August 14, 2013 Proceedings of the CCHHS Quality Assurance and Patient Safety Committee

The new Quality Assurance/Patient Safety Committee consists of chair Lew Collens and members Luis Munoz and Wayne Lerner. New Board member Ada Mary Gugenheim also attended though she’s not on the Committee. It’s an active and attentive group.

For 2014, Dr. Raju will create a schedule allowing most committees to meet on the same day as the Board, to minimize the use of staff time on Board work.

Dr. Das reviewed the regulatory regime under which CCHHS operates, describing its goals as safe, timely, effective, efficient, equitable and patient-centered care. When Gugenheim asked for a definition of patient-centered, Das gave her personal definition (treating patients with respect and allowing them to participate in their own medical decision-making) but acknowledged there was no universally accepted definition. Das also described the evolution of approaches to securing patient safety, from "Quality Assurance" (a retrospective review of outcomes) to QA/CQT (measuring improvement) to the current "Quality, Patient Safety and Improvement" approach, which also considers patient satisfaction. Though regulations come from a variety of sources (the Affordable Care Act, Medicare/Medicaid, the Joint Commission), Das stressed the Board’s ultimate accountability for the System’s performance.

Das then displayed the most recent HospitalCompare data, from 6-9 months ago. Collens asked why CCHHS had only 72% of the pneumonia treatments recommended; Das explained the System uses its own evidence-based approach based on antibiotic resistance in its particular population, rather than the one-size-fits-all recommendations. She also noted that CCHHS has a lower rate of central-line infection than the state average. While Emergency Department waiting time is 6 hours (vs. 91 minutes recommended), Dr. Raju argued the number is good when compared to similar hospitals (e.g. Bellevue) rather than suburban community hospitals. Gugenheim asked whether those times were adjusted for the acute status of individual patients and was assured they were.

Lerner lauded the number of patients who would definitely recommend the hospital but noted the System also needs to measure quality in outpatient services. He proposed measuring ‘kindness’ of providers, and figuring out a way to reflect the patients’ co-obligation for their own care.

The Committee approved proposed bylaws revisions for Provident with one exception, namely, that the draft improperly allowed accumulation of proxies in governance votes. Dr. Wakim explained that the intent was to permit those absent to cast their own vote by written instruction, and only for the election of officers, but the proposed revision wasn’t so limited. Collens suggested that Wakim look to corporate models for unanimous written consent in revising this provision, to achieve the actual purpose without permitting minority domination of voting.

--Submitted by Kelly Kleiman