While most patients and visitors are respectful, there is an alarming trend of intimidating and violent behavior toward healthcare workers. The repercussions are far-reaching, impacting their mental and physical well-being, disrupting patient care and contributing to workforce shortages. Hospital leaders are taking steps to create safer care environments; support from trustees is essential to advancing this important work.

Did you know?

• The healthcare and social service industries have the greatest rates of workplace violence injuries, with workers being five times more likely to be injured than other workers. That rate increased 63% from 2011 to 2018.
• Forty four percent of nurses report experiencing physical violence and 68% reported experiencing verbal abuse during the pandemic.
• A 2022 poll of more than 30,000 emergency physicians found that witnessed emergency department violence was up 24% compared to 2018.

The negative effects of this widespread violence include:

• Harm to healthcare employees’ physical and psychological well-being, as victims are more likely to experience demoralization, depression, loss of self-esteem and signs of post-traumatic stress disorders like sleeping problems, irritability, difficulty concentrating and reliving the incident.
• Reduction of employee productivity and increases absenteeism.
• Healthcare workers avoiding careers in clinical settings, worsening the current workforce shortage.
• Impact on quality of care delivered and increase of the potential for adverse medical events.

For all these reasons, healthcare trustees should be committed to working with their hospital and health system leaders to build safer workplaces and communities. Trustees should ensure there is an organizational strategy to keep their hospital or health system free of violence by initiating important discussions with questions such as:

• Is the board receiving updates on programs and policies related to workplace violence prevention, including education, training and trauma support programs?
• Is your organization routinely reporting data on incidents of violence to leadership, including the board?
• Does the organization have a strategy and dashboard to assess workplace safety and is this shared with the board?
• If your Community Health Needs Assessment or community health initiative identifies violence as a priority, is the board receiving updates on programs and partnerships that aim to reduce community violence?

The Joint Commission’s standards require that a hospital’s workplace violence program be led by a designated individual and that hospital leadership, including the board, receive regular reports on incidents and trends. Trustees should ensure their hospital or health system meets the TJC requirements that include having clearly defined policy, reporting procedures and employee training.

HANYS is dedicated to supporting our members with this issue through advocacy, a member health violence workgroup, and education. Recordings of our Preventing and responding to aggressive patient behavior webinar series and recently released issue brief can be found on HANYS.org. Contact Sarah DuVall, director of behavioral health, at sduvall@hanys.org to learn more.

Information for this article was obtained from:

• Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures, Ann Med Surg (Lond). 2022 Jun; 78: 103727.
• Violence Against Healthcare Workers Is Rising: Here’s How We Can Protect Them, Forbes, Aug. 2, 2023.
• How Boards Contribute to a Safe Workplace and Community, AHA Trustee Services Boardroom Brief. © Used with permission of the American Hospital Association.

The mission of hospitals and health systems is to care for their patients and communities. They provide financial assistance to those in need and have programs to support their communities’ health and well-being, such as help with housing, accessing healthy food, education, health screenings, vaccination clinics and transportation to medical appointments.

Background:

• Nonprofit, or 501(c)3, hospitals are exempt from federal, state or local taxes and receive other benefits, with the idea that profits will be reinvested into the community to further the charitable purpose. Trustees must ensure their organizations meet federal (community benefit standard) and state requirements.
• To collect information and enforce compliance with the requirements, the IRS requires that tax-exempt hospitals report on community benefit activities in IRS tax form 990 and Schedule H. This transparency has led to heightened public awareness and regulatory scrutiny, questioning nonprofit hospitals’ compliance and commitment to their communities.

Reports have been released highlighting nonprofit hospitals’ use of tax breaks and questioning the amount of charity care they provide. Unfortunately, these reports can mislead the public and typically do not recognize the scope and amount of community benefits hospitals provide.

According to HANYS’ Economic and Community Benefit report released earlier this year, New York state voluntary, nonprofit hospitals provided $17.2 billion in community benefits, representing 21% of their total expenses. This figure doesn’t include the billions more in community benefits provided by New York’s 22 public hospitals, which are exempt from filing this IRS form. Trustees can browse HANYS’ statewide, regional, legislative and hospital- and system-specific reports to see how New York’s hospitals and health systems significantly impact their local economies and communities. Updated reports will be released in the coming months.

