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Getting the Board on Board: Engaging Hospital Boards in Quality and Patient Safety

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Background: Transformational change in health care calls on hospital boards of trustees to engage in quality at a level that has never been asked before. Yet little research has been conducted regarding the role of hospital governance in quality.

Methods: Interviews were conducted with chief executive officers (CEOs) and board chairpersons from a convenient sample of 30 hospitals, representing 14 states across the United States. The interviews were 30 to 45 minutes in length and included approximately 30 questions that were open-ended and ratings based.

Results: The level of knowledge of landmark Institute of Medicine (IOM) quality reports among CEOs and board chairs was remarkably low. Conversely, board chairs and CEOs were well attuned to public reporting of quality information. There were significant differences between the CEOs' perception of the level of knowledge of their board chairs and the board chairs' self-perception. There was a mild association between board engagement in quality and hospital performance as defined by their rates in their composite measure of heart failure, heart attack, and pneumonia.

Discussion: The engagement of hospital boards in quality can be enhanced by (1) increasing education on quality to increase the board's quality literacy; (2) improving the framing of an agenda for quality; (3) more quality planning, focus, and incentives for leadership and governance for quality improvement; and (4) greater focus on the patients. Implementing these steps can improve a hospital's overall performance.

Document Type: Research Article

Publication date: April 1, 2006

More about this publication?
  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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