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The acronym, PROBE, summarizes key recommendations for board members who want to help their hospitals improve quality:
P = Personal accountability of the CEO is a key first step. Berwick and the IHI got this right.
R = Recruitment and retention of good clinical staff is a critical success factor for institutional quality, and it may become the single most important factor going forward.
O = Outliers, whether considered particularly bad patient outcomes or poorly performing physicians, are symptoms of quality problems and are good places to begin quality assessments.
B = Budgets represent how the board wants to invest the organization’s resources. Quality and safety should be two of the key targets for allocations of time, effort and money.
E = Expectations for quality should be proactively stated by the board in terms of both indicators of performance and the level of performance desired.
Finally, the word “probe” itself is a reminder that board members need to ask the “Why?” and “Why not?” questions. Trustees need to ask how changes are being made so that improvements will last. Board members’ concern for patients and families should lead them to dig deeper than would be appropriate in an ordinary social setting.
A final thought for board members: exercising your responsibility for quality may make you and others uncomfortable at first, but there is no change without discomfort.
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