Why It Matters
“Without guidance on what constitutes oversight of quality, trustees can easily become overwhelmed by vast amounts of information and never feel they’re adequately fulfilling their governance obligations.”
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Tips for Using a Tool to Evaluate Quality Governance

By Marina Renton | Thursday, April 4, 2019

Photo by Andreas Breitling | Pixabay

A new assessment tool from the Institute for Healthcare Improvement developed in collaboration with leading governance organizations and experts reconciles the numerous existing resources for oversight of quality into a practical, accessible tool.

Why is this tool necessary? Consider the obligations of hypothetical new health system trustees. They volunteer their time and, while they may have business acumen and some affinity for financial data, health care governance comes with unique challenges. Health systems are complex operations, as is the work to improve the quality of care delivery. Even those with backgrounds in health care don’t necessarily have experience with oversight and that means making sense of things like root cause analysis (RCA) reports on adverse events, run charts on hospital-acquired infections, readmission trends, or new endeavors to improve community health.

Oversight also means knowing how to receive information from health system leaders, medical practitioners, and other experts. It requires knowing what questions to ask, how to constructively express concern, and how to make recommendations. Without guidance on what constitutes oversight of quality, trustees can easily become overwhelmed by vast amounts of information and never feel they’re adequately fulfilling their governance obligations.

The Governance of Quality Assessment Tool

The Governance of Quality Assessment Tool (GQA) is the culmination of over a year of work, initiated by the IHI Lucian Leape Institute and undertaken in consultation with prominent governance experts and organizational thought leaders. While trustees and health system leaders may already have access to resources to inform their governance activities, this tool (and the accompanying Framework for Effective Board Governance of Health System Quality white paper) reconciles much of the existing material to maximally benefit busy board members.

The GQA lists 30 foundational components for governing quality. They reflect the multidimensional nature of quality (as described in the Institute of Medicine report Crossing the Quality Chasm), the whole continuum of care, and population health. The tool is comprehensive yet practical, designed with a trustee’s needs and time constraints in mind.

Recommendations for Using the Governance of Quality Assessment

The GQA outlines the key activities necessary for quality oversight and assesses how well a board is doing those activities. Board members and health system leaders can use the GQA in the following ways:

  • Take the GQA individually or in groups to evaluate where you stand regarding governance of quality best practices.
  • Use the results to uncover areas of discrepancy or topics that require additional explanation.
  • Retake the GQA periodically — we recommend annually — to evaluate how performance has evolved over time.
  • Use the results for research purposes (e.g., analyze how the GQA results correlate with the organization’s quality performance).

Additionally, board members should use the GQA as a tool to guide the questions they ask senior leaders and inform the data they request. Health system leaders should use the findings to tailor board education on quality concepts.

Common Governance Areas for Improvement

Many health system senior leaders and board members from organizations around the world have already taken the GQA to evaluate their practice and inform their governance activities. Respondents are asked to evaluate their board’s performance of certain core processes on a scale of zero to two, with zero meaning that the process is not performed to the trustee’s knowledge, and two meaning that the board performs the process regularly and thoughtfully. While we do not have sufficient data to conduct a statistical analysis of the GQA results to date, a few trends have emerged. The processes most commonly given a score of zero fall into three categories.

  • Direct engagement with patients — Board members should have the opportunity to visit the point of care and hear directly from patients and caregivers in their facilities and through engagement with community and patient advocates during every board and quality committee meeting.
  • Link between quality and finance — Trustees should understand the financial implications of quality care by annually reviewing a summary of the effects of poor quality on costs. Boards should also monitor health care affordability and patient medical debt at their organization.
  • Population health and health equity — Health equity is a vital component of quality care. Boards should review data stratified by race, ethnicity, gender, language, socioeconomic status, payer type, and age to identify possible disparities in care. In addition, boards should review health system performance on population health metrics, which might be evaluated through a review of risk-based contract performance.

Governance for Good

Hospital and health system boards have a fiduciary responsibility — and an ethical obligation — to their community. Trustees are responsible, first and foremost, for monitoring their organization’s quality of care. Senior leaders and trustees should waste no time in bringing the GQA and other resources introduced in IHI’s governance white paper into the boardroom. An organization’s success in the rapidly-evolving arena of value-based payments and hospital consolidation depends on informed leadership from the top down. While oversight responsibility may seem daunting — with the right tools and resources — board members and health system leaders can approach governing quality with confidence.

Marina Renton is an IHI Research Assistant.

You may also be interested in:

IHI’s Framework for Effective Board Governance of Health System Quality white paper

The Risks of Keeping Health Care Boards in the Dark

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