
important leadership work is uncommon.
The overall percentage of hospital and health system
boards that compensate their members has not
changed since 2011. While 12 percent of hospital and
Figure 3.4
Figure 3.5 – Forms of Board Member
Compensation by Type of Board
Board Member Compensation
(Excluding Reimbursement for
Out-of-Pocket Expenses)
3%—
10%
2%— 8%
88%
88%
2011
2014
Annual Fee
3%
3%
4%
Per-meeting fee
12%
6%
4%
85%
91%
92%
No compensation
Do not know
0%
0%
1%
health system boards provided some form of
compensation, 88 percent offered no compensation
outside of reimbursement for out-of-pocket meetingrelated expenses (see Figure 3.4).
Freestanding hospitals were most likely to
compensate trustees, with the most common reported
compensation in the form of a per-meeting fee
(12 percent of all freestanding boards do this). Hospital
subsidiary boards that provided compensation were
also most likely to provide a per-meeting fee (6
percent), followed by an annual fee (3 percent). System
headquarters boards were least likely to provide trustee
compensation; those that did were equally divided
between compensating trustees through an annual fee
or a per-meeting fee (4 percent each) (see Figure 3.5).
Board Committees
Board committees are an essential component of
effective hospital governance and leadership. They
form the “substructure” that enables the full
governing board to focus on larger issues of policy,
strategy and vision. Many boards utilize a
combination of standing board committees as well as
ad hoc committees and task forces that address
specific, short-term issues or needs.
100%
75%
50%
25%
0%
Annual Fee Per-Meeting Fee No Compensation
Successful boards use committee to maximize
their governance time and energy, enhance their
effectiveness and understand their position, progress
and performance in key areas. When effective,
substructure groups provide the analysis and
recommendations necessary for effective and
well thought-out full board decisions.
The most common standing committees were quality
and finance. Over half of all boards also reported
having a standing executive committee, governance/
nominating committee and audit/compliance
committee (see Figure 3.6).
The prevalence of a standing quality committee has
markedly increased in the last decade; fewer than six
in 10 boards reported having a quality committee in
2005, compared to more than eight in 10 boards
reporting a quality committee in 2014. The 2014
survey also revealed a slight decrease in the overall use
of standing finance committees, down to 80 percent
17
Figure 3.6 – Standing Committees
75%
82%
Quality
83%
80%
Finance
68%
66%
Executive
Governance/
Nominating
Committee Meeting Frequency
60%
60%
The frequency with which board committees meet
varies, and is typically dependent on how frequently
the full board meets, as well as the individual
committee’s responsibilities. For example, if a board
meets 10–12 times a year, it is common for the
finance committee to meet monthly. If a board meets
quarterly, as system boards do, the committees may
meet less frequently. At the same time, some
committee responsibilities may only require quarterly
meetings, while others may require monthly meetings
to properly carry out the committee’s responsibilities.1
51%
52%
Audit/Compliance
44%
42%
Strategic Planning
Executive
Compensation
36%
37%
Fundraising/
Development
18%
19%
Community
Benefit/Mission
14%
17%
Government
Relations
100%
75%
50%
25%
4%
6%
0%
subsidiary boards, which is reflective in the near
certain use of finance committees on system boards
(98 percent) compared only six in 10 on hospital
subsidiary boards (see Figure 3.7). System boards were
also more likely than their subsidiary boards to have
standing committees in the areas of quality, audit/
compliance, governance/nominating, executive,
strategic planning, and executive compensation.
2011 2014
compared to 83 percent in 2011; however, that decrease
may be attributed to the centralization of finance
responsibilities at system boards resulting in a decline
in finance committees at the subsidiary board level.
Changing Board Structures
As health systems grow in size, the responsibilities of
the system and subsidiary boards are shifting to
complement one another. This change is reflected in
the typical standing committees utilized by each type
of board. System boards typically hold significantly
more responsibility for finance than do hospital
Nearly four in 10 standing board committees met
monthly in 2014. The majority of the remaining
standing committees reported meeting either
bi-monthly (25 percent) or quarterly (28 percent).
Few boards reported their committees meeting
only semi-annually or annually (see Figure 3.8).
Use of “Outside” Expertise
If a hospital or health system is lacking in a particular
competency or area of expertise, it may be beneficial
to engage an individual from outside the service area
to serve on a board committee. These individuals
who serve on a board committee, but not on the full
board, may provide unique and needed expertise and
new perspectives. The practice of engaging external
expertise may also serve as an effective “feeder”
system for identifying competent individuals for
future full board service. In 2014, over half of
1 Adapted from the Summer 2013 Great Boards Newsletter, by Barry S. Bader and Pamela R. Knecht, entitled Most Commonly Asked Questions About
Board Committees.
18
Figure 3.7 – 2014 Standing Committees
By Board Type
76%
87%
94%
82%
Quality
Figure 3.8
Average Number of Times a Year
Committees Meet
3%
5%
85%
Finance
39%
28%
60%
98%
80%
25%
51%
34%
Executive
86%
52%
Monthly Bimonthly Quarterly
Semi-Annually Annually
54%
56%
Governance/
Nominating
88%
60%
13%
20%
21%
17%
Audit/Compliance
hospitals and health systems reported using an
“outsider” on at least one committee (see Figure 3.9).
66%
58%
80%
66%
Strategic Planning
44%
33%
52%
42%
Executive
Compensation
39%
Fundraising/
Development
20%
62%
37%
18%
21%
20%
19%
Community
Benefit/Mission
100%
75%
50%
0%
25%
4%
7%
14%
6%
Government
Relations
Total
Audit Committees
The governing board has a responsibility to engage
external auditors to perform an annual audit of the
hospital’s financial records. This audit helps the board
determine if the financial position and operations are
accurately and fairly presented, and are in accordance
with generally accepted accounting principles. Some
boards fulfill this responsibility through the use of
a standing audit committee, which assists the board
in fulfilling its oversight responsibilities with respect
to the independent auditor’s qualifications and
independence. Members of audit committees
typically possess a strong understanding of finance
and accounting practices, and at least one member
should be a “financial expert.”
About one-half of all hospital boards reported the use
of a separate audit committee in 2014. Separate audit
committees were generally comprised of independent
or outside directors, and were overwhelmingly
chaired by a board member with competencies or
experience in accounting and/or managerial finance
(see Figures 3.10, 3.11 and 3.12).
19
Figure 3.9
Figure 3.10
Use of “Outsiders” Who are
Not Trustees But Serve as Members
of Some Board Committees
Use of a Separate Audit Committee
46%
No
Yes
1%
Don’t
know
Yes
No
0%
Do not
know
0%
25%
2%
25%
2%
50%
56%
50%
48%
75%
50%
75%
53%
100%
42%
100%
CEO Response Board Chair Response
Audit Committee Comprised Solely
of Independent/Outside Directors
Audit Committee Chaired by a Member
with Competencies/Experience in
Accounting and/or Managerial Finance
100%
50%
75%
34%
39%
63%
75%
59%
100%
92%
Figure 3.12
90%
Figure 3.11
50%
1%
1%
1%
1%
Do not
know
6%
No
Yes
Not
applicable
7%
1%
0%
1%
2%
25%
Not
applicable
No
Yes
0%
Do not
know
1%
25%
20
Section Highlights
• The average board term was 3.9 years and
the average number of consecutive terms was
3.3 terms, resulting in a maximum allowable
board service of nearly 13 years
• Freestanding hospitals had longer terms and
term limits than did subsidiary boards and
system boards
• The average number of board meetings
per year was 9
• Freestanding hospital boards met more
frequently than did hospital subsidiary boards
and system boards
• 12 percent of hospital boards offered board
member compensation
• The most common standing committees were
quality and finance
• System boards were more likely than
subsidiary boards to have standing
committees in the areas of finance, quality,
audit/compliance, governance/nominating,
executive, strategic planning and executive
compensation
• Nearly four in 10 standing board committees
met monthly in 2014
• Over half of boards reported using an
“outsider” on a committee
• About 50 percent of all hospital boards had a
separate audit committee in 2014
• Audit committees were generally comprised
of independent directors, and were chaired by
a financial expert
21
SECTION 4
BOARD SELECTION
A growing body of research is beginning to connect
competencies to both individual and organizational
performance in many sectors, including health care.
This link is motivating interest in competency-based
selection and development of people serving on
for-profit and not-for-profit governing boards. In the
wake of calls for greater governance effectiveness and
accountability, competencies are beginning to be
applied to board work because of their capacity to
improve performance.
