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Executing Effective Governance for Quality and Patient Safety


Excellent organizations in Canada are grappling with efforts to make the governance of quality and safety more effective. The development of indicators to monitor quality and safety and of the “right” strategies to “get the board on board” and to improve quality and safety require investment and the implementation of appropriate processes at the board, organizational and clinical levels.

Understanding the Role of the Board in Quality and Safety

  • An expanded role for boards in quality and patient safety has been advocated across Canada and the United States; however explicit processes to support this mandate are not all in place.
  • The Governance Institute suggests that boards can contribute to the improved quality by:
    • Holding the CEO accountable to quality and safety goals
    • Participating in the development of explicit criteria to guide medical staff credentialing and privileging
    • Setting board agenda for quality through reviewing data
  •  North York General Hospital developed a governance renewal strategy and scorecard to ensure that the board was aware of their role and created a strategic destination
    (“Governance Renewal and Scorecard”, PowerPoint presentation)
  •  The Health Association Nova Scotia developed a governance module which emphatically states that “the ultimate responsibility for ensuring quality rests with the board of health organizations”. Furthermore, the boards’ role of ensuring quality in their organization includes that of the quality and performance of physicians granted the privilege of practicing medicine within the organization.

Board Accountability

  • Physician credentialing is an area where boards can execute effective governance and boards should be aware of any provincial/territorial legislation around physician credentialing.

Board Self Evaluation

  •  Boards’ opportunities for reflecting and self-evaluation can support ongoing learning. For example, board members at St. Thomas Elgin General Hospital close meetings with “Self Evaluation of Governance Process” where the group discusses the following questions:
    • What did we do well?
    • What could we improve upon in the future?