When a large regional medical center became part of an integrated delivery system that had a central board of directors, the medical center's board began to struggle with its revised role. The new organization's environment included several outpatient clinics, multi-specialty physician practices, and a medical insurance entity. Many of the current board members had served the organization since the medical center was built, and board activities had always been performed in a certain way. The administration rigidly controlled board meetings. Board members did not ask any questions and routinely approved all committee reports. The reports covered topics such as the organization's financial status, future financial plans, physician credentialing, care quality monitoring, new policies, and plans for a new hospital.
A new board member with a health care background was appointed after extensive screening and a personal interview with the executive committee. She was not part of the local business power structure, and the administration was concerned that her appointment might not be a wise move. During her first board meeting two very interesting reports were presented. One report detailed some re-engineering projects. One of these projects involved redesigning nursing staffing patterns. This redesign decreased the number of registered nurses (RNs) and replaced them with licensed practical nurses (LPNs) and certified nursing assistants (CNAs). The current quality report documented a very high quality of care and positive patient satisfaction surveys. Data excerpted from this report can be seen under the column heading "1st Quarter" in table 15.1 on page 402. Given that this was her first board meeting, the new board member remained silent and did not ask questions.
Within four months, the new nursing staff pattern had been launched. Data excerpted from the quality indicators report presented to the board can be seen in the "2nd Quarter" column of table 15.1 on page 402. The new board member was very concerned and decided to ask the nurse administrator presenting the quality report if the values, which showed a negative trend, were for the nursing units with the new nursing staffing patterns. The administrator reported that there was a direct correlation. This answer initiated discussion among other board members who were accustomed to using quality indicators within their own businesses. This was the first substantive board-level discussion that the new board member had seen. One board member wanted to know whether any data had been gathered from patient focus groups. Another board member asked whether the average length of stay (ALOS) had increased, and someone else asked about a cost-benefit analysis of the new staffing patterns. Following the usual process, the chair called for approval of the report and presentation of the next item on the agenda.
Case Study Questions -
What changes or patterns do you see in the data? What remedies might be suggested for any problems?
Has the CEO carried out his/her responsibility for educating the board? Why or why not?
Depending on the answer to question 2, what strategies would you recommend at this point?
What quality data should be reported and utilized by this board of directors?
Given this administration's style and leadership approach, do you think the minutes of the board meeting reflect actual board meeting discussions.