In 2007 the AHA Center for Healthcare Governance’s
Blue Ribbon Panel on Health Care Governance
identified essential board characteristics, skills and
experience. In a 2009 follow-up Blue Ribbon Panel
report, two sets of core competencies for board
members of hospitals and health systems were
identified. First, the Panel identified the knowledge
and skills that all boards, regardless of the type of
hospital or system they govern, should include:
1) health care delivery and performance; 2) business
and finance; and 3) human resources. Second, the
Panel recommended personal capabilities that should
be sought in board members.
While critical competencies (skills and knowledge)
are important, what differentiates excellent board
members are characteristics that are more difficult to
learn in board member education and orientation,
including social roles, self-image, personality and
motivation. How a trustee perceives the role of the
hospital in the community, and his or her role on the
board, impacts leadership style and decision-making.
A trustee’s self-image must be appropriately aligned
with the new enterprise, and trustees must possess the
personality and intrinsic motivation necessary to
serve. The best trustees are motivated by achievement
of the hospital’s mission.1
Competencies Considered for Board
Selection
Boards should comprise individuals who display a
diversity of opinions and independent thought and
actions. Trustees should have demonstrated
achievement in their career field and possess the
intelligence, education and experience to make
significant contributions to governance. They should
also possess the personal attributes that will contribute
to sound working relationships with other board
members and the executive staff. Instead of a board
composition that is simply representational, boards of
trustees should seek to develop a composition that
also reflects the overarching experience and expertise
needed to successfully govern in today’s era of
transformation. The board should clearly define and
recruit trustees with the skills, experience and
personal characteristics that complement existing
board members’ resources and that result in a more
well-rounded, competency-based board.
This is happening in many hospital boards, but there
is room for growth. In 2014, board chairs reported
that their board used knowledge/skill and personal
capability competencies to select and evaluate board
members at 3.8 on a scale of one (not at all) to five
(completely). CEOs reported the use of competencies
for new board member selection and existing board
member evaluation less often, with an overall rating
of 3.5 (see Figure 4.1).
1 “Leadership Toolkit for Redefining the H: Engaging Trustees and Communities”. American Hospital Association Committee on Performance Improvement
and Committee on Research, 2014
22
Figure 4.1
Extent the Board Uses Knowledge/Skill and Personal Capability Competencies
to Select and Evaluate Board Members
100%
7%
10%
3%
4%
26%
39%
26%
22%
25%
20%
50%
42%
75%
0%
5
Completely
4
3
Somewhat
2
1
Not At All
CEO Board Chair
Average Score: CEO = 3.5 Board Chair = 3.8
Competency-Based Trustee Selection
Essential Core Competencies
Compared to 2011, more hospitals are using
competencies for their trustee selection process.
In 2014, four in 10 board chairs reported using
competency-based criteria for selecting new board
members, and 13 percent reported using competencies
for selection of new board chairs. CEOs rated the use
of competencies for both new trustee selection and
board chairs lower than did board chairs. Overall,
approximately 40 percent of all hospitals did not use
competencies at all in the selection process for new
trustees or new board chairs (see Figure 4.2).
When selecting new board members and board
chairs, board members and CEOs generally agreed
that competencies in the area of finance and business,
strategic planning and visioning were most important
(see Figure 4.3).
Other highly rated competencies for new board
members included quality and patient safety and
previous board experience.
Previous board experience and quality and patient
safety expertise were also rated as important for new
board chairs; however, both board chairs and CEOs
further believe that conflict management is an
important skill for new board members to possess.
In contrast, clinical practice experience, human
resources/organizational development and legal
expertise were viewed as more important in new
board members than in new board chairs.
23
Figure 4.2
Competency-Based Trustee Selection
(Use of Full Board-Approved
Criteria/Competencies for Selecting
New Board Members)
32%
37%
35%
40%
Yes, for all new
board members
5%
5%
7%
13%
Yes, for new
board chairs
40%
31%
42%
38%
No
The annual evaluation process, as well as a
re-nomination process when a trustee’s term expires,
is an opportunity to regularly compare the desired
board competencies with the existing board
composition, skills and experience to ensure that
there are no gaps.
2011 CEO 2011 Board Chair
2014 CEO 2014 Board Chair
24
100%
75%
50%
0%
25%
28%
31%
21%
21%
Not applicable/
don’t know
Board Member Replacement
Defining essential core competencies is critical before
selecting new board members and board chairs;
however, equally important is using those core
competencies to evaluate the performance of existing
board members. Boards should conduct a selfassessment annually; the process should include a
self-evaluation of individual trustees’ performance,
skills and competencies. Leading-edge boards also
conduct a trustee peer evaluation in which board
members anonymously evaluate one another’s
performance and make suggestions for ways their
colleagues may strengthen their contribution to
board leadership.
Despite this, eight in 10 hospitals reported that no
board member has been replaced or not been renominated because of failure to demonstrate the
needed competencies for governance effectiveness
(see Figure 4.4). While commitment to serving on a
hospital board is an honor and a valuable
contribution to the community, hospital boards must
implement a true competency-based approach when
evaluating trustees to ensure that hospital boards are
best positioned to lead their organizations successfully
in the future.
Figure 4.3 – Essential Core Competencies When Selecting
New Board Members and Chairs (Select Top Five)
CEO Response
Board Chair Response
Importance in New
Board Members
Importance in New
Board Chair
Importance in New
Board Members
Importance in New
Board Chair
Finance/Business
17%
17%
17%
15%
Strategic Planning/
Visioning
16%
17%
17%
17%
Education
7%
5%
10%
8%
Patient Safety/
Quality
11%
10%
10%
9%
Previous Board
Experience
9%
15%
10%
14%
Public Relations
6%
7%
7%
9%
Human Resources/
Organizational
Development
6%
4%
6%
7%
Clinical Practice
6%
2%
5%
2%
Legal
6%
3%
4%
3%
Conflict Management
3%
12%
3%
10%
Fundraising
4%
4%
3%
3%
Health Insurance/
Managed Care
3%
2%
2%
2%
Health Information
Technology
3%
1%
2%
1%
Medical/Scientific
Technology
3%
5%
2%
1%
25
Figure 4.4
Section Highlights
Board Members Replaced or
Not Re-nominated in the
Past 3 Years Because of Failure to
Demonstrate Proper Competencies
16%
16%
Yes
75%
2%
0%
50%
Not applicable
25%
3%
2%
0%
Do not know
100%
80%
82%
No
26
• Nearly 40 percent of all hospitals surveyed did
not use competencies in the selection
process for new trustees or new board chairs
• Board chairs reported using competencies for
trustee selection and evaluation more than
CEOs did
• Finance/business and strategic planning/
visioning were viewed as the two most
important board member competencies
• Quality/patient safety and previous board
experience were also top-rated new trustee
competencies
• Conflict management was important for new
board chairs
• Eight in 10 hospitals reported that no board
member has been replaced or not been
re-nominated because of failure to
demonstrate the necessary competencies
• There is an opportunity to expand the use of
competency-based approaches when
selecting and evaluating trustees
SECTION 5
BOARD ORIENTATION AND EDUCATION
Position-Specific Charters
(Job Descriptions) Hospitals Have
for Board Members
Board chair position
charters
37%
43%
Non-leadership
board position
charters
23%
34%
Committee chair
position charters
24%
32%
46%
35%
None of the above
100%
75%
5%
8%
Don’t know
50%
Charters and Job Descriptions
A clearly articulated description of trustee roles and
responsibilities is essential for all board positions,
including board membership, board committees, and
board leadership, including the board chair. The
charters, or job descriptions, should first be used in
the trustee recruitment process where potential
candidates are given a written description of board
and trustee roles and responsibilities to ensure they
have a clear understanding of the accountabilities
they will be assuming and a readiness to commit the
time required to carry out those responsibilities. A
comprehensive description of board roles and
responsibilities should include a summary of fiduciary
duties, a list of essential board functions, and a
summary of the skills, attributes and commitments
expected from trustees. The charters are equally
important for ensuring that all board members
understand and fulfill their responsibilities, and should
be tested as a part of the board’s annual selfassessment process.
Figure 5.1
25%
The increased expectation for trustees’ knowledge
and understanding underscores the critical work of
the board and the importance of well-planned trustee
selection, orientation, and ongoing education. While
orientation is essential to integrating new trustees and
maximizing their potential, ongoing education is
equally important for all board members. Trustee
knowledge-building must take place continuously,
and through a variety of venues.
