GUEST BLOGGER: IHI COO Jeff Selberg:  

For most of the last century, trustees of health care organizations generally defined their roles as limited to financial stewardship. Safety? Quality of care? That was considered the purview of the medical or executive staff.

In recent years, this has changed—but it has not changed enough. Governing boards have a fundamental role to play in quality of care; in fact, they are legally accountable for it. 

What happens in a boardroom may seem far removed from the patient’s bedside. But it isn’t. A recent paper shows statistically significant associations between the adoption of certain governing board practices in not-for-profit hospitals and quality of care measures. (See table below.)

These associations may not prove causation, but they do suggest that board engagement can make a difference in how organizations approach quality of care.  This was IHI’s experience working on hospital governance through our 100,000 Lives and 5 Million Lives Campaigns. 

Consider the following anecdote about an engaged board in practice:

“At a board Clinical Quality Committee meeting of the Seton Family of Hospitals in Austin, TX, operational leaders reviewed a patient safety problem and their plans to prevent a recurrence.  One of the lay board members pushed harder for a reliable plan.  She noted that the plans proposed were not likely to produce reliability at best known levels, and that employing reliability science would be a better solution than working harder. That meeting was an important step toward creating a culture of reliability, and it began with informed questioning by a board member.”

Today, as the data above shows, hospital boards are achieving on some measures and doing less well on others. We see some important practices—quarterly review of quality performance measures, for instance—inching close to universal adoption. But other practices are considerably rarer. Just under 40 percent of boards require their organizations to report quality or safety performance to the public. And over half of boards surveyed were less involved than management in setting the agenda for the board’s discussion on quality.

Boards have come a long way. Gone are the days (for most hospitals, at least) when trustees deemed quality of care to be beyond their job responsibilities. But much progress remains to be made. If you’re a board member, we hope you’ll take a look at our “Boards on Board” How-to Guide.  Among our suggestions are conducting an initial audit of 20 patient charts for harm; devoting 25 percent of board meeting time to quality and safety; and establishing concrete aims for safety and quality improvement.

We hope to see more and more health care board members making their voices heard and being partners on quality and safety issues. Trustees have the power and the responsibility to drive their organizations toward better care. As our founder Don Berwick once put it, “The buck stops in the board room.”