Full and accurate reporting of community benefit activities and investments is crucial as scrutiny is expected to grow. Today, HANYS sent its annual analysis of members’ community benefit and investment reporting on IRS Form 990 Schedule H to hospital and health system leaders. Our analysis helps members improve their reporting through a review of their past Schedule H submissions, comparing their data with hospitals across the state of comparable size and comparing their 2019 through 2021 reporting to help expose potential gaps.

As the debate continues, trustees should be well versed in their hospital/health system’s community benefit impact and be able to speak and advocate on its behalf. Key roles that trustees can play to support their hospital or health system include:

• Adhere to your organization’s mission.
• Be the voice of your community and advocate for their health needs.
• Understand how your organization provides community benefit and addresses your community’s healthcare needs.
• Be a spokesperson for your organization.
• Build constructive relationships in the community to drive better community health.
• Hold management and the board accountable.

Questions that can prompt discussion in the boardroom include:

• What are the health challenges of our community, particularly the poor and most vulnerable? Do our reports provide overall health data or do we also receive stratified data that provide insight on individuals or groups that may be “left behind”?
• How are we actively using the community health needs assessment to drive our actions and investments to improve community health?
• What partners can help address our needs? How does the organization identify and evaluate community organizations that could serve as potential partners?
• What is our annual spending on community benefit activities (IRS form 990 and Schedule H tax filings)? How does our spending compare to the national average? What more can be done?
• What is needed to increase the health system’s capacity to change toward value-based models?

With today’s renewed emphasis on community health, hospitals and health systems need to focus on strong community governance and stay true to their mission.

Information for this article was obtained from:

• AHA Trustee Services article: “The Ever-important Role of Hospital Community Boards.” © Used with permission of the American Hospital Association.
• AHA Benefits to Communities website
• AHA Letter Responding to Report on Tax-exempt Hospitals

This October marks the 20th Cybersecurity Awareness Month, when public and private sectors work together to raise awareness about the importance of cybersecurity.

This year’s CISA Cybersecurity Awareness Month theme, Secure Our World, reflects an enduring message that encourages all of us to take action each day to protect ourselves online and when using connected devices with four simple steps.

Cybersecurity impacts everyone, but as healthcare trustees, it is important to understand how significantly the healthcare industry is affected:

• Over 300 data breaches have been reported to the U.S. Department of Health and Human Services Office for Civil Rights this year alone. This is an increase of more than 104% compared to mid-year 2022. Fortified Health’s Security Mid-Year Horizon Report says that the staggering rise in breaches has affected over 40 million individuals, a year-over-year increase of 60%.
• According to an IBM report, the average cost of a healthcare data breach reached $10.93 million this year, up from $10.1 million last year and more than double the global average cost of a data breach ($4.45 million).
• Ransomware victims who involved law enforcement saved an average of $470,000 in breach costs compared to those who chose not to involve law enforcement, according to a study using real-world data.
• Only one-third of breaches were discovered by internal IT teams, with 27% exposed by the hackers, according to the report. The hacker-exposed breaches cost $1 million more on average, showing the value of having the tools to find a breach quickly.

Healthcare trustees play an important role in curtailing cybersecurity risk. Ensuring patient safety and data protection must be a priority. Learn talking points for the boardroom in the AHA article, “The Board’s Role in Cybersecurity.”

Our world is increasingly digital and interconnected. So while we must protect ourselves, it takes all of us to protect the systems we rely on. Investing in cybersecurity awareness strategies can pay off in the long run. We encourage all hospitals and health systems to engage in this year’s efforts by creating your own awareness campaigns. Use the Cybersecurity Awareness Month 2023 toolkit to help your organization learn the basics of cybersecurity.

Information for this article was obtained from:

• CISA Cybersecurity Awareness Month
• Fortified Health Security Mid-Year Horizon Report
• IBM Report: Half of Breached Organizations Unwilling to Increase Security Spend Despite Soaring Breach Costs
• AHA Trustee Services article: The Board’s Role in Cybersecurity. © Used with permission of the American Hospital Association.

Healthcare governing boards play an important role in ensuring quality and patient safety. Yet, many healthcare boards struggle with quality oversight, given its complexity and the wide variation in guidance and practices across hospitals and health systems.

