...hospital system leaders (presidents/chief executive officers [CEOs]) that was conducted in the first six months of 2006 with a total of 562 respondents. The survey contained 27 questions on various aspects of board engagement in quality. More than 80 percent of the responding 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. The adoption of other practices was reported less frequently. Only 61 percent of the respondents indicated that their governing boards have a quality committee. The existence of a board quality committee was associated with higher likelihoods of adopting various oversight practices and lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality's Inpatient Quality Indicators and the State Inpatient Databases.

Hospital governing boards appear to be actively engaged in quality oversight, particularly through use of internal data and national benchmarks to monitor the quality performance of their organizations. Having a board quality committee can significantly enhance the board's oversight function. Other potentially useful activities--such as board involvement in setting the agenda for the discussion on quality, inclusion of the quality measures in the CEO's performance evaluation, and improvement of quality literacy of board members--are currently performed infrequently.

The Institute of Medicine (2001) report Crossing the Quality Chasm calls for improving healthcare systems and organizations as an important step in improving quality and patient safety. By law and regulation, hospital governing boards are ultimately responsible for quality of patient care (Gautam 2005; Marren, Feazell, and Paddock 2003). The accreditation standards set by the Joint Commission (1995) also clearly state that the board is responsible for maintaining quality patient care. No transformational change will happen unless hospital leaders make quality a top priority and are firmly engaged in quality improvement (CMS 2006). In recent years, hospital governing boards have acquired growing responsibility and potential to help lead hospitals in the direction of improved quality. Governing boards that demonstrate commitment and engagement in significant and sustained quality-of-care improvement convey seriousness of purpose to everyone in their organization. When the board sets the priorities and looks at the numbers, providers at every level in the organization know that their efforts to improve care are an organizational priority and that the board pays attention to results. They also know the board is committed to providing resources to improve and sustain quality.

Anecdotal reports have shown the importance of board leadership to the success of quality and patient safety initiatives (Meyers 2004; Paine et al. 2004; Sandrick 2005). Results of several surveys of hospitals in a number of states also revealed that hospital leadership is engaged in quality, yet variation exists in the adoption of those board practices shown to be associated with better patient outcomes (Kroch et al. 2006; Vaughn et al. 2006). For our study, we drew from a recent survey of hospital and system leaders that has a broader geographic representation and that contains a more comprehensive set of questions than previous surveys. Besides covering board practices commonly addressed in other surveys, this survey also asks hospitals about the existence and composition of board quality committees, thus allowing us to examine this important structural feature in board oversight of quality. Having a board committee that focuses primarily on quality communicates a high level of board attention to quality of care. The board quality committee can thus enhance the visibility of the board's leadership on quality issues and provide an effective mechanism for organizing and directing internal resources to address quality of care.

With the unique features of this survey, we sought to explore the following questions:

* How frequently were various board practices adopted among hospitals?

* Are there any differences in the adoption of these practices and in quality of care between boards with a quality committee and boards without a quality committee?

* What hospital characteristics are associated with the likelihood of having a board quality committee?

* What are the major differences in board practices between boards at the hospital level and those at the system level?

The findings of this study can help inform hospital leaders, accreditation entities, and public policymakers about board leadership in quality and the particular features in board structure and operation that may be significantly associated with board oversight of quality.

METHODS

Data for this study were drawn from multiple sources, including primary data collection on board practices and secondary databases on hospital characteristics and patient outcomes.

Survey on Board Practices

Between January and May 2006, the Governance Institute (TGI) conducted a survey of hospital leaders on practices in board...

NOTE: All illustrations and photos have been removed from this article.



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