JHF Retreat Envisions a New Era of Activist Healthcare Boards
While the U.S. health system performs miraculous acts of healing, it also commits serious acts of harm. Each year in the U.S., between 250,000 to 440,000 people die due to preventable medical error. An estimated 40% of healthcare spending is wasted on unnecessary treatments and preventable complications, inefficiencies, and errors. Front-page stories abound on wrong-site surgeries, provider misconduct, and conflicts of interest.
Many reasons and excuses have been given for the U.S. health system's longstanding quality and safety problems, from the payment system to medical and health professional education to consumer and purchaser inaction. But what are the roles and responsibilities of healthcare governing boards in guaranteeing the quality and safety of the hospitals and systems that they oversee? How much better could the system be if governing boards were designed for, and charged with, active engagement?
On December 10, the Foundation hosted an interactive retreat for JHF, Pittsburgh Regional Health Initiative (PRHI), and Health Careers Futures (HCF) board members that explored the legal, ethical, financial, and quality and safety responsibilities of healthcare governing boards. The retreat introduced a new set of expectations for active healthcare board governance, examined the psychological components of bystander behavior, and imagined how activist boards could have prevented many past deaths and could prevent future harms.
Karen Feinstein set the tone for the retreat by introducing a new compact for healthcare board members — one that treats board governance as a sacred responsibility to protect the well-being of patients, the workforce, and the health system. The compact emphasizes that board members are selected because they bring a unique passion and insight to the task of guiding a health system that is safe, reliably best practice, efficient, and affordable. Under the compact, Dr. Feinstein noted, board members are expected to request and receive information, data, training, and experiences that support quality decision-making.
JHF Board Chair David Ehrenwerth, JD, provided a brief overview of the legal obligations and vulnerabilities of healthcare boards. Gerard Magill, PhD, a professor at Duquesne University's Center for Healthcare Ethics, described the ethical obligations of healthcare boards. Lauren Bairnsfather, PhD, director of the Holocaust Center of Pittsburgh, offered a definition of bystander behavior, which is characterized by group conformity, denial, apathy, and passivity. JHF Consultant Jonathan Weinkle, MD, FAAP, a Squirrel Hill Health Center primary care physician and author of the new book Healing People, Not Patients: Creating Authentic Relationships in Modern Healthcare, explained the conditions that can create physician bystanders and a culture of acceptance.
Then, attendees engaged in three "what if?" breakout discussions that explored how much different the U.S. healthcare system could be if board members were equipped with and empowered by the new compact.
The first breakout challenged attendees to turn back the clock by about 20 years, to the time when the Institute of Medicine's reports revealed the stunning regularity of preventable medical error. Each person assumed the perspective of a critical stakeholder board member, and considered how they might have responded to own the problem of preventable medical error back then and treat it like a public health emergency. Karen Feinstein and JHF Board member Jim Lieber, Esq., author of Killer Care: How Medical Error Became America's Third Largest Cause of Death, and What Can Be Done About It
The second breakout delved into the psychological constructs of bystander behavior. Attendees discussed the potential of board members to enhance care if health systems encouraged them to ask questions, make suggestions, demand accountability, and even voice constructive criticism. They also examined ways to eliminate the "shame and shun" culture that encourages silence when actual or potential harms are known. Psychiatrist Marnin Fischbach, MD; Brad Stein, MD, PhD, Senior Physician Policy Researcher at the RAND Corporation; Jonathan Weinkle; and JHF Special Projects Director John Allison facilitated the breakout.
During the third breakout, attendees operationalized the new compact that Dr. Feinstein introduced. Through case studies, they discussed how a number of prominent mistakes — from fatal medication errors to wrong-site surgeries to profitable but questionable transplant programs — would have been handled differently if the new compact had been in place. Ken Segel, MBA, Managing Director of Value Capture; Gerard Magill; and JHF COO/CPO Nancy Zionts, MBA facilitated the breakout.
"We know how to reduce deaths from medical errors," Dr. Feinstein said during the retreat. "PRHI has demonstrated this for 20 years. Now it takes the will, the leadership, and some ownership of the problem by the boards who govern our health systems and hospitals."