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The capability of boards and board quality committees to function effectively and to move appropriately between fiduciary, strategic and generative modes relies on more than skills. Boards and senior leaders need to develop trust and a strong collaborative relationship, while not undermining the board's duty to maintain its fiduciary role and ask challenging questions. Boards must uphold positive, trusting relationships with a number of diverse stakeholders, within and external to their organization.

Tools and Resources

Work Collaboratively with Senior Leadership and Medical Staff

In general, the Board works closest to Senior Management within the organization.  This relationship should focus on operational excellence and establishing a culture of trust and respect around quality and patient safety, including defined roles and responsibilities. The most critical of all is the need to establish a productive relationship with the CEO around quality and patient safety.

The capability of boards and their committees to function effectively and to move appropriately between fiduciary, strategic and generative modes relies on trust as well as skills. Boards, senior leadership and medical staff need to develop an understanding of each other's roles and create strong collaborative relationships to achieve organizational goals. Position descriptions and performance expectations for medical and senior leaders should be clear and outline their expectations for promoting quality and safety

  • Ottawa Hospital Clinician Engagement Tool
  • Denis et al 2013- Physician Engagement and Leadership for Health System Improvement.
  • Hayes et al 2010 – Case studies of physician leaders.
  • CPSI Checklist for Boards on Physician Engagement.

Foster Frontline Clinical Leadership for Quality and Safety

Quality and patient safety needs to be aligned "from the Board to the ward" and so engagement with clinical leadership, frontline staff and volunteers is very important.  The Board may not interact with clinical leadership, frontline staff and volunteers on a day-to-day basis, but the board must ensure mechanisms are in place that allows each person to understand their contribution in achieving quality and patient safety goals. Board members can be included with senior management in walkabouts / rounds to reinforce their commitment to quality and safety and their support for front line staff.

IHI recommends that the quality commitment and agenda needs to be shared across an organization, front line staff should know how to make changes in their performance and leaders should help diffuse improvements across the organization/system and help sustain these over time.

  • (IHI How to Guide, p.  18. Available at
  • The Scarborough Hospital policy on volunteers

Partner with Patients and Families

Patients and their families (or caregivers) should be seen as active participants in both their own care and in organizational design.  The Board can work with the CEO and leadership team to: embed patient and family centred care into the core values and principle of the organization; ensure there is a "Patient Bill of Rights" and that it is visible throughout the organization; promote active partnerships between care providers, patients and caregivers at various levels across the health care organization or system; patients/caregivers play a role in direct care, organization and governance and policy making; encourage the formation of patient / family advisory councils ; and include patients and family members in care and organizational/policy decisions. Boards need to ensure the patient and family perspective is part of their discussions, decisions and directives.

  • Saskatchewan Patient Engagement Framework
  • IAP2 Spectrum of Public Participation
  • CFHI Patient Engagement website