In 2014, nearly half of all CEOs surveyed reported
that their hospital did not have a job description or
position charter for board positions. Board chairs
reported a higher presence of position charters (only
35 percent reported having none, compared to 46
percent of CEOs). Board chairs were more likely to
have a position charter than were non-leadership
board positions or committee chairs. In all types of
board positions, CEOs reported fewer position
charters than did board chairs (see Figure 5.1).
0%
Hospital board service has never been more
challenging, as trustees today are expected to know
and understand more and take on greater
responsibility than they have in the past.
27
28
New Board Member
Orientation Components
Organization
orientation
88%
91%
One-on-one group
meetings with the
CEO and/or senior
leadership team
80%
80%
Health care
governance
orientation
77%
77%
Health care
orientation
74%
67%
One-on-one
meetings with the
board chair
39%
43%
Mentoring with a
senior board
member
Shadowing with
clinicians
3%
4%
No orientation
3%
3%
Don’t know
2%
0%
100%
24%
27%
75%
Nearly all hospitals and health systems reported
having some form of new trustee orientation in 2014
(97 percent), which typically emphasized educational
basics but did not typically include mentoring or
shadowing of clinicians. Approximately nine in 10
organizations reported that their orientation included
an introduction the organization, and eight in 10
included one-on-one group meetings with the CEO
and/or senior leadership team. A strong majority
also included health care governance orientation
(77 percent) and general health care orientation
Figure 5.2
50%
In addition to providing basic organizational and
governance information and an overview of current
market trends and challenges, a comprehensive trustee
orientation process includes mentoring for new
trustees with little or no prior board experience or
health care expertise. A strong orientation program
and warm welcome to the board are critical to
trustees’ success, as well as to the board’s success as a
cohesive governing body. Mentors play a key role in
welcoming a new trustee to the board, and ensuring
a rewarding opportunity for him or her to contribute
to the success of the organization. Mentoring also
provides an opportunity to learn new behavioralbased competencies such as asking probing questions
respectfully and building consensus around the board
table. New trustees with little or no experience in
health care may also benefit from shadowing clinicians
and/or additional meetings with the CEO or senior
leadership team.
25%
Trustee orientation should be considered a key
component of a broader “onboarding” process that
spans a trustee’s first months on the board. The process
is an opportunity to assist a new trustee to more
rapidly assimilate information and issues, and become
an engaged and contributing member of the board.
(although CEOs reported 74 percent while board
chairs reported 67 percent). About four in 10 new
trustees engaged in one-on-one meetings with the
board chair. Only about one-quarter of hospitals and
health systems reported that their new trustee
orientation process includes mentoring with a senior
board member, and less than five percent included
shadowing with clinicians in their orientation process
(see Figure 5.2).
0%
New Board Member Orientation
The board should have a well-thought out program
for “onboarding” new trustees to ensure they have the
foundation for effective and rewarding board service.
Continuing Board Education
Governance education is a continual process, not an
end result. Education is the vehicle for improved
governance knowledge. The end result and benefit
of governance education is greater knowledge and
heightened leadership intelligence that ensures
trustees are fully-prepared to engage around critical
issues, and make evidence-based decisions. Wellplanned and well-focused governance education
builds the “knowledge capital” the board needs to
ensure that the right decisions will be made, using
meaningful information and data.
Boards should commit to ongoing knowledge
building, with a clearly articulated list of issues and
topics most critical for board members to understand
in order to make critical decisions. A basic education
strategy should be set, with objectives and outcomes;
success should be evaluated periodically; and new
opportunities should be incorporated into the
educational development effort as changes occur in
the market. Education should not be a one-time
event, but should instead be an institutionalized
commitment to ensuring that the governing board
has the knowledge resources necessary to make
strategic decisions and to be a highly-effective
leadership body.
A well-planned and financially well-supported trustee
education effort will result in better decisions based
on better knowledge and insights; an improved
capacity to be a well-informed advocate for the
hospital and its community; increased capacity to
engage in challenging and productive governance
dialogue; and an ability to think beyond
“conventional wisdom.”
Despite the importance of continuing education, in
2014 respondents reported a decline in nearly all types
of board education compared to 2011 (see Figure 5.3).
The growth of webinars and podcasts may account for
some decline in other traditional forms of education.
Figure 5.3 - Types of Education
Included in the Board’s Continuing
Education Process
2011
2014
Publications
83%
76%
On-site speakers
76%
75%
Destination educational
events
72%
72%
Webinars and podcasts
N/A
33%
Membership in an outside
governance support
organization
36%
33%
Online education
35%
31%
Other
10%
10%
Briefings from Legal Counsel
Hospital trustees have legal requirements that may
be covered in a comprehensive trustee orientation
process and general ongoing education, or may
require targeted education from legal counsel. The
basic fiduciary duties of loyalty, care and obedience
are critical for trustees to understand. In addition,
trustees should receive education about legal
compliance, confidentiality requirements, preventing
and responding to conflict of interest, and any
pending legal proceedings, investigations, compliance
issues, or other contingent liabilities that could have a
significant impact on the hospital.
Most survey respondents reported that they
periodically received educational briefings on conflict
of interest and how they should be dealt with (83
percent for CEOs and 88 percent for board chairs),
as well as board confidentiality (71 percent for CEOs
and 83 percent for board chairs). Fewer reported
receiving compliance education (68 percent of board
chairs compared to 77 percent of CEOs), and even
29
Figure 5.4
Section Highlights
Periodic Educational Briefings from
Legal Counsel Provided to Boards
Trustee conflicts of
interest and how they
should be disclosed
and dealt with
83%
88%
Compliance
education
77%
68%
The need for trustees
to keep certain
hospital and board
matters confidential
71%
83%
Legal fiduciary duties
of loyalty, care, and
obedience
100%
75%
50%
25%
0%
60%
68%
• In 2014, nearly half of all CEOs surveyed
reported that their hospital did not have a job
description or position charter for board
positions
• In all types of board positions, CEOs reported
fewer position charters than did board chairs
• Nearly all hospitals and health systems
reported having some form of new trustee
orientation in 2014
• Trustee orientations typically emphasized
educational basics but did not include
mentoring or shadowing of clinicians
• Despite the importance of continuing
education, in 2014 respondents reported a
decline in nearly all types of board education
compared to 2011
• Most trustees periodically received
educational briefings on conflict of interest
and confidentiality
• Only six in 10 CEOs reported that trustees
received a periodic briefing on the board’s legal
fiduciary duties of loyalty, care and obedience
fewer reported a periodic briefing on the board’s
legal fiduciary duties of loyalty, care and obedience
(68 percent of board chairs compared to 60 percent
of CEOs) (see Figure 5.4).
30
SECTION 6
BOARD EVALUATION
The AHA has coined the phrase “redefining the H”
as hospitals consider what it means to be a hospital in
today’s transforming health care environment. In
order to be successful in this endeavor, hospital
trustees must also redefine their expectations of
governance, including the board’s roles, responsibilities,
and composition. An annual board evaluation is an
important starting point boards can take to ensure
that they are well-poised to carry their organizations
into the new health care world.
A board self-assessment is an organized evaluation of
board members’ satisfaction with all aspects of board
performance in fulfilling the board’s governance
responsibilities. Governance assessments generally
use a combination of quantitative and qualitative
measurements of board, committee and individual
performance.
Successful assessments enable boards to identify
“governance gaps,” or areas in which the board has
the greatest potential for improvement. The
assessment process identifies these gaps, and facilitates
the development and implementation of initiatives
and strategies to improve leadership performance.
Through an effective, well-developed board
evaluation process growth opportunities can be
realized, education can be pinpointed to unique
governance needs, recruitment of new trustees can be
undertaken with increased confidence, and long-range
planning can be conducted within a consensus-based
framework with everybody on the same page.
Types of Board Evaluations
A successful board assessment engages the board in a
wide-ranging evaluation of its overall leadership
performance, focused on the full board as well as the
responsibilities of individual board committees. At the
same time, it provides trustees with an opportunity to
gauge their personal performance as vital contributing
members of the board of trustees, as well as the
leadership performance of the board chair.
An individual performance assessment is a critical
piece of a quality board evaluation process. Trustees
may have one view of the overall board’s
performance, and have an entirely different view of
their own individual performance, and that of their
colleagues. A personal, introspective look at individual
leadership enables trustees to focus on the essentials
of good leadership and their personal impressions of
their individual performance.
