Principles

The capability of boards and board quality committees to function effectively and to move appropriately between fiduciary, strategic and generative modes relies on more than skills. Boards and senior leadership need to develop trust and a strong collaborative relationship, while not undermining the board’s duty to maintain its fiduciary role and ask challenging questions.

Foster Frontline Clinical Leadership for Quality and Safety

• Position descriptions and performance expectations for medical and senior leaders should be clear and outline their expectations for promoting quality and safety.
• IHI recommends that the quality commitment and agenda needs to be shared across an organization, front line staff should know how to make changes in their performance and leaders should help diffuse improvements across the organization/system and help sustain these over time. (IHI How to Guide, p.  18. Available at www.ihi.org)
• Work with nursing leaders (e.g. Chief Nursing Officer) who can act as a transformative leader on 3 core areas (Article:  Mastal et al., 2007):
• Improve quality and safety literacy
• Serve as a role model of professional nursing and nursing quality
• Build the evidence base for nurse staffing

Work Collaboratively with Senior Leadership

• The capability of boards and their committees to function effectively and to move appropriately between fiduciary, strategic and generative modes relies on trust as well as skills. Boards, senior leadership and medical staff need to develop an understanding of each other’s roles and create strong collaborative relationships to achieve organizational goals.

Boards' Role in Discipline

• Boards should be aware of organizational policies on professional discipline and disruptive behaviors.
• The Joint Commission (USA) developed a leadership standard that addresses disruptive and inappropriate behavior in two elements of performance:
1. The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors
2. Leaders create and implement a process for managing disruptive and inappropriate behaviors
Other Joint Commission suggested actions include:
• Educate team members on appropriate behaviors
• Hold team members accountable for modeling desirable behaviors
• Develop policies/procedures that address disruptive behaviors
• Provide training for cultural tools to measure and assess culture
• Develop a system for assessing staff perceptions of the extent of disruptive behaviors
• Develop tiered intervention strategies which can be escalated
• Conduct interventions within the context of an organizational commitment to the health and well-being of staff
• Encourage inter-professional dialogues
• Document all attempts to address disruptive behaviors