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Perspectives on Governance from Beyond Canada

Issues of governance for quality and patient safety are not unique to Canada, and there is a great deal of attention and research on these topics in other healthcare systems. For example, the National Patient Safety Agency (NPSA) in the United Kingdom has a dedicated stream of the National Reporting and Learning Service focused on tools for governing boards. The Institute for Healthcare Improvement (IHI) in the United States developed a collaborative program for Boards to dovetail with the 5 Million Lives campaign. This was intended to provide governance bodies with the aims, foundation and will to execute large quality improvement collaborative at their organizations, and enhance their knowledge to support patient safety improvements. Joshi and Hines (2006) conducted qualitative interviews with CEOs and board chairpersons around the role of governance in quality and suggest strategies and tactics for board engagement in quality. These strategies align with research conducted in Canada, and there are valuable tools from other jurisdictions referenced in this report which build upon strategies suggested for board quality engagement in the United States and elsewhere.


Joshi and Hines (2006)
Strategies and Tactics for Hospital Board Engagement in Quality

Increase the Board’s Quality Literacy

  • Educate the board on salient quality issues beyond public reporting.
  • Initiate discussion with the board on what defines a quality expert and consider adding quality experts to the board.
  • Use retreats for having in-depth dialogue on quality and quality-improvement projects within the hospital and nationally.
  • Have board members attend quality conferences.

Frame an Agenda for Quality

  • Initiate discussion between the board chair and the CEO on the status of quality improvement in the hospital. How is the hospital progressing? What are the barriers? What are the strengths? How can the board support improvement?
  • Ensure that discussion of quality on the board agenda gets equal billing with other important agenda items.

Quality Planning, Focus and Incentives

  • Create a vision for quality for the hospital with long term outcome measures and goals. These outcome measures may include aggregate quality measures such as mortality rates.
  • Review the hospital’s quality plan and ensure it is aligned with the overall hospital strategic plan.
  • Ensure the quality measures the board reviews are assessed annually and are well understood by board members.
  • Integrate the quality measures into the overall board performance metrics and board strategic milestones.
  • Analogous to financial responsibility, ensure that the CEO is considered ultimately accountable for the overall quality of the organization.
  • Link incentive compensation for leadership to quality metrics.


  • Share patient stories at board meetings to further increase focus on patient-centeredness.
  • Ensure that patients are involved in improvement, such as by having patients participate on improvement teams.