In the past decade the healthcare climate has embraced the imperative to improve quality and patient safety after studies showed pervasive quality and safety problems. In Canada, 7.5% of patients admitted to acute care hospitals in 2000 experienced one or more adverse events, 36.9% of which were highly preventable (Baker et al., 2004). Researchers estimate that adverse events are responsible for the death of 5,000 to 10,000 Canadians each year (Wong, 2004).
Healthcare organizations use a number of strategies to improve the safety of care, but in order for these strategies to be sustained, organization-wide commitment is required. Embedding principles of quality and safety into the culture of the organization and the daily practices of each individual remains a formidable challenge and lengthy journey. The role of various groups, such as management, physicians, and clinicians, has been studied and articulated; however, the role of boards has traditionally been neglected.
This is changing. Boards have a critical role in safety and quality improvement. But board members, traditionally coming from business, legal, or government sectors, tend to feel a lack of familiarity with the clinical aspects of quality and patient safety, and may experience apprehension around their contribution to quality and safety efforts.
Governing boards of healthcare organizations are legally responsible for the performance of their organizations. To meet their quality and safety responsibilities they can perform various functions:
- Develop a vision around quality and safety improvement for their organization
- Define and set clear and realistic goals
- Access, interpret, and use valid and appropriate information
- Monitor performance
- Support initiatives to develop capabilities and foster a culture of quality and safety
These responsibilities are assumed in different degrees, and there is variation in the structures and processes of healthcare governance with limited information on the effectiveness of different structures.
Recent developments in the Canadian healthcare landscape emphasize the importance of good governance in healthcare. There is growing evidence of problems in the general level of quality and safety of care across healthcare organizations, advancing our understanding of these issues. In response to this evidence and a need for greater transparency, there have been significant improvements in the availability and quality of information about such issues at the level of individual hospitals and other healthcare delivery services and systems. This information has clearly demonstrated wide variations in performance between healthcare organizations.
There is a growing effort to establish explicit accountabilities and to use these performance measures to hold CEOs and boards responsible for performance on quality and safety measures (in addition to financial performance). Greater demands for accountability and performance measurement have led to several enhancements to Accreditation Canada’s accreditation program standards, which focus on strengthening governance and clarifying the role of the board for quality and patient safety.
In response to all this, the Canadian Patient Safety Institute (CPSI) and the Canadian Health Services Research Foundation (CHSRF) partnered to commission a team of researchers to investigate governance for quality and safety in healthcare organizations. In 2008, the research team, lead by Dr. G. Ross Baker, synthesized the available scientific evidence from the literature on current structures, processes, strategies, and tools used by healthcare boards in setting goals, monitoring improvements, and achieving results for quality of care and patient safety.
The researchers consulted with many healthcare leaders and board members to better understand the knowledge, skills, and current practices of healthcare boards in hospitals and health systems across the country and internationally to prepare the report Effective Governance for Quality and Patient Safety in Canadian Healthcare Organizations.
The team also conducted case studies of four organizations whose boards have undertaken a quality and safety journey. The tools used by these organizations, and their stories, are woven through this toolkit to provide context, evidence, and examples of how healthcare boards can exercise good governance for quality and safety.
This toolkit gives board members resources to guide them on their quality and safety journeys, both as individuals learning to promote and understand quality and patient safety issues, and as members of a governance body supporting the delivery of high-quality healthcare.