Getting the Board on Board

Interviews with hospital chief executive officers (CEOs) and board members were conducted to obtain their views on how governance and leadership relate to quality improvement (QI) efforts at hospitals. Leaders from 30 hospitals across 14 states were interviewed in person or by phone about safety and quality issues, QI actions and the knowledge level and activities of hospital boards.

Key Findings:

  • CEOs reported being more familiar with Institute of Medicine (IOM) quality reports than were board members. Knowledge of IOM reports was low overall.
  • CEOs and board chairs understood public quality data more than IOM reports. Hospital leaders did not report expertise in QI at high levels.
  • For both CEOs and board members, knowledge level and board engagement were positively related. Knowledge level was positively related to evaluations of progress made in QI for CEOs.
  • Board members' reports of expertise in QI were significantly higher than the assessment of board member expertise by CEOs.
  • Strategies to improve hospital leadership and governance in QI include: promoting literacy about quality among leaders; structuring a quality agenda; increasing quality planning, focus, and incentives; and moving toward a patient-centered approach in hospitals.