Boards that prioritize quality oversight and are well-educated on the topic tend to perform better on key quality indicators.

Boards that are well-educated about their quality of care role and the hospital’s quality improvement and credentialing processes can understand the information they receive, ask insightful questions and make good decisions.

Board education along with a clear, actionable framework for better quality governance is imperative. To clarify trustee responsibilities and help leaders and boards govern most effectively, the Institute for Healthcare Improvement developed a white paper that includes a framework for quality governance, a quality assessment tool and three support guides.

Take advantage of this white paper and other available resources and education to understand and fulfill your fiduciary responsibility and commitment to the patients and community you serve.

Plus, attend our Annual Trustee Conference next week to hear directly from Jonathan Perlin, MD, president and CEO of The Joint Commission, who will discuss the important leadership role for governance in healthcare quality. He’ll also discuss new federal guidance for boards through the Quality Assurance and Performance Improvement Plan and review resources and strategies that trustees can apply in their organizations.

Information for this article was obtained from: Daley Ullem E, Gandhi TK, Mate K, Whittington J, Renton M, Huebner J. Framework for Effective Board Governance of Health System Quality. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2018.

Healthcare trustees play a pivotal role in guiding organizations during troubled times. Amid today’s financial challenges, how can trustees best support their facility’s journey to better financial performance?

First, consider whether you need a:

• Turnaround: A financial overhaul, which attempts to reverse poor financial performance and bring an organization back from financial collapse; or a
• Transformation: A type of strategic adaptation that focuses on creating a different business model or a new way of doing business.

Work strategically with your CEO to conduct a thorough strategic diagnosis to ensure your board understands the organization’s position. If a turnaround or transformation is necessary, trustees can start with four action-oriented strategies:

1. Reexamine and shift your business and market strategy.

   Spend adequate time discussing the organization’s competitive business strategy at board meetings, which defines how you intend to compete, who you intend to serve, where you are headed and how you intend to get there. Bring in strategic consultants or experts, spend time exploring options and support the CEO’s transformation efforts.

2. Identify gaps and bolster your core leadership team.

   Seek to identify if there are gaps in leadership and how those gaps can be filled. Transformations require a leader who can help set strategy, identify new paths, find new partners and create different business models.

3. Develop performance management capacity.

   Encourage and request routine updates on performance management, focusing on total organizational health and including financial resiliency, workplace culture, patient satisfaction, employee turnover, vendor performance, and quality and brand metrics.

4. Create an actionable board agenda.

   Trustees can create actionable agendas while operating at the strategic level by monitoring:

   • board composition;
   • board charge (or board agenda);
   • level of control to exert on certain areas;
   • types of communication with the CEO and senior leadership team;
   • consistency of updates on important topics including regular financial updates; and
   • contributions to organizational strategy.

Require that these topics come up on the board docket with regular updates.

The value created from an organizational transformation or turnaround should be measured in financial, market performance, shareholder performance and human resource terms. Boards that closely monitor these areas will be more effective in their strategic oversight.

These four strategies together can ensure that governance and leadership are aligned and focused on the same objectives during times of financial distress. Read more in the AHA Trustee Services’ article, “Strategic Transformation for Health Care Systems Post-COVID-19.”

Register now for our 43rd Annual Trustee Conference being held Sept. 21 - 23 in Saratoga. Our theme this year, Renewing Healthcare Governance to Navigate the Future, reflects our focus on providing you with more strategies to support your leadership in this challenging environment.

Information for this article was obtained from the AHA Trustee Services article, Strategic Transformation for Health Care Systems Post-COVID-19. © Used with permission of the American Hospital Association.

Part of a board’s duties is to stay current on governance and healthcare issues. No matter how much experience they have, board members should regularly pursue education.

Board agendas are full of critical issues to discuss, but making time to ensure your board has the knowledge and leadership skills to responsibly run your organization is just as important.

Make it a priority with these six steps to operationalize board member education:

1. Establish a plan.

• Add board member education to your “Strengths, Weaknesses, Opportunities and Threats” process and strategic plan and review your education plan annually.
• Begin board member education during orientation and carve out 15 minutes during regular board meetings to continue education. Customize it based on your organization’s needs.

