Commission on a High Performance Health System. Framework for a High Performance Health System for the United States. New York, New York: The Commonwealth Fund; August 2006.

This consensus statement describes the most critical sources of the US health care system's current failures and outlines a vision of a uniquely American, high performance health system. While acknowledging that the US provides some of the best medical care in the world, the Commission maintains that overall, the nation fails to achieve adequate value for the resources it devotes to health care.

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Berwick DM, Leatherman S. Steadying the NHS. British Medical Journal. 2006 Jul;333(7561):254-255.

In April 2006, the BMJ Editor called for an independent National Health Service in the UK, run by a board of governors responsible for managing health care within a set budget and a broad political framework. Berwick and Leatherman, along with other opinion leaders, provide their views on whether it is time to give the NHS greater independence from government.

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Whittington J. Key issues in developing a successful hospital safety program. Agency for Heathcare Research and Quality WebM&M [serial online]. July 2006.

One of the most important interventions is for hospital leadership to get the hospital's board involved with safety and quality. Not only does the board have fiduciary responsibility for the organization, but they have responsibility for quality and safety as well. Accordingly, it is crucial for the board to explicitly make safety and quality a top priority. Boards are typically comprised of mostly nonclinical individuals, so hospital leaders and staff will need to educate them.

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Improving clinical quality and patient safety of greater importance to not-for-profit hospitals. Special Comment. Moody’s Investor Service. May 2006.

This article reflects the growing importance of clinical quality and patient safety in the eyes of multiple stakeholders: patients, physicians, payers, employers, and hospitals. In the Summary Opinion, the authors write, “Moody’s anticipates that in the short-term, strategies to improve quality and patient safety will likely reduce operating results for many hospitals as the tools and steps to implement the strategy may require adding costs faster than benefits are realized. However, hospitals that eventually demonstrate a sustainable link between quality investments and better clinical outcomes will likely gain competitive advantage, thereby improving financial performance and possibly their bond ratings.”

Copyright Moody's Investor Service, Inc. and/or its affiliates. Reprinted with permission. All rights reserved.   

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Joshi MS, Hines SC. Getting the board on board: Engaging hospital boards in quality and patient safety. Joint Commission Journal on Quality and Patient Safety. Apr 2006;32(4):179-187.

This article describes a study in which interviews were conducted with chief executive officers and board chairs from a sample of 30 hospitals, representing 14 states across the United States. The study's results showed that the level of knowledge of the landmark Institute of Medicine (IOM) quality reports among CEOs and board chairs was remarkably low, but they were very aware of public reporting of quality information. The article also presents ideas for how to engage hospital boards in quality. 

VHA Georgia CEO Summit on Quality. How Do Hospitals Become "Best in Class?" February 9-10, 2006. Meeting proceedings, prepared by The Governance Institute.

This report contains a summary of presentations from the VHA Georgia CEO Summit on Quality in February 2006. The program faculty included three respected leaders in quality: James Reinertsen, who spoke about the Seven Leadership Leverage Points; Roger Resar, who presented on Building Improvement Capability; and Michael Pugh who spoke about Engaging the CFO/Quality as a Business Strategy.

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Board quality committees: The Governance Institute’s fax poll results. The Governance Institute. December 2002.

As health care watchdogs move into health care organizations’ backyards, board involvement in quality oversight increases in importance. But how much is just the right amount of board involvement? The Governance Institute surveyed its members to determine the extent to which quality oversight responsibilities have permeated the formal structure of its members’ boards.

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Bass KH. The board’s role in quality oversight: Not a responsibility that can be delegated. The Governance Institute BoardRoom Press newsletter. October 2004.

Trustees who are new to their role on the hospital or system board are often aghast to learn that their responsibilities include the oversight of quality — clinical quality. This article presents some guidance for trustees to engage in their oversight role.

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Fosdick GA. Getting on board with quality. The Governance Institute BoardRoom Press newsletter. February 2005.

What the hospital board chooses to monitor, understand, and act upon becomes important to the entire organization. When the board takes on an issue and sticks with it, it becomes part of the corporate culture. This is necessary for hospitals and health systems to improve quality and patient safety performance.

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Conway J. Taking a strong stance on quality oversight. The Governance Institute BoardRoom Press newsletter. October 2005.

At Dana-Farber Cancer Institute, it took a major incident to turn things around. The board dealt with the issue by giving management two specific messages: use the tragedy of the unnecessary death of a young woman to take the organization to a different place, and “this tragedy will never ever happen again.” Jim Conway, an executive arriving at Dana-Farber after discovery of the incident, describes his board’s journey from conciliation on quality and patient safety matters to aggressive, comprehensive quality oversight. He provides five key points for effective quality oversight.

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