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Board Skills and Role in Quality and Patient Safety

Chambers, N., Harvey, G., Mannion, R., Bond, J., & Marshall, J. (2013). Health Services and Delivery Research Towards a framework for enhancing the performance of NHS boards: a synthesis of the evidence about board governance, board effectiveness and board development. Southampton (UK): NIHR Journals Library. 

Conway, J. (2008). Getting boards on board: engaging governing boards in quality and safety. Jt Comm J Qual Patient Saf, 34(4), 214-220.
BACKGROUND: As hospitals seek to drive rapid quality improvement, boards have an opportunity-and a significant responsibility--to make better quality of care the organization's top priority.

Curran, C. R., & Totten, M. K. (2011). Governing for improved quality and patient safety. Nurs Econ, 29(1), 38-41.

Board members have a critical oversight role to play in monitoring and providing direction to improve health care quality and safety. In the emerging environment of health care reform, the board's role in overseeing quality and safety on behalf of stakeholders will become as or even more important than its financial oversight role.

Goeschel, C. A., Wachter, R. M., & Pronovost, P. J. (2010). Responsibility for quality improvement and patient safety: hospital board and medical staff leadership challenges. Chest, 138(1), 171-178. doi:10.1378/chest.09-2051

Concern about the quality and safety of health care persists, 10 years after the 1999 Institute of Medicine report To Err is Human. Despite growing awareness of quality and safety risks, and significant efforts to improve, progress is difficult to measure.

Hastings, S. E., Armitage, G. D., Mallinson, S., Jackson, K., & Suter, E. (2014). Exploring the relationship between governance mechanisms in healthcare and health workforce outcomes: a systematic review. BMC Health Serv Res, 14, 479. doi:10.1186/1472-6963-14-479.
BACKGROUND: The objective of this systematic review of diverse evidence was to examine the relationship between health system governance and workforce outcomes.

Hastings, S. E., Mallinson, S., Armitage, G. D., Jackson, K., & Suter, E. (2014). Mind the gap: governance mechanisms and health workforce outcomes. Healthc Policy, 10(1), e108-114.

Attempts at health system reform have not been as successful as governments and health authorities had hoped. Working from the premise that health system governance and changes to the workforce are at the heart of health system performance, we conducted a systematic review examining how they are linked.

Higginson, J., Walters, R., & Fulop, N. (2012). Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? BMJ Qual Saf, 21(7), 576-585. doi:10.1136/bmjqs-2011-000603.
INTRODUCTION: National Health Service hospitals and government agencies are increasingly using mortality rates to monitor the quality of inpatient care. Mortality and Morbidity (M&M) meetings, established to review deaths as part of professional learning, have the potential to provide hospital boards with the assurance that patients are not dying as a consequence of unsafe clinical practices.

McFadden, K. L., Stock, G. N., & Gowen, C. R., 3rd. (2014). Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. J Nurs Adm, 44(10 Suppl), S27-37. doi:10.1097/nna.0000000000000119
BACKGROUND: Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals.

Millar, R., Freeman, T., & Mannion, R. (2015). Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence. BMC Health Serv Res, 15, 196. doi:10.1186/s12913-015-0771-x.
BACKGROUND: Hospital boards, those executive members charged with developing appropriate organisational strategies and cultures, have an important role to play in safeguarding the care provided by their organisation.

Millar, R., Mannion, R., Freeman, T., & Davies, H. T. (2013). Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research. Milbank Q, 91(4), 738-770. doi:10.1111/1468-0009.12032.
CONTEXT: Recurring problems with patient safety have led to a growing interest in helping hospitals' governing bodies provide more effective oversight of the quality and safety of their services.

Parand, A., Dopson, S., Renz, A., & Vincent, C. (2014). The role of hospital managers in quality and patient safety: a systematic review. BMJ Open, 4(9), e005055. doi:10.1136/bmjopen-2014-005055.
OBJECTIVES: To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care. DESIGN: A systematic review of the literature. METHODS: A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC.

Prybil, L. D., Bardach, D. R., & Fardo, D. W. (2014). Board oversight of patient care quality in large nonprofit health systems. Am J Med Qual, 29(1), 39-43. doi:10.1177/1062860613485407
In hospitals and health systems, ensuring that organizational standards for patient care quality are adopted and that processes for monitoring and improving clinical services are in place are among governing boards' most important duties. A recent study examined board oversight of patient care quality in 14 of the country's 15 largest private nonprofit health systems.

Scott, B. C. (2015). Hospital boards – why quality and safety matter.  Physician Leadersh J, 2(1), 62-64.

Totten, M. K., & Paloski, D. (2013). Governance in transformational times: six fundamental building blocks create opportunities for CEOs and boards. Healthc Exec, 28(1), 80, 82-83.

Vaughn, T., Koepke, M., Levey, S., Kroch, E., Hatcher, C., Tompkins, C., & Baloh, J. (2014). Governing board, C-suite, and clinical management perceptions of quality and safety structures, processes, and priorities in U.S. hospitals. J Healthc Manag, 59(2), 111-128.
To achieve quality improvement in hospitals requires greater attention to systems thinking than is typical at this time, including a shared understanding across different levels of the hospital of the current state of quality improvement efforts. A self-administered survey assessed the perceptions of board members, C-suite executives, and clinical managers regarding quality activities and structures.

Walker, L. (2013). Governance never events. Trustee, 66(1), 6-7, 1. Governance never events have long-term consequences for a hospital's leadership and operations.

Walker, L. (2013). The quality-driven agenda. Trustee, 66(3), 6-7. Every item on the meeting agenda has a quality angle.