2. Choose the right materials.

• Develop an outline or template of your goals for board member education.
• Set up a new policy for how often or how many hours should be spent on it.

3. Assign a group or individual to be accountable.

• This responsibility could be given to one board member or you could create an education committee to identify important issues and resources and track education.

4. Make board member education an extension of the recruitment process.

• Assess and document each new board member’s level of governance and healthcare knowledge. This will allow you to target specific areas for education without duplicating information they’ve already acquired.

5. Develop a list of resources.

• Make it easy for your board members to take advantage of opportunities for education.
• Share the resources list and make it available on an ongoing basis.
• Direct board members to online articles and encourage them to attend seminars or conferences.

6. Identify governance trends and topics.

• It is critical to educate your board on governance, the issues that affect all organizations, and healthcare-specific issues and trends.

After you get buy-in from the full board and make a commitment to follow through, these steps will be easy to implement.

Remember, HTNYS can be your go-to resource for the education your trustees need to better understand and navigate the shifting healthcare landscape, advocate for their organizations and fulfill their governance responsibilities. Ensure your board has access.

Encourage your board to attend our 43rd Annual Trustee Conference on Sept. 21 - 23 in Saratoga. Our theme this year, Renewing Healthcare Governance to Navigate the Future, will support their leadership in a challenging environment. Stay tuned for registration to open in July.

Information for this article was obtained from the article, “6 Key Steps to Operationalize Board Member Education” by BoardEffect.

Being a first-rate board is key to the success of the entire organization. How would you rate the quality of your board?

As a trustee, it’s easy to feel too busy governing to be deliberative about how you are governing. By “just doing your job” as a board member, you are fulfilling the three core fiduciary duties:

• duty of care;
• duty of loyalty; and
• duty to purpose.

A great board member performs those duties and actively engages in practices that promote good governance. Below are 12 suggestions to enhance your governance.

1. Know your “ABCs” – Always Be Curious and ask questions.
2. Mind your own business – Perform a check on your board’s governance.
3. Support the CEO with accountability – Set goals and monitor results.
4. Mission: The ultimate touchstone – Ask, “Does this further our mission?”
5. Pay attention to dollars and cents – Regularly review financial reports.
6. Integrity – Ensure it is a common thread through all trustee and organization actions.
7. In controls we trust – Ensure compliance with legal and regulatory requirements.
8. Apply an ounce of prevention – Be prepared for unexpected events.
9. All trustees are not the same – Ask them what they wish they knew more about.
10. Know when to fold ‘em – Recruit veteran trustees whose talents are needed for other volunteer opportunities or bring them back after a hiatus.
11. Everyone’s an “all-star”? – Pick the right people through a formal process.
12. Be a true believer – Be engaged, enthusiastic and dedicated to the highest standards of governance.

Tips for implementation:

• consider forming a governance committee to explore and share best practices;
• conduct a board self-assessment (such as the quiz " How does your board rate?");
• create a long-term plan to build on your board’s strengths and address weaknesses; and
• ask your members, at least annually, what they wish they knew more about.

How does your board compare with these best practices? Read more details in the AHA article, “Becoming a First-Rated Board,” and ask your board to reflect on your practices. Knowing this can make a crucial difference to the future of your organization.

Information for this article was obtained from AHA Trustee Services. © Used with permission of the American Hospital Association.

Have you heard of ChatGPT, the new artificial intelligence tool that is taking the digital world by storm? OpenAI launched this tool in November and quickly reached more than a million active users in five days and over 100 million in 60 days.

AI is changing the face of business and healthcare, so trustees and executives must understand the capabilities of this emerging technology and how it might bring opportunities and threats to their organizations.

What is ChatGPT?

It is a simulated “chatbot” primarily designed to interact with customers on a website, provide information on products, answer frequently asked questions and process orders. Using data from sources including textbooks, websites and articles, ChatGPT generates responses to a wide range of queries. Mimicking human speech, ChatGPT interacts in a conversational way and answers follow-up questions, admits its mistakes, challenges incorrect premises and rejects inappropriate requests.

What is ChatGPT currently used for?

Surveys report that almost half of U.S. companies are already using it and 93% of them are looking to expand its use further in upcoming months.

