Hospital boards adopt practices to enhance oversight on quality of care
Research Activities, December 2011, No. 376
In response to external pressures for better care quality and patient safety, hospital governing boards have sought to enhance their oversight function on quality of care by adopting a variety of practices. A new study found that a number of specific practices, not examined in prior research, showed significant association with better performance on process of care and/or mortality rates (adjusted for patient risk factors). These practices included: requiring major new clinical programs to meet quality-related criteria; setting some quality goals at the "theoretical ideal" level; requiring both the board and the medical staff to be as involved as management in setting the agenda for discussion on quality; and requiring the hospital to issue public quality/safety performance reports.
The study combined survey data of hospital governance collected by The Governance Institute (TGI) with hospital performance data drawn from The Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services. Of the 13 board practices examined in the TGI survey, the one most commonly adopted was regular review of the hospital's quality performance. Ninety-six percent of the responding hospitals conducted such reviews at least once a year. There are other areas, however, that appear to fall short of expectations, note Joanna Jiang, Ph.D., and Irene Fraser, Ph.D., AHRQ researchers, and Carlin Lockee, M.P.H., formerly of TGI. For example, only around 60 percent of the responding hospitals had a board committee focused specifically on quality. Less than 40 percent of the responding hospitals reported their quality/safety performance to the general public. Another area for improvement is engagement of physician leadership in both oversight activities and quality improvement efforts.
See "Enhancing board oversight on quality of hospital care: An agency theory perspective," by Drs. Jiang, Lockee, and Fraser in Health Care Management Review [Epub ahead of print], 2011. Reprints (AHRQ Publication No. 11-R068) are available from the AHRQ Publications Online Store .