Just over one-half of all hospital and health systems
reported conducting a full board assessment in the
past three years (reported by 57 percent of CEOs and
58 percent of board chairs); however, only about
one-third of hospitals reported conducting an
individual board member self-assessment (see Figure
6.1). While neither board chair assessments nor
committee assessments were widely used, board chairs
reported a higher use of both than did CEOs, with
15 percent of board chairs reporting use of a board
chair assessment (compared to 7 percent of CEOs) and
14 percent reporting the use of committee assessments
(compared to 9 percent of CEOs). The percentage of
boards conducting a peer-to-peer assessment indicates
this is not a practice used by many.
Using Assessment Results
Conducting the governance assessment is the first
step in improving governance leadership
performance. The key to success of the full process
is not simply the measurement of trustee viewpoints,
but is instead the actions that are taken as a result of
a careful examination of trustee viewpoints.
31
Figure 6.1
Figure 6.2
Assessments Boards Have Used
in the Past Three Years (2011-2013)
Assessments Used to Create an
Action Plan to Improve Board, Trustee,
or Committee Performance
57%
58%
Committee
Assessments
9%
14%
4%
4%
Do not know
75%
7%
15%
0%
Board Chair
Assessment
20%
20%
No
50%
33%
36%
25%
Individual
Board Member
Self-Assessment
Peer-to-Peer
Assessment to
evaluate the
performance of each
board member
6%
5%
100%
0%
1%
75%
Not applicable
50%
0%
1%
0%
Don’t know
25%
26%
24%
None of the above
The assessment results should be a catalyst to engage
trustees in a wide-ranging discussion of findings that
highlight performance gaps and areas where trustees
may lack consensus about the board’s performance.
A full review of trustees’ viewpoints should stimulate
the board to discuss their opinions and ideas for
improving board success, and result in the
development of a governance improvement action
plan with clearly defined responsibilities, time frames
and projected outcomes. Boards should then monitor
their progress to ensure that projected outcomes are
achieved, and revise the governance improvement
action plan when necessary.
32
76%
75%
Yes
100%
Regular Full Board
Assessment
Three-quarters of hospitals and health systems
reported that self-assessment results were used to
create an action plan to improve board, trustee or
committee performance; however, that leaves nearly
one-quarter of boards that did not use the results for
improvement or did not know how they use the
results (See Figure 6.2). Most hospitals did not use
their assessment results when determining whether
trustees should be reappointed for additional terms
(See Figure 6.3). This finding corresponds with earlier
findings indicating that board members are typically
not replaced or not re-nominated because of failure
to demonstrate the needed competencies for
governance effectiveness (See Figure 4.4, earlier).
Competency-Based Evaluations
Board evaluations should use pre-established, objective
criteria to assess board effectiveness in improving
hospital performance. The criteria should correlate
with the board’s defined roles and responsibilities, as
well as individual trustee performance expectations.
As hospital boards increasingly strive for a membership
that possesses needed critical competencies, board
evaluations should test the presence of those
competencies in the annual self-evaluation process.
When evaluating the performance of individual board
members, the most important competencies identified
were community orientation, strategic orientation,
accountability, knowledge of business and finance,
and organizational awareness. At the same time,
community orientation and collaboration were both
rated as less important in 2014 when compared to
2011 by both board chairs and CEOs (see Figure 6.4).
Figure 6.3
Assessment Results Used
for Reappointment to
Additional Terms
31%
44%
Yes
65%
53%
No
100%
75%
50%
0%
25%
4%
3%
Do not know
Board chairs and CEOs differ in their opinions about
which competencies were most important when
evaluating individual board member performance.
Board chairs generally valued community orientation,
achievement orientation, knowledge of health care
delivery and performance, innovative thinking, and
team leadership as most important. CEOs ranked the
Figure 6.4 – The Most Important Competencies Board Members Consider
When Evaluating the Performance of Individual Board Members
2011
2014
CEO
Board Chair
CEO
Board Chair
Community Orientation
74%
79%
62%
66%
Strategic Orientation
55%
52%
54%
54%
Accountability
56%
47%
47%
49%
Collaboration
58%
45%
41%
38%
Knowledge of Business and Finance
50%
41%
46%
44%
Organizational Awareness
31%
41%
40%
42%
Professionalism
36%
39%
36%
36%
Achievement Orientation
31%
35%
20%
27%
Knowledge of Health Care Delivery and Performance
25%
29%
29%
32%
Innovative Thinking
26%
28%
26%
32%
Relationship Building
26%
23%
29%
21%
Complexity Management
16%
22%
14%
15%
Team Leadership
13%
22%
11%
14%
Impact and Influence
21%
20%
30%
21%
Information Seeking
18%
15%
15%
6%
Change Leadership
9%
7%
12%
10%
Knowledge of Human Resources Development
5%
3%
1%
3%
33
competencies of collaboration, impact and influence,
relationship building, and change leadership as
more important evaluation competencies than did
board chairs.
Section Highlights
• Just over one-half of all hospital and health
systems reported conducting a full board
assessment in 2014
• The percentage of boards conducting a
peer-to-peer assessment indicates that this is
not a practice used by many boards
• Nearly one-quarter of boards did not use their
self-assessment results for improvement or
did not know how they used the results
• Most hospitals did not use their assessment
results when determining whether trustees
should be reappointed for additional terms
• When evaluating the performance of individual
board members, the most important
competencies identified were community
orientation, strategic orientation,
accountability, knowledge of business and
finance and organizational awareness
• Community orientation and collaboration as
a board competency were both rated as less
important in 2014 when compared to 2011
by both board chairs and CEOs
• Board chairs and CEOs differed in their
opinions about which competencies were
most important when evaluating individual
board member performance
34
SECTION 7
EXECUTIVE PERFORMANCE AND
COMPENSATION
The board of trustees is responsible for ensuring that
the CEO is appropriately and fairly compensated,
which includes both a regular performance evaluation
as well as compensation tied to that evaluation. The
compensation and performance review process plays
a critical role in building leadership loyalty and
commitment, and ensuring leadership success and
continuity. The process is about more than simply
evaluating the CEO’s compensation — it is an
opportunity to strengthen the board/CEO
relationship, and ensure that both the board and CEO
have mutually agreed upon goals and expectations.
CEO Performance Evaluation
The CEO evaluation sets specific direction on board
expectations for the CEO and overall organizational
performance. It ensures a consistent focus by the
CEO, and continuous leadership accountability,
renewal, focus and success. It defines the essential
CEO functions and personal attributes required by
the board, and encourages two-way communication
between the board and CEO as they determine
those functions and attributes, and discuss how they
will be measured.
In addition, the CEO evaluation identifies
performance areas requiring increased attention by
the CEO, and defines the leadership competencies
most critical to organizational success.
Board chairs reported that the most important
criteria in CEO evaluations in 2014 were financial
performance, patient satisfaction, vision or other
leadership qualities, and clinical quality of care/
outcomes. While CEOs and board chairs agreed on
the weight given to financial performance in the
CEO evaluation, CEO’s perceptions of CEO
accountability were lower in every other area when
compared to board chairs. The biggest gaps between
CEO and board chair perceptions of CEO
accountability were risk management, community
health improvement, system/network performance
and legal and regulatory compliance (See Figure 7.1).
There was little difference in CEO evaluation criteria
in 2014 when compared to 2011.
CEO Compensation
Board oversight of CEO compensation is a
responsibility examined by the Internal Revenue
Service (IRS), and any failure may be subject to
penalties, as well as potential media attention and
other unwanted public scrutiny. The CEO’s
compensation must be reasonable and rewarding of
performance, yet not “excessive.” The CEO’s
compensation must be approved by the board or by a
compensation committee whose members have no
conflict of interest. In addition, the board or
compensation committee must use relevant data to
establish fair market compensation levels when
approving executive compensation. Resources for
comparability data include compensation surveys or
studies, use of an independent compensation
consultant, or review of Form 990 filings by similarly
sized and/or structured organizations.
