Institute for Healthcare Improvement: Executive Quality Academy

The New Role of Health Care Executives

Listen to an Executive Quality Academy informational call with faculty and past participants.

The responsibilities of senior executives in health care are changing. For example, hospital CEOs once could argue that their role was to get the finances, facilities, and capital investments right, and that it was the job of the doctors and nurses to deliver quality care.

Reports such as To Err Is Human, along with public report cards such as those from HealthGrades, have created powerful public pressure for quality improvement in health care.

This pressure, when combined with early versions of "pay-for-performance" initiatives such as Bridges to Excellence and the Centers for Medicare & Medicaid Services/Premier, Inc.’s Hospital Quality Incentive Demonstration Project, has made clinical quality performance a strategic imperative — and no longer just a regulatory requirement, or the "right thing to do." In other words, clinical quality performance is no longer delegable to "the quality people."

Responsibility for measured performance in clinical quality and safety rests squarely on the shoulders of each member of the senior executive team, regardless of whether or not they have a clinical background.

So the question is not whether CEOs and other senior executives must take responsibility for measured system-level quality performance.

The question is how to do this new job while still doing all the components of the old job.

That is the core question that the Executive Quality Academy answers.

Intense Program

By what methods are CEOs, COOs, CFOs, CMOs, CNOs, and other members of the senior executive group prepared for these new responsibilities?

Executive leaders who have had any direct involvement in quality in the past have largely experienced it as a series of projects — efforts to improve quality and reduce defects in one disease, or department, or unit. Their new responsibility is to achieve measured performance improvement at the level of the whole system — in measures such as:

Adverse drug events per 1,000 doses of medication across the entire system, not just for one ICU
Wound infection rates for all surgical services, not just for orthopedics
Mortality rates for the whole hospital, not just for acute myocardial infarction

The methods that work at the project level are not adequate to achieve the scale, spread, cultural change, and sustainability required for system-level performance improvement.

Why Participate?

As a senior executive, ask yourself the following questions:

Do you feel frustrated about your organization’s ability to spread improvements across the entire organization?
Do you find that you implement successful improvements for a while, but when you revisit the department a few months later, there’s no apparent evidence that any of the changes have been embedded into standard work practices?
Are you faced with achieving measured quality aims that you have no idea how to reach?
Are you confident that your executive team has the right skills to achieve your stated quality aims, including measured performance on items such as the Centers for Medicare & Medicaid Services Core Measures?

If any of these questions give you pause, this is the program for your executive team.