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Hospitals' boards may influence the quality of care that hospitals provide, but their engagement in quality-related issues is largely unknown. The authors of this study surveyed a nationally representative sample of board chairs of 1,000 U.S. hospitals to understand their expertise, perspectives and activities in clinical quality. Fewer than half of the boards rated quality of care as one of their two top priorities, and only a minority reported receiving training in quality. The large differences in board activities between high-performing and low-performing hospitals the study found suggest that governing boards may be an important target for intervention for policy-makers hoping to improve care in U.S. hospitals.