The trustee and patient safety: Redefining boundaries

Abstract

The voluntary hospital trustee has traditionally seen issues of medical care, including those of patient safety, as falling within the delegated sphere of the medical staff. This customary distancing of the trustee from direct involvement in patient safety issues is now challenged by unprecedented scrutiny of hospital safety results through voluntary disclosure or mandatory public reporting. This new climate, fostered by the Institute of Medicine's To Err is Human and the Institute for Healthcare Improvement's 100,000 Lives campaign, has complicated the role of the trustee in satisfying the traditional “prudent person” test for meeting fiduciary obligation as the trustee's breadth of involvement expands. Viewed theoretically, Mintzberg models the hospital as a case of a professional bureaucracy, in which the professional staff is responsible for standard setting and regulation. This traditional role of the professional staff is potentially assumed by others lacking technical background. Trustees are now asked to examine reports identifying physician compliance in attaining safety standards without education in the practice supporting those standards. Physician board members, whose numbers have increased in the past decade, are often sought to take the lead on interpretation of patient safety standards and results. The very public nature of patient safety reporting and its reflection on the reputation of the organization for which the trustee is ultimately accountable create a new level of tension and workload that challenges the dominant voluntary model of trusteeship in the United States health system.

Citation

Culbertson, R.A. and Hughes, J.A. (2008), "The trustee and patient safety: Redefining boundaries", Savage, G.T. and Ford, E.W. (Ed.) Patient Safety and Health Care Management (Advances in Health Care Management, Vol. 7), Emerald Group Publishing Limited, Leeds, pp. 127-148. https://doi.org/10.1016/S1474-8231(08)07006-7