It is important that board actions and decisions about
CEO compensation are supported with solid
evidence, and that evidence is adequately documented
in the board’s written or electronic records. The
board must have a clearly established process for
determining compensation, use reliable comparative
compensation information in evaluating the CEO’s
compensation plan, evaluate the CEO’s specific skills
and accomplishments in carrying out board-approved
plans and priorities, and ensure that the CEO’s total
35
Figure 7.1 – Weight Given to Criteria in the Most Recent CEO Evaluation
2011
2011
2014
2014
CEO
Board Chair
CEO
Board Chair
Financial performance
4.3
4.4
4.3
4.4
Patient satisfaction
4.0
4.2
3.9
4.3
Vision or other leadership qualities
3.8
4.3
3.9
4.3
Physician relations
3.9
4.2
3.8
4.1
3.8
4.1
Cost reduction/efficiency
Strategic plan fulfillment
3.9
4.1
3.8
4.1
Clinical quality of care/outcomes
3.8
4.1
3.8
4.2
Employee Satisfaction
3.6
3.9
3.6
3.9
Legal and regulatory compliance
3.5
4.1
3.5
4.0
System/network performance
3.1
3.6
3.3
3.8
3.1
3.7
2.7
3.3
Risk management
Community health improvement
2.5
3.3
* Respondents indicated how much weight the criteria had in the most recent CEO evaluation, on a scale from 1 (no weight) to five (absolutely critical).
compensation package is commensurate with his or
her responsibilities and performance.
Approximately eight in 10 hospitals reported that
they use comparative data to ensure that CEO
compensation reflects full market value. About
one-half of respondents used a compensation
committee comprised of independent members, or
used an outside compensation consultant when
determining CEO compensation (See Figure 7.2).
Boards not using a separate compensation committee
may rely on their executive committee or full board
when making compensation decisions.
CEO Retention and Succession Planning
One of the principal accountabilities of the board of
trustees is to ensure that the organization has
consistently effective executive leadership at the top.
The board is responsible for recruiting, motivating
and retaining the chief executive officer. This
responsibility is a continuing, evolving process of
ensuring that leadership succession is planned and
coordinated in a meaningful way to ensure a seamless
transition from one executive leader to another.
According to the American College of Healthcare
Executives, hospital CEO turnover is currently 20
percent, the highest rate since it was first calculated in
1981.1 The need for clear retention and succession
1 Hospital CEO Turnover 1981 – 2013. American College of Healthcare Executives. March 10, 2014. www.ache.org.
36
plans are clear.Yet in 2014, only one-quarter of CEOs
reported having a CEO retention plan in place that
had been updated in the past year. More board chairs
(37 percent vs. 26 percent) reported the presence of a
CEO retention plan that was updated within the last
year. Both board chairs and CEOs reported an
increase in the updating of CEO retention plans in
2014 when compared to 2011 (see Figure 7.3).
Figure 7.2
Board Oversight of
Executive Compensation
Use of a compensation
committee composed
of independent
members
52%
54%
Use of comparative
data to ensure that
compensation reflects
full market value
Even hospitals with strong CEO retention plans
should prepare for CEO turnover. The aim of
succession planning is not necessarily to identify a
specific individual or individuals in the organization
to groom as potential successors, or to determine
specifically ahead of time who the next chief
executive should be. Instead, a responsible succession
planning process consists of guidelines and options
for the organization to utilize in the event of a need
78%
81%
Use of an outside
compensation
consultant
100%
75%
50%
25%
0%
51%
53%
Figure 7.3 – Updating CEO Retention and Succession/Transition Plans
When did your board last update its CEO retention plan?
2011
2011
2014
2014
CEO
Board Chair
CEO
Board Chair
Less than 1 year ago
22%
35%
26%
37%
At least 1 year ago but less than 2 years ago
6%
10%
11%
14%
At least 2 years ago
6%
4%
10%
10%
Figure 7.4 – Updating CEO Retention and Succession/Transition Plans
When did your board last update its CEO succession plan?
2011
2011
2014
2014
CEO
Board Chair
CEO
Board Chair
Less than 1 year ago
25%
35%
18%
31%
At least 1 year ago but less than 2 years ago
13%
13%
7%
10%
At least 2 years ago
9%
9%
6%
8%
37
to recruit or appoint a new CEO, whether the CEO
leaves abruptly, or whether the leave is well planned
and organized in advance.
Unlike the increase in CEO retention planning
efforts, the frequency with which CEO succession
plans are updated has declined when compared to
2011. In 2014, both board chairs and CEOs reported
updating their CEO succession plan less frequently in
2014 when compared to 2011, with only 18 percent
of CEOs reporting an updated succession plan within
the last year (see Figure 7.4).
Section Highlights
• Board chairs reported that the most important
criteria in CEO evaluations in 2014 were
financial performance, patient satisfaction,
vision or other leadership qualities, and clinical
quality of care/outcomes. There was little
difference in 2014 when compared to 2011
• CEO’s perceptions of CEO accountability
were lower in every area except financial
performance when compared to board chairs
• Approximately eight in 10 hospitals reported
that they used comparative data to ensure that
CEO compensation reflects full market value
• About one-half of respondents used a
compensation committee comprising
independent members, or used an outside
compensation consultant when determining
CEO compensation. Boards not using a
separate compensation committee may rely
on their executive committee or full board
when making compensation decisions
• Only one-quarter of CEOs reported having a
CEO retention plan in place that had been
updated in the past year
• Both board chairs and CEOs reported an
increase in the updating of CEO retention
plans in 2014 when compared to 2011
• The frequency with which CEO succession
plans are updated has declined when
compared to 2011
• Only 18 percent of CEOs reporting an
updated succession plan within the last year
38
SECTION 8
QUALITY AND STRATEGY OVERSIGHT
Boards of trustees are responsible for ensuring the
quality of care and patient safety provided by their
organizations, and must take strong, organized action
to establish and ensure an organizational culture that
continually strives to improve quality and patient safety.
A “culture of safety” should be ingrained in the
hospital, a responsibility that begins with the board.
The board sets the tone for the hospital, and ensures
the resources necessary for employees and others to
carry out the quality and patient safety vision. The
board then regularly measures and monitors quality
and patient safety progress to ensure success.
Use of Quality Objectives and Benchmarks
An effective method for monitoring quality
performance is through quality benchmarks, usually
implemented through a quality “dashboard.”
The dashboard should be reviewed regularly at
board meetings, ensuring that trustees are aware of
the hospital’s actual quality performance, and are
empowered to make decisions based on hard facts
and evidence.
Quality dashboards assist hospitals in accomplishing
the goal of regular trustee review and assessment of
patient quality and safety measures. Dashboards are
presented in the same easy-to-read format at every
board meeting, ensuring that all trustees understand
the reports and can make informed decisions about
whether the hospital is “on track” with its quality and
patient safety goals.
Compared to 2011, more boards have developed
precise and quantifiable hospital quality and safety
objectives, although the reporting varies between
hospital CEOs and board chairs. More than nine in
10 board chairs reported the presence of precise and
quantifiable quality and safety objectives, while just
over eight in 10 CEOs reported their presence.
When asked about specific components, board chairs
reported more widespread use of precise and
quantifiable measures in the areas of patient safety,
service quality/patient satisfaction, and clinical quality
when compared to CEOs (see Figure 8.1).
Figure 8.1 – Areas Where Boards Have Developed Precise and Quantifiable
Hospital Quality and Safety Objectives
2011
2011
2014
2014
CEO
Board Chair
CEO
Board Chair
Service quality/patient satisfaction
71%
83%
73%
89%
Patient safety
68%
86%
70%
88%
Clinical quality
71%
86%
74%
87%
No precise and quantifiable
objectives have been developed
24%
10%
19%
8%
Don’t know
2%
2%
3%
2%
39
Figure 8.2 - Board Benchmark Used When Evaluating Hospital/System Performance
2011
2011
2014
2014
CEO
Board Chair
CEO
Board Chair
Financial performance
96%
96%
94%
92%
Patient/family satisfaction
90%
95%
92%
96%
Human resources
73%
80%
67%
71%
Clinical outcomes
74%
75%
78%
82%
Clinical quality
60%
65%
62%
72%
Efficiency or cost of care measures
52%
68%
56%
69%
Market share
42%
48%
43%
51%
Community health
19%
44%
26%
47%
Other
6%
2%
3%
2%
When evaluating the hospital or system’s performance,
the most common benchmarks used by boards in
2014 were patient/family satisfaction, financial
performance, and clinical outcomes. Board chairs
placed greater emphasis on community health,
efficiency or cost of care measures, and clinical
quality than did CEOs when evaluating overall
organizational performance (see Figure 8.2).
Board Engagement and Accountability
for Quality
Quality is not a one-time agenda item. Instead,
quality and patient safety should be at the forefront
in board discussions and decisions on virtually any
agenda topic. In addition to tracking progress in
achieving hospital quality and safety objectives and
comparing the organization’s performance to
benchmark data, boards should receive executive
reports of medical staff quality meetings, information
about quality and patient safety improvement plans
and general information about health care quality
trends. Boards should also receive information about
40
grievances, adverse events, “near misses,” and potential
liabilities, as well as progress reports on correction
action plans to address known challenges.