It is a handy tool for content generation, so businesses are using it for purposes including:

• writing emails and articles;
• creating presentations;
• managing meetings;
• drafting business plans;
• generating code;
• making calculations;
• summarizing books;
• creating flyers and brochures; and
• crafting website or social media posts.

How is it transforming healthcare?

ChatGPT is already transforming the way healthcare providers deliver care to their patients — and we haven’t yet scratched the surface of its capabilities. Expect to see ChatGPT-like tools aiding clinicians with its ability to emulate how doctors make clinical decisions, provide around-the-clock medical assistance, prevent medical errors and improve physician performance.

Like other automation tools, it’s great for non-clinical, back-office tasks. Uses can include:

• virtual assistant for telemedicine;
• clinical decision support;
• medical recordkeeping;
• medical translation;
• medication management;
• disease surveillance;
• medical writing and documentation;
• clinical trial recruitment;
• creating symptom checkers;
• patient triage;
• drug information;
• medical education;
• mental health support; and
• remote patient monitoring.

Epic announced that it will use GPT-4 in its electronic health records to help physicians and nurses spend less time at the keyboard, and to help them investigate data in more conversational, easy-to-use ways.

Considerations

While there are many benefits of ChatGPT, there are also significant challenges and concerns. First, it isn’t using reasoning to create the output, so sometimes the tool is just plain wrong. The information it provides may contain biases and may present opinions as facts and it does not offer sources or citations for the information it uses, raising the issue of credibility.

It’s apparent that AI won’t replace healthcare professionals any time soon. But AI tools will increasingly be used to help them do their jobs better and more efficiently. For an in-depth look at ChatGPT, read HANYS’ recent HIT Update.

To prepare, leaders should assess potential risks and opportunities, and discuss ethical, accountability, transparency and liability implications. Policies should be developed before allowing use, including a commitment to ongoing education and training for healthcare providers, regular evaluations of the tool’s performance and outcomes, and continuous efforts to mitigate any potential biases and challenges.

By addressing all of these issues, leaders can ensure that this tool is used to enhance the quality of care for all patients, while protecting their privacy, security and rights, and the organization’s compliance with relevant regulations.

Information for this article was obtained from:

• Introducing ChatGPT – OpenAI
• Epic to use Microsoft's GPT-4 in EHRs – Becker’s Hospital Review
• 5 Ways ChatGPT Will Change Healthcare Forever, For Better – Forbes
• What does ChatGPT mean for Healthcare? – News-Medical.Net
• Revolutionizing Healthcare: The Top 14 Uses Of ChatGPT In Medicine And Wellness – Forbes
• Could ChatGPT technology join the board? – Board Agenda
• 10 Ways Businesses Are Using ChatGPT Right Now – tech.co
• Envisioning the Healthcare Landscape with ChatGPT – NYMC (note this article was written entirely by ChatGPT!)

Hospitals across New York and the nation have reported an alarming rise in patients who become caught in limbo in emergency departments and inpatient units for weeks, months and even years after they are medically ready for discharge.

These delays most often occur due to a lack of care options, administrative gridlock and/or the inability to pay for post-discharge care. Complex case discharge delays, also known as bed blocking or boarding, are devastating for patients, exacerbate bed shortages and result in enormous, unnecessary costs.

Trustees should have a good understanding of the problem to be able to discuss it in the boardroom and advocate for their organizations.

HANYS conducted a three-month data collection pilot in 2022 with hospitals statewide to learn more about the scope of the problem and recently released the results. This builds off of HANYS’ 2021 white paper, The complex case discharge delay problem, which provided an overview of this longstanding challenge and offered suggested actions.

The data collection pilot sought to estimate the number of patients who, for circumstances largely outside hospitals’ control, were unable to be safely discharged and spent more than four avoidable days in the emergency department and/or more than 14 avoidable days in an inpatient unit between April 1 and June 30, 2022.

For the three-month data collection period, 52 participating New York hospitals reported:

• 1,115 patients impacted;
• approximately 60,000 delay days;
• an average ED discharge delay of close to two weeks;
• an average hospital inpatient unit discharge delay of two months; and
• $169 million in estimated associated costs (for much of which hospitals receive no reimbursement).

Who experienced the most frequent and longest delays?

