A matter of perspective. The best boards respect the line between governing and managing.

Is your board governing or managing? Learn how to spot the difference.

Why board culture matters. Interpersonal and group dynamics can affect the entire organization.

How a board functions as a group affects its ability to govern an organization.

Board oversight of quality: any differences in process of care and mortality?

In response to legal and accreditation mandates as well as pressures from purchasers and consumers for quality improvement, hospital governing boards seek to improve their oversight of quality of care by adopting various practices. Based on a previous survey of hospital presidents/chief executive officers, this study examines differences in hospital quality performance associated with the adoption of particular practices in board oversight of quality. Quality was measured by performance in process of care and risk-adjusted mortality, using the Hospital Compare data from the Centers for Medicare & Medicaid Services and the Healthcare Cost and Utilization Project inpatient databases of the Agency for Healthcare Research and Quality. Board practices found to be associated with better performance in both process of care and mortality include (1) having a board quality committee; (2) establishing strategic goals for quality improvement; (3) being involved in setting the quality agenda for the hospital; (4) including a specific item on quality in board meetings; (5) using a dashboard with national benchmarks that includes indicators for clinical quality, patient safety, and patient satisfaction; and (6) linking senior executives' performance evaluation to quality and patient safety indicators. Involvement of physician leadership in the board quality committee further enhanced the hospital's quality performance. Taken together, these findings seem to support the will-execution-constancy of purpose framework on improving the effectiveness of hospital boards in overseeing quality. Future study should examine how specific board practices influence the culture and operations of the hospital that lead to better quality of care.

Board engagement in quality: findings of a survey of hospital and system leaders.

Hospital governing boards assume an important role in improving delivery of quality care in the hospital. More knowledge about the prevalence and impact of particular board activities can help them perform this role more effectively. This study draws from a survey of hospital and system leaders (presidents/chief executive officers [CEOs]) that was conducted in the first six months of 2006 with a total of 562 respondents. The survey contained 27 questions on various aspects of board engagement in quality. More than 80 percent of the responding CEOs indicated that their governing boards establish strategic goals for quality improvement, use quality dashboards to track performance, and follow up on corrective actions related to adverse events. The adoption of other practices was reported less frequently. Only 61 percent of the respondents indicated that their governing boards have a quality committee. The existence of a board quality committee was associated with higher likelihoods of adopting various oversight practices and lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality's Inpatient Quality Indicators and the State Inpatient Databases. Hospital governing boards appear to be actively engaged in quality oversight, particularly through use of internal data and national benchmarks to monitor the quality performance of their organizations. Having a board quality committee can significantly enhance the board's oversight function. Other potentially useful activities-such as board involvement in setting the agenda for the discussion on quality, inclusion of the quality measures in the CEO's performance evaluation, and improvement of quality literacy of board members-are currently performed infrequently.