When asked about their overall board’s engagement
in quality and safety issues, both board chairs and
CEOs indicated that their boards are highly engaged
(4.3 and 4.1 respectively on a five-point scale) (see
Figure 8.3). The majority of hospitals also reported
that their CEO is held accountable for defined
quality objectives during the performance evaluation;
however, 78 percent of board chairs reported that the
CEO is accountable for quality, while only 68 percent
of CEOs reported this accountability (see Figure 8.4).
Tracking Strategic Performance
One of the board’s primary responsibilities is setting
long-term and high-level strategic direction; however,
the process cannot stop there. Hospital boards must
know whether the strategies and objectives adopted
and implemented are achieving the desired outcomes.
Being able to engage in a continuous analysis and
Figure 8.3
Board Engagement in Quality and Safety Issues (Scale of 1-5)
100%
5
Completely
Engaged
4
3
Somewhat
Engaged
2
1%
1%
3%
0%
1%
19%
25%
16%
38%
37%
45%
50%
39%
75%
1
Not Engaged
CEO Board Chair
Figure 8.4
CEO is Held Accountable for
Defined Quality Objectives During
Performance Evaluation
68%
78%
Yes
Not applicable
8%
6%
100%
4%
4%
75%
Do not know
0%
Nearly nine in 10 board chairs, and 85 percent of
CEOs, reported that their board assesses at least
annually the hospital’s strategic performance using
measures established at the beginning of the year.
At the same time, 14 percent of CEOs reported that
their board did not review the hospital’s strategic
performance at least annually, and a small percentage
of CEOs and board chairs did not know whether this
review took place.
50%
19%
12%
No
25%
dialogue about strategic progress and performance
requires a set of key performance indicators that tell
the board where current strategic gaps exist, and
where potential strategic gaps may be on the horizon.
With the input of the CEO and management team,
the board should track performance and progress
using a set of metrics, a periodic review process, and
an incentive system to reward management for
meeting organizational objectives.
41
Figure 8.5
Section Highlights
Board Assesses the
Hospital’s Strategic Performance
Using Measures Established
at the Beginning of the Year
(At Least Annually)
85%
89%
Yes
14%
8%
No
• Board chairs reported more widespread use
of precise and quantifiable measures in the
areas of patient safety, service quality/patient
satisfaction and clinical quality when
compared to CEOs
• The most common benchmarks used by
boards in 2014 were patient/family satisfaction,
financial performance and clinical outcomes
100%
75%
50%
25%
2%
3%
0%
Do not know
• Compared with 2011, more boards have
developed precise and quantifiable hospital
quality and safety objectives, although the
reporting varies between hospital CEOs and
board chairs
• Both board chairs and CEOs indicated that
their boards are highly engaged in quality and
safety issues (4.3 and 4.1 respectively on a
five-point scale)
• Seventy-eight percent of board chairs
reported that the CEO is accountable for
quality, while only 68 percent of CEOs
reported this accountability
• Nearly nine in 10 board chairs, and 85 percent
of CEOs, reported that their board assesses
at least annually the hospital’s strategic
performance using measures established at
the beginning of the year
• At the same time, 14 percent of CEOs reported
that their board did not review the hospital’s
strategic performance at least annually
42
SECTION 9
INTERNAL AND EXTERNAL STAKEHOLDERS
Hospital boards play a role in facilitating strong
and trusting partnerships both internally and in the
community. Boards play a pivotal leadership role in
ensuring that their organizations have a workplace
culture that will attract and retain a high-quality
workforce and medical staff prepared to meet both
today’s and tomorrow’s community needs. At the
same time, hospital boards have a unique opportunity
to ensure that their organizations consistently
engage in meaningful ways with a broad range of
community stakeholders.
Alignment with Physicians and Clinical Staff
Health care transformation encourages more than
hospitals, physicians, nurses and other clinical caregivers
to cooperate to care for patients. It requires hospitals
and clinicians to provide integrated care —care that is
coordinated, uses seamless technology, and involves
providers across the spectrum working together to
care for each patient as an entire “episode of care.”
This is a necessary shift in thinking for many health
care trustees. Hospital trustees should be preparing
for that shift now, working jointly with their medical
staff, nurses and other providers in the community to
develop shared solutions and forge partnerships that
will provide better care and prepare all health care
providers for a successful future.
Overall, both CEO and board chair respondents
indicated relatively high levels of alignment between
the board and the medical staff and nursing staff
(see Figure 9.1). Despite this reportedly high alignment,
clinical board representation has declined from
31 percent in 2011 to 29 percent in 2014
(see Figure 2.9, earlier).
Understanding Community Health Needs
A comprehensive community needs assessment
provides the hospital with first-hand information
about the health care needs of the community it
serves. With this “snapshot” of the community’s
health, organizations can identify the most pressing
community health care needs, populations of
individuals in need, gaps in care and services, barriers
and challenges to receiving services, and information
about other organizations that may already be
working to meet specific needs. This information
provides the foundation needed to build strategic and
operational plans that will advance the hospital’s
mission of service to the community.
In 2014, boards overwhelmingly reported that they
consider the results of their organization’s community
health needs assessment when developing their
strategic plan (see Figure 9.2). Although the majority
of board chairs and CEOs both reported considering
the needs assessment as a part of the strategic
planning process, 12 percent of CEOs reported not
using a community needs assessment when
developing the strategic plan, in contrast to only five
percent of board chairs reporting the needs
assessment was not considered.
Board Receipt of the IRS Form 990
IRS revisions to the Form 990 and the addition of
the form “Schedule H” have resulted in trustees being
held to greater accountability for oversight of the
hospital’s financial and community benefit reporting.
A broader scope of information is now required to be
collected and reported, allowing more transparency
into hospitals’ actions and their community benefit
contributions. With this additional reporting and
increased transparency there is opportunity for greater
scrutiny; however, the revisions also give hospitals and
43
Figure 9.1
Alignment of Hospital/System Board and Medical Staff/Nursing Staff
in Pursuing the Organization’s Goals and Vision
2
CEO
Board & Medical Staff
3
Somewhat
aligned
Board Chair
Board & Medical Staff
Board Considers the Organization’s
Community Health Needs Assessment
When Developing the Strategic Plan
75%
50%
25%
5%
4%
0%
Do not know
100%
83%
90%
Yes
12%
5%
44
30%
26%
24%
20%
55%
48%
4
CEO
Board & Nursing Staff
5
Completely
aligned
Board Chair
Board & Nursing Staff
trustees a greater opportunity to tell their story, and
to build strong public trust and confidence.
Figure 9.2
No
25%
4%
4%
5%
1
Not at all
aligned
3%
1%
0%
1%
0%
0%
25%
18%
30%
50%
25%
45%
75%
49%
100%
While the core Form 990 asks whether a complete
copy of the Form was provided to all members of the
governing body before its filing, there can be a variety
of methods for accomplishing this requirement.
In 2014, there was a disconnect between the CEO
and board chair responses about how boards are
receiving a copy of the organization’s IRS Form 990
Schedule H. While approximately one-half of CEOs
reported that the Form 990 is a discussion item on a
board agenda, less than one-third of board chairs
provided the same response. Similarly, 25 percent of
CEOs reported that the Form 990 is distributed in
executive session, and only 14 percent of board chairs
reported the form’s distribution in that forum. More
CEOs also reported the Form 990 being reviewed by
the Finance or Audit Committee than did board
chairs (see Figure 9.3).
Figure 9.3
Section Highlights
How Boards Are Provided a Copy
of the Form 990 Schedule H
Paper copy distributed
in executive session
25%
14%
Discussion item on
a board agenda
49%
• In 2014, boards overwhelmingly reported that
they consider the results of their organization’s
community health needs assessment when
developing their strategic plan
29%
Included in the board
consent agenda
13%
12%
100%
• There are a variety of methods for providing
a complete copy of the IRS Form 990 to the
board prior to its filing. There was a disconnect
between the CEO and board chair responses
about how boards are receiving a copy of the
Form 990
75%
35%
23%
50%
Reviewed by the
Finance or Audit
Committee
25%
30%
22%
0%
Posted on the board
portal
• Overall, both CEO and board chair
respondents indicated relatively high levels of
alignment between the board and the medical
staff and nursing staff. Despite this reportedly
high alignment, clinical board representation
has declined
45
SECTION 10
BOARD CULTURE
Appropriate topics for an executive session may
include personnel matters, investigations or updates
on alleged improper conduct, CEO performance
assessment, legal negotiations and financial discussions
with an auditor, or other topics that must remain
highly confidential for a limited period of time. Items
appropriate for executive sessions will vary if the
organization is a public or private hospital, and
depending upon state laws and regulations.
