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 organizational environment included several outpatient clinics, multispecialty physician practices, and an insurance entity. Many of the current board members had served the organization since the medical center was built, and board activities always had been performed in a certain way. The administration rigidly controlled board meetings. Board members did not ask questions and routinely approved committee reports. The reports covered topics such as the organization’s financial status and future financial plans, physician credentialing, care quality monitoring, new policies, and plans for a new hospital.
A new board member with a healthcare 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 given. One report detailed some reengineering projects. One of these 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 surverys. Data excerpted from this report can be seen in the “1st Quarter” column of table 15.1 (found on page 326). 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 staffing 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 (found on page 326). After reviewing the data presented by the nurse administrator, the new board member was very concerned and decided to ask if the values in the quality report, which show 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 in their businesses. This was the first substantive board-level discussion that the new board members had seen. One board member wanted to know whether any data had been gathered from patient focus groups. Another board member ask whether the average length-of-stay data 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
1. What changes or patterns do you see in the data? Determine what remedies d you might be suggested for any problems?
2. Has the CEO carried out his or her responsibility for educating the board? Justify you answer.
3. Depending on the answer to question 2, what strategies would you recommend at this point?
4. What quality data would you recommend to be reported and utilized by this board of directors?
5. Given this administration’s style and leadership approach, do you think the minutes of the board meeting reflect actual board meeting discussions?