Eastern Health learns that creating a new culture starts and ends with the Board

by admin admin | Nov 01, 2009
In 2005, when Joan Dawe was appointed to chair the Board of Trustees for Eastern Health, she took the helm of a new $1.2-billion health authority created from the merger of seven separate organizations within Newfoundland and Labrador. Like most of the boards Dawe had chaired since 1975, finance dominated their corporate agendas. However, Dawe saw a need for the board to move patient safety and quality of care to the top of its priority list.

Key Messages

In the last year, patient safety and quality of care has become the No. 1 item on the agenda of the Eastern Health Region in Newfoundland and Labrador, thanks to a shift in the focus of the Board of Trustees.

The Board established a Quality and Safety Committee in 2007, and now spends at least 25 percent of its time dealing with quality and safety reports prepared by the organization.

Although shifting the culture of the organization takes time, over the last two years Eastern Health has seen the Board make significant investments in tools and resources that will help the organization to monitor, analyze, and modify key aspects of quality and safety.

In 2005, when Joan Dawe was appointed to chair the Board of Trustees for Eastern Health, she took the helm of a new $1.2-billion health authority created from the merger of seven separate organizations within Newfoundland and Labrador. Each organization had its own culture and method of governance, and like most of the boards Dawe had chaired since 1975, finance dominated their corporate agendas.

However, the newly-amalgamated Eastern Health decided to break with tradition and take a new tack, opting to make patient safety and quality of care its main focus while continuing to fulfill its fiscal responsibility. “I personally believe that this is the role of the Board,” says Dawe, a former deputy minister of health and community services and social services, who in June 2009 retired as Eastern Health’s Board chair.

Dawe’s commitment to patient safety and quality of care was bolstered by her attendance at a Canadian Patient Safety Institute conference in Halifax in 2006. During the conference, she was asked to bring together trustees and board chairs of healthcare organizations from across Atlantic Canada to explore how many of them had patient safety committees. As it turned out, few had any such committee at the board level; clinical staff co-ordinated most quality and patient safety activities.

Dawe returned to St. John’s determined to be among the first to lead from the top down. “I believe we have a responsibility to ensure that our organization creates a safe environment where quality services are provided. This starts at the Board table. It’s our responsibility to foster a culture of quality and safety for the organization,” she says.

New structure, new approach

To start, the Board knew it had to rethink its overall approach to governance, and so in 2007 adopted a new structure based on the Carver Policy Governance Model, named after John Carver, a U.S.-based consultant and author of Reinventing Your Board. Eastern Health modified the Carver governance model and appointed three Board committees – including one that ensures that the organization adheres to the policies the Board has adopted related specifically to safety and quality of care.

If you're not constantly turning over rocks in your organization and looking underneath them, you are less likely to make the improvement you need to make.

“Traditional boards are often driven by what the CEO wants,” says Wayne Miller, Eastern’s vice-president of planning, quality and research. “Under the policy governance approach, the Board sets the strategic directions and is driven by what it has predetermined are issues that need to come forward on a regular basis. The beauty of this is that you eventually end up developing comprehensive reports that are meaningful to the Board.”

As a result of these changes, quality and safety have been the Board’s priority agenda items for the past year, and trustees spend at least 25 percent of their time at Board meetings dealing with quality and safety reports, says Dawe. Quality and safety are also major items articulated in Eastern’s strategic plan.

The Carver policy governance model “helps to create a healthy tension between the Board and the organization,” adds Miller. “If you’re not constantly turning over rocks in your organization and looking underneath them, you are less likely to make the improvement you need to make.”

Lessons learned

To continue to focus on patient safety, and to help meet provincial legislation stressing transparency and accountability, the Board is implementing a computerized occurrence reporting system. Under the new system, directors of the organization automatically get an e-mail when an adverse event has occurred, and are required to reply. Miller reports that the new process is already yielding results. “In areas where the new system has been introduced we are seeing an increase in the reporting of occurrences. The fact that it’s electronic has encouraged more reporting, and enables the organization to more readily monitor and trend occurrences,” he says.

According to Dawe, one of the important things about handling those adverse events is to make sure corrective action is taken to avoid reoccurrence. This may involve addressing system issues or individual responsibility. “In other words adverse events cannot always be blamed on problems with ‘the system’. Individuals must also take responsibility for their actions,” says Dawe.

Changes to how Eastern reports its adverse events are being driven in part by recommendations from the Commission of Inquiry on Hormone Receptor Testing. The inquiry, led by the Honourable Margaret Cameron, reported in March 2009 on the faulty lab tests that led to inaccurate diagnoses for hundreds of breast cancer patients in the province. From this, Miller says that Eastern Health has “learned a lot” about how to handle major critical events better in the future.

Formally designating who is responsible for reporting and responding to safety and quality issues has meant a change in the culture of the health region, and Miller and Dawe agree that changing the safety and quality culture of a new organization which is attempting to merge seven former organizations is challenging. As the role of the Board in quality and safety has evolved, it has required a change in the way that senior management of the authority views the Board. The Board has grown more confident in challenging the information it gets and when it gets it, he says.

Eastern Health is still grappling with defining which quality and safely indicators are presented to the Board, but can so far point to a redefined relationship with the medical staff, investments in electronic occurrence reporting, a region-wide client satisfaction survey, gradual improvements in areas such as Safer Healthcare Now! priorities, and increased numbers of staff being educated in how to improve patient safety and care.

In future, Dawe hopes the Board will involve more representatives from patients and patients’ families in direct patient safety and quality of care initiatives. For now, she’s pleased with the direction in which the Board has moved. “The organization's quality and safety program begins and ends at the Board table,” she says.

Disclaimer:

Pass it on! is a publication of the Canadian Health Services Research Foundation (CHSRF). Funded through an agreement with the Government of Canada, CHSRF is an independent, not-for-profit corporation with a mandate to promote the use of evidence to strengthen the delivery of services that improve the health of Canadians. The views expressed herein do not necessarily represent the views of the Government of Canada. © CHSRF 2009