Clinical quality comes from the top down

Hospital boards of directors that pay close attention to clinical quality have a positive effect on overall management scores and clinical quality metrics, according to a study in this month's Health Affairs.

Researchers identified two "signatures of high-performing hospital boards and management practice." First, when hospital boards paid greater attention to clinical quality, management teams better monitored quality performance. Second, when boards used clinical quality metrics more effectively, hospital management staff performed better when it came to operations, setting and monitoring targets and human resource management.

The researchers looked at World Management Survey data on roughly 500 hospitals in the U.S. and England. They measured focus on clinical quality by the amount of time and attention placed on quality during board meetings and use of clinical quality metrics by how often the metrics inform board decisions and whether they play a role in senior administrators' compensation.

In short, more effective management practices means higher-quality care, the authors said. And higher-rated hospital boards inspire superior performance by hospital management.

Hospital boards often focus on fundraising, finance, and hiring and firing chief executive officers, but many take a hands-off approach to quality issues, FierceHealthFinance has reported. "Board members often feel like clinical quality is physicians' jobs, and they don't want to step on doctors' toes," said Ashish Jha, M.D., director of the Harvard Global Health Institute.

But the new study suggests it would be worth their while: Board and management practices are both "strongly related to a hospital's performance on clinical quality metrics and may provide a unique target for quality improvement interventions reaching across multiple clinical domains," the Health Affairs article notes.

"Understanding the dynamics among hospital governance, management and clinicians will provide new opportunities for quality improvement."

Paul Levy, former Beth Israel Deaconess Medical Center CEO turned consultant, wrote on his blog that it is "lovely" to see documentation of the role boards play in clinical quality.

"Those of us who have run hospitals where we've been serious about achieving improvements in quality and safety know that without a highly committed board of trustees, the results will never be sustainable," he wrote.

To learn more:
- here's the study
- see the blog post

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