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Link between hospital boards and quality of care

Written by Diane Archer

Quality of care in U.S. hospitals remains a serious concern. A good number of hospitals do not follow evidence-based practices a lot of the time. The data suggests a link between hospital boards and quality of care. So where do hospital boards stand on quality of care? It’s not a top priority for many, according to a 2010 Health Affairs article by Ashish Jha and Arnold Epstein.

Delivering health care is costly and hospitals have increasingly become big businesses, with directors focused heavily on financial performance. Much like for-profit hospitals, non-profit hospitals are looking hard to control costs. So, where does the mission of hospitals to provide good care to their patients and the communities they serve fit in? (Did you know that most hospitals offer financial assistance and that non-profit hospitals must work with their local communities to prioritize local needs?)

A hospital’s board of directors, which must oversee hospital performance and set the strategic direction of the hospital, has a large role to play in ensuring that quality remains a top priority. A 2006 report in the Joint Commission on Accreditation of Healthcare Organizations’ Journal on Quality and Safety showed a link between patient mortality and the hospital board’s engagement in quality. There was a statistically meaningful difference between mortality rates in hospitals more engaged in quality and those less engaged, with the evidence suggesting that the board’s engagement can improve hospital quality.

Jha and Epstein surveyed hospital board chairs from among the 85 percent of acute care hospitals that are non-profit. They found that higher quality hospitals tended to have boards which made quality a priority.

Of the 722 hospital board chairs who responded to the Jha-Epstein survey, almost three out of four said that their boards had moderate to substantial expertise in quality of care. The reported rate of expertise at high-performing hospitals was 87 percent as compared with a rate of 66 percent at low-performing hospitals.

Boards might be better able to ensure hospital quality if they were trained in clinical quality. Based on the data, quality training appears to play a significant role. Fewer than one in three hospital boards received any training in clinical quality at the time of the Jha-Epstein study. Yet, of those that received training, 49 percent were in high-performing hospitals and 21 percent in low-performing hospitals.

Boards might also put greater emphasis on quality performance to promote hospital quality of care. Almost seven in ten board chairs recognized the influence of the CEO on quality of care. Yet, fewer than half of the board chairs (44 percent) Jha and Epstein surveyed saw quality performance as one of the two top criteria for evaluating CEO performance.

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