In addition, there are times when the board simply
needs to have an opportunity to openly and
confidentially share opinions among board members
on a particular topic. In order to be effective and not
misused with a “shadow-agenda,” executive sessions
should address only pre-determined issues and not
delve into discussion and decision-making that could
more appropriately be conducted in the regular board
meeting. The executive session is not an excuse to
avoid difficult topics and conversations, or
inappropriately hide board deliberations behind
closed doors.
46
Executive Session
Routinely Included in the Agenda
of Every Board Meeting
41%
49%
Yes
59%
50%
No
100%
75%
0%
0%
50%
Do not know
25%
Executive Sessions
One of the most productive places for candid and
forthright board/CEO discussion to take place is in
an executive session. Executive sessions are settings
that allow the board to handle confidential matters
behind closed doors, without staff present.
Figure 10.1
0%
Effective, high-performance boards spend most of
their time on important strategic and policy issues.
They engage in rich discussion and dialogue, assess
outcomes and participate in ongoing learning and
gathering of new ideas and perspectives. Whether in a
full board meeting or executive session, they focus on
the issues that are most critical to the organization,
and where they can have the greatest impact.
2011 2014
In 2014, half of all hospitals reported that an
executive session was routinely included in the
agenda as a part of every board meeting, up from
41 percent in 2011 (see Figure 10.1).
CEO Participation in Executive Sessions
Holding regular executive sessions is a constructive
way to build a strong sense of connection and
communication between the board and the CEO.
The executive session enables both to engage in the
kind of dialogue that is oftentimes difficult during
regular board meeting when staff members and, in
the case of public hospitals, the press and members
of the community, may be in attendance.
In 2014 CEOs participated in the entire executive
session in 59 percent of hospitals, and in part of the
executive session in 35 percent of hospitals. Few
hospitals conducted an executive session without any
CEO participation at all (six percent) (see Figure 10.2).
Typical Topics Discussed
Figure 10.2
The most common topics discussed at executive
sessions in 2014 were executive performance and
evaluation, followed by executive compensation,
miscellaneous governance issues, general strategic
planning and strategy with regards to mergers and
acquisitions. Compared to 2011, it was reported that
more executive sessions now focus on miscellaneous
governance issues and strategy with regard to mergers
and acquisitions (see Figure 10.3).
CEO Participation
in Executive Sessions
6%
35%
59%
There were differences between board chair and
CEO respondents’ perspectives on all topics, with the
exception of executive performance and evaluation
and executive compensation. In nearly all other areas,
board chairs reported a higher prevalence of
discussion topics than did CEOs.
CEO Participates in Entire Executive Session
CEO Participates in Part of Executive Sessions
CEO Does Not Participate in Executive Sessions
Figure 10.3 – Topics Typically Discussed at Board Executive Sessions
2011
2011
2014
2014
CEO
Board Chair
CEO
Board Chair
Executive performance and evaluation
82%
84%
77%
78%
Executive compensation
72%
73%
62%
62%
Miscellaneous governance issues
29%
38%
43%
54%
General strategic planning
36%
51%
41%
53%
Strategy with regards to mergers and
acquisitions
40%
44%
46%
51%
Financial performance of institution(s)
28%
49%
32%
47%
Clinical or quality performance measures
28%
47%
33%
45%
Board recruitment and selection
28%
42%
24%
41%
Succession planning
37%
37%
32%
39%
Board performance and evaluation
29%
35%
31%
38%
Government relations
17%
27%
15%
27%
Other
21%
16%
17%
12%
47
Board Meeting Dialogue and Discussion
Board and committee meeting time is limited, and
should strive to be purposeful and productive. Board
members must ensure their governance conversations
are vibrant, vital and focused on purpose and
outcomes. Through critical conversations, decisions
are made by grappling with concepts, ideas and
practical solutions, leading to informed and rational
conclusions.
When boards experience a “dialogue deficit” they
miss unique opportunities to explore alternative ideas,
choices and courses of action. In many cases a lack of
dialogue results in “proforma” decisions that are made
with little insight or real understanding. In contrast,
there are continual opportunities for board learning
that occur when trustees engage in robust discussion,
challenge one another’s assumptions and work toward
a consensus that is grounded in mutual knowledge,
understanding and commitment.
CEOs and board chairs reported that they are
spending some board meeting time in active
discussion, deliberation and debate about the strategic
priorities of the organization (rather than listening to
briefings, presentations, and reports). On a five point
scale, board chairs reported 3.3 and CEO’s 3.2
(see Figure 10.4).
One way to ensure that meetings are focused on
where the hospital is headed, rather than where it has
been, is to design the agenda to ensure that the
majority of governance attention and discussion is on
issues in which the board has the greatest impact:
planning, setting policy, making critical decisions and
setting future direction.
Little progress has been made since 2011 with regard
to the percentage of board meeting time that boards
normally spend in active discussion, deliberation, and
debate at each board meeting. While just over 40
percent of hospital boards reported spending more
than 50 percent of their time in active discussion,
deliberation and debate in 2014, 19 percent of board
chairs reported spending less than 25 percent of their
meeting time on such activities (see Figure 10.5).
Figure 10.4
Extent the Majority of Board Meeting Time Is Spent in Active Discussion,
Deliberation and Debate about Strategic Priorities of the Organization
100%
0%
5
Completely
4
3
Somewhat
2
1%
1%
3%
4%
25%
12%
15%
48%
46%
32%
50%
38%
75%
1
Not At All
CEO Board Chair
48
Figure 10.5 – Approximate Percentage of Board Meeting Time the Board
Normally Spends in Active Discussion, Deliberation and Debate
at Each Board Meeting
2011
2011
2014
2014
CEO
Board Chair
CEO
Board Chair
Greater than 0% but less than or equal to 25%
23%
19%
23%
19%
46%
41%
40%
40%
23%
26%
30%
33%
Greater than 75%
7%
13%
7%
8%
Figure 10.6
Use of Electronic Board Portal
52%
56%
Yes
100%
25%
0%
For hospital boards, an electronic board portal reduces
waste and administrative time required to prepare for
meetings and ensures that governance resource
materials are always up to date. Board portals can also
offer an ongoing way for trustees to access information
anywhere from a mobile device or computer,
including basic organizational information, ongoing
education and resources, a board calendar, trustee and
administration contact information and more.
75%
48%
44%
No
50%
Electronic Board Portals
Whether it is an everyday social interaction, patientphysician communication, or interaction between
hospital leaders and board members, technology
increasingly plays a role. Technology is an unparalleled
tool for enhancing and strengthening communication,
one that is rapidly changing our culture.
Hospitals and health systems must be adept and
innovative in leveraging the benefits that technology
offers across a variety of settings and for any number of
purposes. At the same time, hospital boards, physicians
and senior leaders must be cautious to not replace the
personal connections and face-to-face meetings that
are essential to strong and effective governance
leadership. In 2014, over half of hospitals reported
using an electronic board portal (56 percent of board
chairs and 52 percent of CEOs) (see Figure 10.6).
49
Section Highlights
• Half of surveyed hospitals reported that an
executive session was routinely included in
the agenda as a part of every board meeting
• CEOs participated in the entire executive
session in 59 percent of hospitals, and in
part of the executive session in 35 percent
of hospitals
• The most common topics discussed at
executive sessions in 2014 were executive
performance and evaluation, and executive
compensation
• CEOs and board chairs reported that they are
spending some board meeting time in active
discussion, deliberation and debate about the
strategic priorities of the organization (rather
than listening to briefings, presentations and
reports). On a 5 point scale, board chairs
reported 3.3 and CEO’s 3.2
• Little progress has been made since 2011
with regard to the percentage of board
meeting time that boards normally spend in
active discussion, deliberation and debate at
each board meeting
• Over half of hospitals reported using an
electronic board portal in 2014
50
SECTION 11
READINESS FOR HEALTH CARE
TRANSFORMATION
The transformation from a fee-for-service to a
value-based payment system is prompting hospitals to
embrace population health management and promote
care across the continuum, with goals to improve the
health of the community, provide better access to
primary care, reduce admissions and readmissions, and
make meaningful and measurable improvements in
outcomes of care. Hospitals are accountable to their
communities, not only for the care provided inside
the hospital, but also for improving the overall health
of the communities they serve. Many are making that
commitment by striving to achieve the goals of the
Institute for Healthcare Improvement’s Triple Aim:
improving the patient experience of care, improving
the health of populations and unparalleled patient
outcomes, and providing care at an affordable cost.1
A recent survey by the AHA of more than 1,000
hospital CEOs, C-suite leaders and board chairs found
a general agreement on the direction in which the
health care field is heading. These leaders forecast that
in five years there will be more hospitals aligned with
health systems, greater hospital/physician affiliation,
increased ownership of health plans by systems, and
increased value-based and capitated payments.1
To better understand how well hospitals and their
governing boards are preparing to make this shift, the
2014 survey included new questions focusing on
board chair and CEO perceptions of board readiness to
govern in the transforming health care delivery system.