Children and older adults living with medically complex and/or behavioral health conditions.

What caused the delays?

An absence of post-discharge care options, followed by a lack of insurance coverage or means to pay for post-discharge care, and extended administrative processes, such as state and local agency referrals and determining eligibility for services and benefits.

To learn more details and a framework to focus solutions, review the full report: The scope of complex case discharge delays in New York state.

HANYS shared the pilot findings and recommendations with policymakers. We continue our work to develop policy solutions and strategies to address this longstanding challenge.

Trustees can help support their organizations by sharing their facility’s complex case discharge experiences and the impacts on patients and care delivery with legislators and media.

Information for this article was obtained from HANYS’ Complex Case Discharge Delay webpage.

The healthcare industry is undergoing substantial transformation; board governance is too. The American Hospital Association recently released its latest triennial report on governance structures and practices at U.S. hospitals and health systems, based on data from 933 hospital and health system CEOs surveyed between November 2021 and March 2022.

The survey report describes board structures, composition, culture, diversity and other practices that are transitioning in today’s changing environment. Board members and executives are encouraged to compare their own structures and practices with the report’s findings.

To help, the report provides commentary from an array of governance experts and discussion questions to help boards evaluate where they are rising to meet challenges and opportunities for improvement.

The AHA survey report highlights positive governance trends including:

• Progress has been made in racial/ethnic diversity and gender diversity on boards.
• Ninety-one percent of respondents said they are interested in identifying and engaging board candidates who represent diverse characteristics.
• Nearly 70% of all responding boards have engaged in restructuring to improve their governance.
• The use of knowledge, skills and behavioral competencies to select board members has steadily increased in the past decade. This is considered a governance best practice.
• The use of a board portal, considered a governance best practice, has become more prevalent.

However, there are opportunities for improvement:

• A third of respondents’ boards did not use term limits.
• Survey results indicated a growing number of older board members and a declining number of younger members.
• More than 75% of respondents’ boards either did not replace board members during their terms or continued to reappoint them when eligible during the past three years, resulting in low levels of board turnover.
• Sixty-one percent said they do not have a continuing education requirement for board members.
• More than a quarter of boards did not do any type of assessment in the past three years.
• About half of all boards do not hold the CEO accountable for diversity, equity and inclusion goals as part of their performance review.

AHA’s 2022 National Health Care Governance Survey Report is complimentary to AHA members.

Information for this article was obtained from AHA Trustee Services. © Used with permission of the American Hospital Association.

For a board to be effective, it must first be engaged. Today’s complex and volatile healthcare environment requires that boards be highly engaged in the mission and business of your hospital or health system.

While not all-inclusive, here are seven activities that can support board member engagement:

1. Provide board members with clear job descriptions and share your vision of what board engagement looks like.
2. Have a thorough on-boarding and orientation process for new members, and assign a mentor.
3. Involve board members in activities beyond the board room, such as programs, events, meetings and other opportunities to interact with stakeholders — leading them to fresh insight into your organization’s mission and business.
4. Make sure your board meetings have plenty of opportunities for meaningful discussion.
5. Make it clear board members should question assumptions; probing questions are welcome at meetings.
6. Make sure board members receive materials with ample time to review before board meetings.
7. Make information easy to find for board members — allow them to satisfy their own curiosity.

People join boards because they want to contribute — and the way their time is spent at board and committee meetings can make a big difference. In his article, The right stuff, the right way. Barry Bader identifies 10 steps for optimizing the way a board uses its meeting time and 10 ideas for creating more engaging board meetings.

How do you know if your board is engaged? Board member engagement can be measured by tracking attendance, evaluating preparation for meetings, having candid board discussions and assessing whether there’s a positive, constructive relationship with the CEO and mutual trust and respect among board members. But this only provides a partial view. Ultimately, trustees need to provide direct input through a board assessment. Results of the assessment should be used to make improvements and work to achieve the level of governing excellence required for success in today’s challenging healthcare environment.

Information for this article was obtained from “7 Ways to Destroy Board Engagement,” Board Effect; “The right stuff, the right way: 10 ways to improve board meetings”, AHA Trustee Services; and “Assessing the Engagement and Effectiveness of Boards”, AHA Trustee Services.