Document Sample
                 HOSPITAL GOVERNANCE:
                                     Santa Monica, California

                                        January 28-29, 2008

                                CONFERENCE SUMMARY
Impetus for the Conference

This conference was first imagined in January, 2005 shortly after the promulgation of the National
Quality Forum’s (“NQF”) groundbreaking document, “Hospital Governing Boards and Quality of Care:
a Call to Responsibility” (the “NQF’s Call to Responsibility.”) Leadership transitions and competing
priorities made it impossible for the NQF to take a leadership role in conference planning, but The
Leapfrog Group (“Leapfrog”) committed to sponsor the conference and asked Dan Roble and Eric Lister
(both of whom had been involved in convening the NQF process that resulted in the NQF’s Call to
Responsibility) to serve as co-directors of the conference. From the outset, Leapfrog’s desire was to
create a unique event, bringing together a wide variety of stakeholders, focused on every aspect of the
governance / quality intersection.

After much planning, the conference was designed for hospital and health system trustees, senior
executives, and those in the legal, accounting, and insurance industries who support hospital and health
system boards. The conference topics addressed a range of interrelated issues germane to the hospital or
health system board's role in driving quality. Specific topics included:

        How health care quality is defined and measured
        The National Quality Forum Call to Responsibility for Healthcare Boards
        Research on the connection between governance and quality
        The effect of board involvement in quality issues on access to capital and D & O insurance
        The appropriate role for system and subsidiary boards in assuring quality
        What a board needs to understand in evaluating technological initiatives
        The legal issues associated with quality matters

Conference Sponsorship

While we received an enthusiastic response to the idea of the conference from multiple parties, our
search for sponsorship took some time. By early 2007, Leapfrog had received substantial commitments
from the UniHealth Foundation (“UniHealth”) and the Agency for Healthcare Research and Quality
(“AHRQ”). (UniHealth, a foundation established to support nonprofit hospitals in L.A. and Orange
Counties, requested that the conference take place in Southern California. UniHealth’s funding was
directed toward significant reduction in the registration fee for attendees from its member hospitals.
Armed with financial support from UniHealth and AHRQ, we proceeded to plan the conference, while
pursuing additional financial support.

By the time of the conference, Aetna, the California Healthcare Foundation, and Ropes and Gray LLP
had all come forward with financial support. Ki Associates, the National Business Group on Health, and
the Texas Medical Institute of Technology contributed in-kind support. Lehman Brothers and
Arrowsight each agreed to sponsored an award, the first for a hospital or health system whose Board had
led unique progress in patient-centered care, the second for a hospital or health system whose Board had
driven exceptional progress in quality. The quality award was won by the Virginia Mason Clinic in
Seattle; the patient-centered care award was won by the Baylor Health System, Dallas. The awards were
presented during the conference lunch on January 28.

Development and Implementation of the Conference

UniHealth also funded a related conference in October, 2007 put on by the Institute for Healthcare
Improvement (“IHI”). Dan Roble attended the IHI conference to assure that our agenda would
complement and further the work done at that event.

Additionally, we asked all L.A. and Orange County hospitals to participate in a survey designed to
identify their current governance practice in the quality arena, and their needs. Twelve hospitals agreed
to a personal or telephone interview. Leaders of VHA West Coast and Southern California Hospital
Association were also interviewed in person. Although most respondent hospitals in the survey
acknowledged that their Board had developed a clear sense of responsibility, there was a wide diversity
of Board practice in setting a quality agenda and overseeing progress in quality improvement efforts.

Our final conference agenda (attached) contained two sets of breakout groups and several interactive
panels in order to offer variety and maintain audience energy. We were able to integrate a detailed
description of the U.S. healthcare system’s quality problem with numerous perspectives on how a
hospital Board can help to address the quality problem. Our conference notebook supplied summaries
and workbook sections (specific questions for discussion or analysis “back at home”) for each session
and breakout. Speakers all agreed to participate for travel reimbursement only.

Logistical support for the conference was coordinated by Lisa Gail of the B.L. Seamon Company, a
Maryland conference support company.

The conference was attended by 189 registered participants. From a budgetary perspective, the
Conference was virtually break-even, although principle organizers (Leapfrog, Eric Lister, Dan Roble)
were only minimally reimbursed for time devoted to conference preparation.

Conference Feedback and Next Steps

Measured by the immediate feedback from our attendees (below), the conference was a clear success.
Responses are on a 5 point scale, with 5 being the top score

                            OVERALL CONFERENCE EVALUATION
                Participation in this activity enhanced my professional             4.29
                The overall quality of instruction                                  4.32
                The overall relevance to hospital governance                        4.54
                Conference facility accessibility, visual and auditory              4.33
                Facilities were conducive to learning                               4.04
                Content was relevant to objectives                                  4.46
                Content was consistent with the stated program                      4.52
                objectives / goals
                Audiovisual handout materials were effective                        4.04
                Overall conference rating                                           4.26

We are in the process of a post-conference survey of attendees, to see whether, 2 months out from the
conference, attendees can point to specific attitudinal or behavioral changes as a consequence of the
Leapfrog conference. Results will be appended to the next iteration of this summary.

We also are currently discussing the possibility of a second conference on the East Coast. If funding can
be obtained in short order, we will proceed with conference planning for this second conference.

                The Leapfrog Conference on the Future of Hospital
                                  Quality at the Leading Edge
                             The Fairmont Miramar Hotel Santa Monica
                                        Santa Monica, CA

                                         January 28–29, 2007

                                  Day 1: Monday, January 28, 2008
7:00 – 8:00 a.m.          Registration

8:00 – 8:15 a.m.          Welcome, Acknowledgement of Sponsors
                          Speaker:     Jill Berger, Chair of The Leapfrog Group’s Board; Vice President,
                                         Health and Welfare Plans
                                         Marriott International

8:15 – 8:45 a.m.          Opening Keynote: The Quality Challenge in American Medicine: What Is the
                          Hospital Board to Do?

