CEOs should personally conduct investigations of events that caused significant patient injury, according to the How To Guide. And then, the CEO "should personally present that case to the board in a session of no less than one hour in length." And if possible, the patient and family should be there to add their account in person.
"The trustees have to become outraged," he says. That doesn't happen "if they don't know that they killed someone, or that five people got serious infections." Those boards also have to make it clear to their CEOs that they expect to be told about such issues. But for some CEOs, "this just isn't the type of information they usually share with the board."
Conway knows what he's talking about. He was COO of Dana Farber Cancer Institute in Boston in the mid-1990s when two chemotherapy overdoses resulted in the death of one woman, a reporter for the Boston Globe, and serious heart injury to another. The events provoked a major introspection of processes and medical error prevention at the institute, and may have laid much of the groundwork for the safety movement today.
Now, regulatory agencies and payers are pushing for boards that have a better appreciation for quality matters, Conway says.
For example, in some states, insurance companies and the Joint Commission are focusing attention on board involvement in hospital quality benchmarks. Blue Cross Blue Shield of Massachusetts will reimburse hospitals more money if the board undergoes quality training, he says.
States like New Jersey have passed laws requiring hospital boards to go through a formal quality curriculum. And, Conway says, quality training for trustees has even provoked some state attorneys general to weigh in on the issue.
"The Inspector General has issued several reports on the topic, and Leapfrog has embraced this as well."
Is it working? I asked Conway.
"Am I meeting more extraordinary boards today? Yes," he says. Today, if the Harvard researchers conducted the same survey, nearly three-fourths would rank clinical quality a major priority, he said, up from 50%.
"But do I also meet with boards whose journey has yet to begin? No question."
Of course, some of hospital boards' failure to grapple with these topics might be blamed on CEOs, who keep their board in the dark. Boards must insist that they expect to be informed.
A formidable obstacle to change remains, one he calls the "arrogance of excellence."
"Good organizations talk about the wonderful things that go on in their hospitals, and bring you to tears about their beautiful stories. But the problem is that those stories are seductive. The arrogance of excellence is that you don't create a space to talk about the harm, the tragedy, and the waste."
Conway says one board meeting he recently attended "was lovely. Everyone was very nice to each other. But there was no discussion of the degree of harm that had gone on. There was a detailed report, and if you were smart enough, you could go find it, but no one pointed it out to the board that it was there."