At Johns Hopkins Medicine, board members turn their attention to quality improvement efforts

The Johns Hopkins Hospital at night from Orleans Street.
Hospitals' board members and patients can get more involved in quality improvement and delivery reform efforts. (Getty/Chris Ryan)

Hospitals grappling with care delivery reforms should engage two groups that are often left out of clinical quality discussions: the organization's governance board and its patients. 

Healthcare boards of directors or trustees tend to fixate on finances, not clinical measures. Johns Hopkins Medicine decided to change that by forming a committee focused on quality improvement.

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Borrow best practices from finance committees

Ron Peterson
Ronald Peterson (Johns Hopkins)

Board finance committees "are disciplined and sticklers for accountability," which makes them an excellent blueprint for a quality initiative, according to an NEJM Catalyst post by Peter Pronovost, M.D., director of the Armstrong Institute for Patient Safety and Quality; C. Michael Armstrong, former Johns Hopkins board chair; Renee Demski, vice president of quality at The Johns Hopkins Hospital; Ronald Peterson, former president of Johns Hopkins Health System; and Paul Rothman, M.D., dean of medical faculty and CEO of Johns Hopkins Medicine. 

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Johns Hopkins Medicine mapped its care delivery system into seven areas and then tapped leaders for each area. Once those leaders were established, they met to align quality improvement into five buckets: safety, performance on quality measures, patient experience, value and equity. 

Another key element, also modeled after the finance committee, was to increase oversight each time quality goals were not met, according to the post. The Armstrong Institute audits each area and provides a report to the committee on failings and areas for improvement. 

Bring patients on board with governance, too

Bringing the patient voice into quality improvement and healthcare design reform is also crucial, especially as providers strive for a patient-centered approach. However, a report (PDF) from the Health Care Transformation Task Force (HCTTF) found that providers could stand to connect more with patients in some areas. 

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The number of avenues for patients to help with care delivery innovation has increased, with more than 91% of the thirteen health systems interviewed by HCTTF saying they had created more organizational structures to engage with patients, including advisory councils and patient advocate offices. 

But hospitals and health systems have trouble recruiting and retaining patients for governance roles, the report found. Finding younger, working patients to participate (as opposed to retirees) poses a challenge. And providers' underlying resistance to change can hinder progress, as well. 

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"The research shows that many forms of consumer engagement are taking place at a level above and beyond a patient's immediate care, but the implementation of the highest levels of engagement remains a balancing act with other aspects of a provider's business strategy," Jeff Micklos, executive director of HCTTF, said in an announcement (PDF). 

“There is a realization that consumers need to be engaged not just as patients but as participants in the value model design and governance of our delivery systems,” he added. “Providers clearly have an opportunity to better involve consumers.”