                                         Robert K. Smoldt, Chief Administrative Officer
                                         Mayo Clinic

8:45 – 10:15 a.m.         Panel Discussion: What Is Quality? “Quality Literacy” and the Current Quality-
                          Related Initiatives
                          Participants:    Carolyn Clancy, M.D., Director
                                         Agency for Healthcare Research and Quality
                                         U.S. Department of Health and Human Services

                                         Bruce E. Bradley, M.B.A., Director
                                         Health Care Strategy and Public Policy General Motors Corporation

10:15 – 10:30 a.m.        Break

10:30 a.m. – 12:00 p.m.   Panel Discussion: Excellence in the Boardroom
                          Moderator:    Eric Lister, M.D.
                          Panelists:    Maulik Joshi, Dr.P.H., President and CEO
                                         Network for Regional Healthcare Improvement (NRHI)

                                         Dennis A. Johnson, CFA, Senior Portfolio Manager
                                         California Public Employees’ Retirement System (CalPERS)

12: 00 – 1:30 p.m.        Networking Lunch
                          Award Presentation
                          Viewing of “When Things Go Wrong”
                                        Tom Delbanco, M.D., Richard and Florence Koplow – James Tullis
                                        Professor of General Medicine and Primary Care
                                         Harvard Medical School

                      Day 1: Monday, January 28, 2008 (cont.)
1:30 – 2:30 p.m.   Consumer and Employer Perspective on Quality and How do we Engage Both
                   Moderator:   Jill Berger, Chair of The Leapfrog Group’s Board; Vice President,
                                  Health and Welfare Plans
                                  Marriott International

                   Speaker:       Laura Landro
                                  The Wall Street Journal

2:30 – 3:00 p.m.   Film and Commentary:
                   The National Quality Forum’s Safe Practices: What a Board Needs to Know
                   Speaker:      Charles R. Denham, M.D., Chairman
                                  Texas Medical Institute of Technology (TMIT)

3:00 – 3:20 p.m.   Break

3:20 – 4:30 p.m.   Breakout Sessions #1–Concurrent

                      1. Large Not-for-Profit System Governance
                         Leaders:       Robert Issai, President and CEO
                                          Daughters of Charity Health System

                                          Daniel Roble, Esq., Partner
                                          Ropes & Gray LLP

                      2. Governance in the For-Profit Sector
                         Leaders:      Jill Fainter, Vice President of Corporate Quality
                                          HCA, Inc.

                                          James Rice, Ph.D., Vice Chairman
                                          Governance Institute

                      3. The Board’s Role in Risk Management Issues
                         Leaders:      Larry L. Smith, Esq., Vice President Risk Management,
                                          MedStar Health

                                          Margaret H. Campbell, Esq.
                                          Ropes & Gray LLP

                      4.   Bond Rating Agencies’ Perspective on Quality and Borrowing Capacity
                           Leaders:     Lisa Goldstein, Senior Vice President
                                          Moody's Investor Services

                                          James Molloy, Senior Vice President
                                          Lehman Brothers

4:30 – 5:45 p.m.   Getting Down to Work: The Board's Quality Dashboard and How to Use It
                   Speaker:      Eric Lister, M.D., President
                                  Ki Associates LLC

6:00 – 8:00 p.m.   Cocktail Reception

                           Day 2: Tuesday, January 29, 2008
8:00 – 9:00 a.m.   The Government Weighs In
                   Introduction: Daniel Roble, Esq.
                   Speaker:      Steve Hill, Administrator
                                  Washington State Health Care Authority

9:00 – 10:15 a.m.         Breakout Sessions #2–Concurrent

                              1. Information Technology as a Path Towards Quality
                                 Leaders:      Alisa Ray, Executive Director
                                                 Certification Commission for Healthcare Information
                                                 Technology (CCHIT)

                                                 Jane B. Metzger, Research Director
                                                 First Consulting Group

                              2. Evolving Trends in D & O Insurance
                                 Leader:       Nicholas J. Conca, Esq., Managing Principal
                                                 Integro Insurance Brokers

                              3. Bond Rating Agencies’ Perspective on Quality and Borrowing Capacity
                                 Leaders:     Lisa Goldstein, Senior Vice President
                                                 Moody's Investor Services

                                                 Thomas Whalen, Managing Director
                                                 Lehman Brothers

                              4. The Board’s Role in Risk Management Issues (repeated)
                                 Leaders:      Larry L. Smith, Esq., Vice President Risk Management
                                                 MedStar Health

                                                 Margaret H. Campbell, Esq.
                                                 Ropes & Gray LLP

10:15 – 10:40 a.m.        Break

10:40 – 11:45 a.m.        Panel Discussion: CEO/Board Chair Dialogue
                          Moderator:    Ruth Katz, J.D., M.P.H., Dean and Walter G. Ross Professor of
                                         Health Policy
                                         The George Washington University School of Public Health
                                          and Health Services

                          Panelists:     Richard M. Levy, Ph.D., Board Member, Sutter Health, Chairman and
                                         Varian Medical Systems

                                         Daniel J. Wolterman, President and Chief Executive Officer
                                         Memorial Hermann Healthcare System

                                         Jane Metzger, Chair, Board Quality Committee, Member, Board of
                                         Cambridge Health Alliance

                                         James H. Hinton, President and C.E.O.
                                         Presbyterian Healthcare Services

11:45 a.m. – 12:30 p.m.   Closing Keynote: A Call to Action

                          Speaker:       Michael Millenson, Author, Demanding Medical Excellence