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​​​​​Skills and Role


Board effectiveness relies on the ways in which board members translate their knowledge and information into quality and safety plans with measurable goals, maintain oversight on progress towards these goals, and hold the CEO, and through her or him, accountable for these goals.

Role of Boards in Quality and Safety

  • Board effectiveness for quality and safety governance relies on the ways in which board members translate knowledge and information into quality and safety plans with measurable goals, maintain oversight on progress to these goals, and hold the CEO and the organization accountable for goals.
  • Quality and safety committees of the board may help to organize information and review all material pertinent to quality and safety, although a board may delegate some tasks, the entire board is still responsible for oversight and decision making around quality and safety.
  •  Etchells et al. (2005) suggest that a ‘framework of accountabilities’ is a means by which individuals and systems accountabilities are laid out based upon the type of unsafe act, or error, that occurred.
  •  The role of the board vis a vis the CEO should be clear around addressing quality concerns and questions, the Ottawa hospital follows this model:


Role of the board in answering the quality questions Role of CEO in answering the quality questions 
  • Delegate
  • Facilitate
  • Engage
  • Approve
  • Monitor
  • Evaluate
  • Creating the quality plan
  • Communicating
  • Integration
  • Organizational and operational alignment
  • Execution
  • Monitoring and reporting
  • Evaluation of performance


Legislative Responsibilities for Quality and Safety

  • The provincial/territorial legislative responsibilities and accountabilities for quality and safety should be understood by boards, including relevant hospitals, health facilities, health services, or regional health authorities Acts and Regulations.
  • Processes should be in place so that boards can perform their duties within the legislative framework.
  • Some provinces have created statutory adverse event reporting mechanisms. The critical incident reporting legislation in Saskatchewan, Manitoba and Quebec enables reporting by setting out how certain incidents are to be investigated and by making the reporting of such incidents mandatory.
  • Receiving Royal Assent in June 2010, the Excellent Care for All Act now requires health care organizations in Ontario to develop and publicly post annual quality improvement plans and to create quality committees which report to each hospital board on quality related issues. The Act also creates explicit accountability for healthcare providers and executives for improving patient care and enhancing the patient experience.  In addition, the Act outlines specific requirements regarding patient and employee surveys; patient relations processes; patient declaration of values; and performance based compensation.

Board Self Evaluation

  • Boards should be on an ongoing journey of self improvement – 7 Board Tools for Ongoing Improvement
    1. Board recruitment – choose board members with the right stuff
    2. Educate the board
    3. Use measures to focus the boards work on what’s important
    4. Pursue perfection, not improvement
    5. Pay more attention to culture
    6. Exercise leaders’ powerful influence
    7. Recognize and reward excellence
  • Board self evaluation is an important practice to identify what the board perceives as their education needs and practices.

Board Competencies to Lead on Quality and Patient Safety

  •  Boards should have a framework for education on quality and patient safety, which can leverage The Safety Competencies
  •  Healthcare professionals who contribute to a culture of patient safety understand (The Safety Competencies, 2008, p. 5)
    • Key patient safety concepts
    • Key patient safety processes
    • Knowledge translation of patient safety principles and practices
    • Approaches to minimizing risk
    • Characteristics of organizations and how they relate to healthcare
    • Systems based approaches to reducing system failures