Patient Safety and Quality

Several practices of hospital governing boards are linked to improved quality of care

Legal responsibility for hospital quality of care ultimately resides with the hospital's governing board. Several hospital governing board practices are linked to improved quality of hospital care, reveals a new study. Governing boards need to organize themselves to actively participate in setting the quality agenda, establish strategic goals for improvement, and evaluate the hospital's clinical performance against those goals, assert H. Joanna Jiang, Ph.D., and Irene Fraser, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ). Along with coinvestigators at The Governance Institute, they measured quality by performance in process of care and risk-adjusted mortality rates. They analyzed Hospital Compare data from the Centers for Medicare & Medicaid Services and the AHRQ Quality Indicators and Healthcare Cost and Utilization Project inpatient databases.

Hospitals that had a single board committee that focused exclusively on quality had better performance in process of care and mortality indicators. Having a chief medical officer/vice president of medical affairs on the quality committee further enhanced a hospital's quality performance. Another favorable practice was use of a dashboard with internal data and national benchmarks for monitoring clinical quality, patient safety, and patient satisfaction. Holding senior executives accountable for meeting specific goals by including measures for quality and patient safety in their performance evaluation was also linked to improved quality.

Other board practices linked to improved hospital care quality included discussion of quality-specific items at board meetings; establishing strategic goals for quality improvement; and board involvement in setting the quality agenda of the hospital. More details are in "Board oversight of quality: Any differences in process of care and mortality?" by Dr. Jiang, Carlin Lockee, Karma Bass, F.A.C.H.E., and Dr. Fraser, in the January/February 2009 Journal of Healthcare Management 54(1), pp. 15-30. Reprints (AHRQ Publication No. 09-R041) are available from the AHRQ Publications Clearinghouse.

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