Hospital governance often has a quality disconnect

Hospital boards often take on the big tasks of fundraising, finance, and hiring and firing chief executive officers, but many take a hands-off approach to quality issues, the New York Times reported.

"Most board members are community leaders, serving on the board to support fundraising goals," Ashish Jha, M.D., director of the Harvard Global Health Institute, told the New York Times. "They don't think it's their job to hold management accountable for performance. Board members often feel like clinical quality is physicians' jobs, and they don't want to step on doctors' toes."

Directors of not-for-profit hospital boards are usually recruited based on their fundraising prowess, while for-profit institutions seek directors with expertise in finance and compliance, according to Jha. As a result, he believes hospital governance is squandering an opportunity to improve clinical performance. "I'm a much better doctor in a well-managed hospital where the systems are in place to help me do my best work," he said. "Even a great chef can't produce a good omelet with eggs that are stored in the freezer or the stove doesn't work reliably."

That's despite the fact that when boards exert more control over management--by say, taking a greater hand in how compensation is set--clinical quality tends to be better, according to the publication. However, not many boards focus on clinical quality.

Based on research performed by Jha and other medical scholars, only about 20 percent of non-profit hospital board chairs said their boards were forces for clinical quality, and only half of boards say clinical quality is among their top two concerns. Fewer than a third of boards receive any training in clinical quality.

Meanwhile, hospitals that have better outcomes in some clinical areas, such as heart attack survival rates, tend to see their market share grow over time, according to the newspaper. Also, hospitals that have more competition also tend to focus more closely on their quality inititatives and patient outcomes.

A recent survey by the American Hospital Association's Center for Healthcare Governance demonstrated a split in opinions among CEOs and hospital board chairs in terms of how much progress is being made in terms of care innovation and preparedness for change.

The governance of physician organizations may help show how hospitals and healthcare systems can make changes.

"Physician organizations' strong focus on doing what's best for patients and communities is positioning them as significant drivers of improved quality and financial performance, and architects of the new care delivery system," according to a recent article in Hospitals & Health Networks.

While their governance practices may not exactly mirror those of hospitals and health systems, the publication noted that those practices adapt to meet the needs of "these unique organizations at different points in their development."

To learn more:
- read the New York Times article 
- check out the Hospitals & Health Networks article