Knowledge of Health Care Transformation
The first step in preparing for health care
transformation is ensuring that hospital and health
system boards of trustees understand the factors
driving health care transformation, as well as the
potential implications on their organization and
community. Trustees should continually seek
information and education about changes in the
environment, and engage in dialogue about the
strategic implications for their organization. Boards
need to ensure that a fundamental question is
regularly asked and answered: “What do we know
today that we didn’t know at our last meeting, and
how does that new information impact or reshape the
assumptions that underpin our strategic direction?”
Both board chairs and CEOs reported that their
boards were fairly knowledgeable about the coming
changes, with scores of 3.9 and 3.8 respectively on a
five point scale (see Figure 11.1).
Engagement in Transformational
Governance Practices
Engaging in transformational governance practices
may be different for every board, but typically
includes discussion and dialogue around key
considerations for future board thinking, board
competencies, and the organization’s overall strategic
direction. Areas explored in this area of the survey
included board engagement in:
• examining emerging governance models and
considering how they might apply to their
organization;
1 “Leadership Toolkit for Redefining the H: Engaging Trustees and Communities”. American Hospital Association Committee on Performance Improvement
and Committee on Research, 2014
51
Figure 11.1
How Knowledgeable is Your Board About the Transformational Changes
Occurring in Health Care?
100%
5
Extremely
Knowledgeable
4
3
Has Some
of Knowledge
2
0%
0%
0%
1%
2%
25%
33%
45%
21%
20%
50%
25%
53%
75%
1
Extremely
Uninformed
CEO Board Chair
• having a candid strategic discussion about what
health care transformation means for their
organization, and how to best deploy assets to
meet community health needs;
• developing a new vision and strategy for
transformational change for their organization;
• developing future-focused metrics that assess
today’s performance and shape future outcomes;
• strengthening board and organizational
competencies to manage change and risk; and
• developing new or revised competencies required
for board membership in a transformed
environment.
Overall, there were significant differences in the
responses between board chairs and CEOs about the
extent to which boards are currently engaged in new
practices to prepare for governing in a transformed
52
health care delivery environment, with the board
chairs reporting much higher levels of engagement
than CEOs.
On a scale of one to five, board chairs rated the
board’s level of engagement highest for having candid
strategic discussion about what health care
transformation means for the organization and how
to best deploy assets to meet community health needs
(4.0, see Figure 11.3), and developing a new vision
and strategy for transformational change in their
organization (3.9, see Figure 11.4).
CEOs rated the board’s level of engagement lowest
for examining emerging governance models and
considering how they might apply to their
organization (3.1, see Figure 11.2) and developing
new or revised competencies required for board
membership in a transformed environment
(2.7, see Figure 11.7).
Figures 11.2, 11.3, 11.4
Board Engagement in Examining Emerging Governance Models and
Considering How They Might Apply for Their Organization
100%
3%
9%
8%
16%
35%
34%
25%
20%
25%
12%
50%
37%
75%
0%
Board Engagement in Having a Candid Strategic Discussion About
What Health Care Transformation Means for Their Organization and
How to Best Deploy Assets to Meet Community Health Needs
100%
0%
1%
2%
3%
7%
35%
36%
31%
25%
25%
24%
50%
35%
75%
Board Engagement in Developing a New Vision and Strategy
for Transformational Change for Their Organization
100%
1%
5%
0%
3%
27%
35%
35%
30%
9%
25%
22%
50%
32%
75%
5
Actively
Engaged
4
3
Beginning
to Engage
2
1
Not At All
Engaged
CEO Board Chair
53
Figures 11.5, 11.6, 11.7
Board Engagement in Developing Future-Focused Metrics that Assess
Today’s Performance and Shape Future Outcomes
100%
2%
5%
9%
16%
34%
37%
29%
21%
25%
14%
50%
33%
75%
0%
Board Engagement in Strengthening Board and Organizational
Competencies to Manage Change and Risk
100%
3%
6%
8%
18%
33%
37%
27%
15%
25%
11%
50%
41%
75%
0%
Board Engagement in Developing New or Revised Competencies
Required for Board Membership in a Transformed Environment
100%
11%
16%
26%
36%
26%
18%
15%
5%
25%
10%
50%
36%
75%
0%
5
Actively
Engaged
4
3
Beginning
to Engage
2
1
Not At All
Engaged
CEO Board Chair
54
Information Technology Resources to
Support Transformation
The goal of population health, or improving the
overall health of a population, is closely aligned with
hospitals’ missions to improve the health of the
community they serve. As hospitals and health systems
foster partnerships with other providers and build
community relationships to impact the overall health
of the community, information technology is
necessary to define, track and measure success,
including using predictive modeling for population
health management, as well as the use of data analytics
for care management and operational management.
Both board chairs and CEOs expressed some concern
about the adequacy of their organizations’ information
technology resources for supporting population
health. On a scale of one to five, board chairs rated
their IT adequacy for supporting population health
at 3.5, while CEOs rated it as 3.0 (see Figure 11.8).
Progress in Transformation
Transformation takes time and patience. Many
hospital and health system boards reported that they
are well on their way to creating a transformed health
care organization, while board chairs reported that
they are slightly further along than CEOs reported.
Only 1 percent of respondents indicated that they
have not yet begun the transformational process, and
only 1 percent reported that they have completed the
work; this leaves the vast majority of organizations in
the process of transitioning toward a transformed
health care organization (see Figure 11.9).
Willingness to Give Up Some Autonomy
As organizations increasingly engage in collaborations,
alliances, mergers and acquisitions, the structure of
governance and the role of local boards may change.
While no single governance model fits every
organization, many larger systems are redefining the
role of the larger, system board that results in a more
limited, yet essential role for local governing bodies.
Figure 11.8
How Adequate Are Your Organization’s Information Technology Resources
for Supporting Population Health?
100%
2%
7%
12%
27%
33%
26%
13%
25%
8%
50%
32%
39%
75%
0%
5
Extremely
Adequate
4
3
Adequate
2
1
Not At All
Adequate
CEO Board Chair
55
Figure 11.9
How Far is Your Organization in the Journey to
Create a Transformed Heath Care Organization?
21%
5
Completed
Work
4
3
Well on the way
2
1%
4%
12%
1%
0%
1%
25%
23%
50%
41%
41%
75%
53%
100%
1
Have Not Yet
Begun
CEO Board Chair
Figure 11.10
Would Your Board be Willing to Give up
Some Autonomy in Order to Ensure
the Survival of Your Organization?
86%
91%
Yes
100%
75%
50%
25%
14%
9%
No
0%
When asked if their boards would be willing to give
up some autonomy to ensure the survival of their
organizations, a strong majority of both board chairs
and CEOs would agree to their boards having less
autonomy. Responses between board chairs and
CEOs differed slightly, with 91 percent of board
chairs indicating a willingness on the part of
the board to give up some autonomy, and with
86 percent of CEOs agreeing (see Figure 11.10).
56
Section Highlights
• Both board chairs and CEOs reported that
their boards were fairly knowledgeable about
the emerging changes in health care delivery
and financing, with scores of 3.9 and 3.8
respectively on a five point scale
• There were significant differences in the
responses between board chairs and CEOs
about the extent to which boards are currently
engaged in new practices to prepare for
governing in a transformed health care
delivery environment, with the board chairs
reporting much higher levels of engagement
than CEOs
• Board chairs rated their IT adequacy for
supporting population health at 3.5, while
CEOs rated it lower at 3.0 on a five-point scale
(extremely adequate to not at all adequate)
• Many hospital and health system boards
reported that they are well on their way to
creating a transformed health care organization
• When asked if their boards would be willing to
give up some autonomy in order to ensure the
survival of their organizations, a strong majority
of both board chairs and CEOs would agree
to having less autonomy in favor of survival
57

Board Book June 25, 2015

Transcription

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