IHI 2018: Getting health system boards engaged in quality improvement is tricky. IHI releases new framework to help

Conference table in office of modern business center, boardroom interior
IHI has created a new framework for engaging boards around quality improvement. (Getty Images/Fizkes)

ORLANDO, Fla.—Tackling quality and safety improvement in healthcare facilities is vitally important. But with its increasing complexity, health system board members may struggle to keep up. 

So, the Institute for Healthcare Improvement has issued a framework aimed at making quality governance easier on board members who may lack clinical knowledge, and thus more effective. Released as part of IHI’s National Forum, the framework offers a baseline for a conversation about quality improvement and includes an assessment tool that allows providers to track their progress

“Boards are a very underleveraged resource,” Tejal Gandhi, M.D., the institute’s chief safety officer, told reporters at the forum. “If the board is not engaged in quality and safety, it can be very hard for organizations to reach their ultimate goals.” 

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The framework was developed after a year of study and in partnership with major industry organizations like the American College of Healthcare Executives, said Beth Daley Ullem, faculty lead at IHI and president of Quality and Safety First. 

RELATED: Institute for Healthcare Improvement—5 considerations for making home healthcare safer 

It centers the key elements of quality on the patient perspective: “timeliness,” for example, is instead framed as “help me navigate my care.”  

“Medical jargon seems to overwhelm boards,” Daley Ullem said. “We flipped those through the eye of the patient—board members loved this. It made their reason for their service on the board come to life.” 

Daley Ullem, who spearheaded the framework, said that the guidelines also aim to address the significant variance that exists between how different health systems govern quality and safety. A larger health system, for example, may have smaller regional board quality committees operating under a larger umbrella group, while a rural hospital may have less structure. 

RELATED: At Johns Hopkins Medicine, board members turn their attention to quality improvement efforts 

She said another key to success is making sure that CEOs and other C-level executives are a part of the conversation. The board and C-suite may not be on the same page, and bridging that gap for complete, top-down leadership is crucial to sustaining quality improvement initiatives. 

Though boards are involved in quality improvement and there is movement to better educate them on the intricacies of quality and safety, Gandhi said it’s still “early days” for truly effective oversight. IHI is hoping that its new framework can build momentum toward improved board education in other areas, too, such as equity. 

"We’re hoping the release of this starts the re-energizing,” Gandhi said.

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