Why It Matters
Governing quality has become more complex for trustees in recent years. The new IHI Framework for Effective Board Governance can help.
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How to Help Boards Oversee Quality

By IHI Multimedia Team | Tuesday, December 18, 2018

How to Help Boards Oversee Quality

The Institute of Medicine (IOM) reports To Err Is Human and Crossing the Quality Chasm prompted health care leaders to address the patient safety crisis and advance the systems, teamwork, and improvement science needed to deliver safer care to patients. Following the IOM reports, research on health care governance practices identified a correlation between health system board prioritization of quality oversight and higher performance on key quality indicators. Quality oversight by a board has been shown to correlate with patient outcomes on key quality metrics, and boards that prioritize quality support a leadership commitment to quality and the incentives and oversight to achieve the quality care that patients deserve.

Two main evolutions have made governing quality more complex for trustees and the health system leaders who support them:

  • The definition of “quality” has evolved and expanded over the last decade, from a singular focus on safety to an expanded focus on all six dimensions of quality as identified in the Crossing the Quality Chasm report.
  • The expansion of health systems beyond hospital walls and the addition of population health oversight have created complexity both in terms of what to govern to support high-quality care and how to oversee quality outside of the traditional hospital setting and across the health care continuum.

Many health system leaders have worked to ensure that their trustees are sufficiently prepared to oversee quality, but the two factors noted above have increased the need for board education and the time commitment for trustees and the health system senior leaders who support them. Therefore, there is a need for a clear, actionable framework for better governance of quality across all dimensions, including identification of the core processes and necessary activities for effective governance of quality.

Ultimately, the most valuable resource of a board is time — both in terms of how much time they allocate and how they use it — to engage in oversight of the various areas of governance. To help health system leaders and boards use their governance time most effectively, the Framework for Effective Board Governance of Health System Quality white paper includes three components:

  • Framework for Governance of Health System Quality: A clear, actionable framework for oversight of all the dimensions of quality;
  • Governance of Quality Assessment: A tool for trustees and health system leaders to evaluate and score current quality oversight processes and assess progress in improving board quality oversight over time; and
  • Three Support Guides: Three central knowledge area support guides for governance of quality (Core Quality Knowledge, Core Improvement System Knowledge, and Board Culture and Commitment to Quality), which health system leaders and governance educators can use to advance their education for trustees.

The framework, assessment tool, and support guides aim to reduce variation in and clarify trustee responsibilities for quality oversight, and also serve as practical tools for trustees and the health system leaders who support them to govern quality in a way that will deliver better care to patients and communities.

To learn more about a framework that can help health care boards and leaders effectively oversee quality, read the Framework for Effective Board Governance of Health System Quality white paper.

You may also be interested in:

To Err Is Human: Building a Safer Health System

Crossing the Quality Chasm: A New Health System for the 21st Century

Hospital governance and the quality of care

Board oversight of quality: Any differences in process of care and mortality?

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