Board Oversight of Quality: Any Differences in Process of Care and Mortality?, H. Joanna Jiang, Carlin Lockee, Karma Bass, and Irene Fraser
In response to legal and accreditation mandates as well as pressures from purchasers and consumers for quality improvement, hospital governing boards seek to improve their oversight function for quality of care by adopting various practices. Based on a survey of hospital presidents/chief executive officers, this study examines differences in hospital quality performance associated with the adoption of particular practices in board oversight of quality.
Quality was measured by performance in process of care and risk-adjusted mortality, using the Hospital Compare data from the Centers for Medicare & Medicaid Services and the Healthcare Cost and Utilization Project inpatient databases of the Agency for Healthcare Research and Quality. Board practices found to be associated with better performance in both process of care and mortality include (1) having a board quality committee; (2) establishing strategic goals for quality improvement; (3) being involved in setting the quality agenda for the hospital; (4) including a specific item on quality in board meetings; (5) using a dashboard with national benchmarks that includes indicators for clinical quality, patient safety, and patient satisfaction; and (6) linking senior executives’ performance evaluation to quality and patient safety indicators. Involvement of physician leadership in the board quality committee further enhanced the hospital’s quality performance.
Taken together, these findings seem to support the will–execution–constancy of purpose framework on improving the effectiveness of hospital boards in overseeing quality. Future study should examine how specific board practices influence the culture and operation of the hospital that leads to better quality of care.
Use of Board Certification in Ambulatory Surgery Center Credentialing: A Pilot Study Kelly M. Dunham, Dianne Singer, and Gary L. Freed
Ambulatory surgical centers (ASCs) play a considerable role in providing surgical care in the United States. However, ASCs may have less oversight and less well-developed policies for credentialing and privileging compared to hospitals.
Specialty board certification is one metric for measuring physician competence. What proportion of ASCs currently requires board certification for privileging is unknown. This article examines the relationship between board certification and privileging policies at ASCs in the United States. A telephone survey of privileging personnel among a convenience sample of 139 freestanding ASCs with two or more specialty services was conducted between February and May 2007. Fifty out of 81 eligible ASCs completed the survey, resulting in a cooperation rate of 62 percent.
More than half of ASCs surveyed require that surgical specialists (54 percent, N = 27), nonsurgical specialists (56 percent, N = 22), and non–American Board of Medical Specialties (ABMS) specialists (56 percent, N = 24) be board certified at some point during their tenure. Among ASCs that call for board certification during physician tenure, 11 percent (N = 3) require surgical specialists, 5 percent (N = 1) require nonsurgical specialists, and 12 percent (N = 3) require non-ABMS specialists to hold current board certification at the point of initial privileging. Twenty-nine ASCs (59 percent) allow physicians to retain their privileges after certification expires.
Ensuring safe medical care necessitates coordination across healthcare organizations and regulatory agencies. Nevertheless, our results indicate that almost half of multispecialty ASCs are not using this measure of physician competence issued by specialty boards as part of their privileging process.
An Attempt to Forecast Hospital Market Share Using Admission Data, Bita A. Kash, Robert L. Ohsfeldt, and Larry D. Gamm
The purpose of this study was to develop a model to forecast market share before actual market share data become available to a hospital system. The typical data lag is about six to nine months, and market share information is often based on incomplete admissions data. Therefore, this exploratory analysis of admissions for all hospitals in a Texas hospital system was performed as an attempt to improve the accuracy and timeliness of market share data.
We used four data sources: (1) Texas Health Care Information Council Public Use Data File, (2) Solucient, (3) internal data on admissions for three small nearby hospitals not reporting to the state, and (4) population growth data based on the U.S. census. Data analysis was performed using STATA 9 and SAS statistical software. Six prediction models were chosen and evaluated that best predicted present and future market share using historical market share data, historical and current admissions data, and population growth data. These included models for the total market area; the core cluster; and the eastern, western, northern, and southern market clusters.
Only two of the six forecasting equations were useful, with a relatively high prediction value. Overall, the attempt to predict market share based on historical and current admissions data while controlling for demographic factors and seasonality was of limited success. Future research should consider additional factors associated with market share; these factors could include changes in physician referral patterns and third-party-payer contracts. The value of this type of research for management is explored here as well.
Finding the Frontier of Hospital Management, John R. Griffith
The frontier of demonstrated high-performance community hospital management is a valuable guide to the potential of this important healthcare sector. The best documented frontier cases are recipients of the Malcolm Baldrige National Quality Award, a varied set of 34 U.S. community hospitals in nine states. As validated by trained independent examiners, recipient data suggest that performance at or near the best decile of current distributions can be sustained simultaneously across several critical dimensions. However, these hospitals operate substantially differently from tradition, emphasizing a broadly communicated mission, a supportive learning culture, universal measurement and benchmarking, and systematic process improvement.