When hospital D became part of Western Healthcare system that had a central board of directors, your hospital’s board began to struggle with its revised role. The new organizational environment included several outpatient clinics, multispecialty physician practices, multispecialty physician practices, and an insurance entity. Many of the current board members had served the organization since the hospital 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 plan 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 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 surveys. Data excerpted from this report can be seen in the First Quarter column of the table below. Given that this was her first board meeting, the new board member remained silent and did not ask any questions. Performance data Quality Performance Measure 1st Quarter 2nd Quarter Medication errors 3.2% 10.42% Patient falls 4.21% 8.56% Cesarean sections 14.21% 17.87% Rate of vaginal birth after C-sections 18.27% 15.72% Healthcare associated infections 1.78% 4.85% Surgical errors 0.15% 0.21% Patient Satisfaction Measure 1st Quarter 2nd Quarter Overall service 40.52% 20.74% Overall clinical 86.72% 70.82% Overall quality of service 45.40% 22.34% Food 30.56% 32.54% Overall cleanliness 85.89% 83.26% Within four months, the new nursing staffing patterns had been launched. Data excerpted from the quality indicators report presented to the board can be seen in the “2nd Quarter” column of the table. 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 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 memb.

1. When hospital D became part of Western Healthcare system that
had a central board of directors, your hospital’s board began to
struggle with its revised role. The new organizational
environment included several outpatient clinics, multispecialty
physician practices, multispecialty physician practices, and an
insurance entity. Many of the current board members had served
the organization since the hospital 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 plan 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 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 surveys.
Data excerpted from this report can be seen in the First Quarter
column of the table below. Given that this was her first board
meeting, the new board member remained silent and did not ask
any questions.
Performance data

2. Quality Performance Measure
1st
Quarter
2nd
Quarter
Medication errors
3.2%
10.42%
Patient falls
4.21%
8.56%
Cesarean sections
14.21%
17.87%
Rate of vaginal birth after C-sections
18.27%
15.72%
Healthcare associated infections

3. 1.78%
4.85%
Surgical errors
0.15%
0.21%
Patient Satisfaction Measure
1st
Quarter
2nd
Quarter
Overall service
40.52%
20.74%
Overall clinical
86.72%
70.82%
Overall quality of service
45.40%

4. 22.34%
Food
30.56%
32.54%
Overall cleanliness
85.89%
83.26%
Within four months, the new nursing staffing patterns had been
launched. Data excerpted from the quality indicators report
presented to the board can be seen in the “2nd Quarter” column
of the table. 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 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 member had seen. One board
member wanted to know whether any data had been gathered
from patient focus groups. Another board member asked
whether the average length-of-stay data had increased, and
someone else asked a 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.
Questions:

5. What changes or patterns do you see in the data? What remedies
might be suggested for any problems? (20 points)
Has the CEO carried out his or her responsibility for educating
the board? Why or why not? (10 points)
Depending on the answer to question 2, what strategies would
you recommend at this point? (10 points)
What quality data should be reported and utilized by this board
of directors? (20 points)
Given this administration’s style and leadership approach, how
do you think the minutes of the board meeting reflect actual
board meeting discussions? (10 points)