Quality of care low on hospital boards' priority list

Only 44% of hospital boards say quality is among the top two criteria they use to evaluate their chief executives, according to a survey of 722 board chairs.

The survey results, published online Nov. 6 in Health Affairs, also found a strong link between the importance hospital leaders placed on quality improvement and their hospitals' performance on Medicare and Joint Commission care metrics (link).

"This study shows there's a close association between how boards think about their ability to affect quality, how closely they pay attention to it, and the quality of care those hospitals actually provide," said Arnold Epstein, MD, a study co-author and chair of the Dept. of Health Policy and Management at the Harvard School of Public Health in Massachusetts.

Getting health care executives to prioritize quality and safety "could be a major lever for improving the quality of care in hospitals," Dr. Epstein said.

The study results are not surprising, said James L. Reinertsen, MD, a health care consultant and former hospital CEO. He was not involved in the study.

"Boards tend to think that quality and safety are already pretty good or OK and that it's not an issue," Dr. Reinertsen said. "They're looking for leaders at the board level and executive leadership to work on financial issues, strategic issues, growth issues and the whole list of what I'd call 'business issues' within health care systems. They take the core business of delivering care kind of for granted."

Less than two-thirds of hospital boards discuss clinical quality issues at every meeting, and for most boards, that discussion takes up less than 20% of their time, according to the survey, conducted between November 2007 and January 2008. That inattentive approach to quality may be changing, said Dr. Reinertsen, who also is a senior fellow at the Institute for Healthcare Improvement.

The Cambridge, Mass.-based nonprofit in 2007 launched the "Boards on Board" initiative aimed at helping hospital boards make care quality a priority. Registration for the last two related IHI workshops had to be closed due to excess demand, Dr. Reinertsen said.

Hospital executives don't need to get medical degrees to help improve quality, he said.

"When the board has adopted a quality aim that it cares about and expects management and physician leadership to accomplish that aim, then things start to change," he said. "They don't have to be experts to say, 'Why aren't we achieving our goals?' "