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

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.