Patient Safety and Quality

Hospital governing boards are actively engaged in quality oversight, especially those with a board quality committee

Hospital governing boards appear to be actively engaged in quality oversight, particularly in reviewing and tracking the organization's performance through use of internal data and national benchmarks. However, they could significantly improve their quality oversight with a board quality committee, suggests a new study.

Agency for Healthcare Research and Quality investigators, H. Joanna Jiang, Ph.D., and Irene Fraser, Ph.D., in collaboration with researchers at The Governance Institute (TGI), examined data from a TGI survey of hospital and system leaders in 2006 with a total of 562 respondents. Funded and conducted by TGI, the survey included 27 questions about various aspects of board engagement in quality.

More than 80 percent of responding chief executive officers (CEOs) indicated that their governing boards establish strategic goals for quality improvement, use quality dashboards to track performance, and follow up on corrective actions related to adverse events. Nevertheless, less than half of responding CEOs considered their organization's governing board very effective in its quality oversight function, with only 61 percent indicating their boards had a quality committee.

Boards with a quality committee had lower mortality rates for six common medical conditions than boards without a quality committee (5.4 vs. 6 percent). They were also more likely to adopt various oversight practices. For example, 91 percent of boards with a quality committee used quality dashboards or scorecards compared with 79 percent of boards without a quality committee. Boards with a quality committee were also more likely to use a written policy on quality and formally communicate it throughout the organization (34 vs. 26 percent); establish strategic goals for quality improvement (90 vs. 68 percent); be involved in setting the quality agenda for the organization (72 vs. 53 percent) and the board's discussion on quality (49 vs. 33 percent); and mandate alignment on quality initiatives among key stakeholders in the organization (43 vs. 29 percent).

More details are in "Board engagement in quality: Findings of a survey of hospital and system leaders," by Dr. Jiang, Carline Lockee, Karma Bass, F.A.H.E., and Dr. Fraser, in the March/April 2008 Journal of Healthcare Management 53(2), pp. 121-135.

Reprints (AHRQ Publication No. 08-R057) are available from the AHRQ Publications Clearinghouse.

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