Quality not a priority for many boards, says flawed study

A study just published in Health Affairs on Hospital Governance And The Quality Of Care, by Harvard faculty Ashish K. Jha and Arnold M. Epstein asserts that “fewer than half of (responding not-for-profit hospital) boards rated quality of care as one of their two top priorities, and only a minority reported receiving training in quality.”

The study has a lot of important and legitimate findings. For example, it found a positive correlation between high-performing hospitals and many practices for board oversight of quality. For example, boards of high-performing hospitals (measured by quality objective indicators) are more likely to:

  • Include quality performance on every board meeting agenda
  • Spend at least 20% of their time on clinical quality issues
  • Have a Board quality committee
  • Review a quality dashboard with trends over time and benchmarks
  • Review hospital-acquired infections rates, medications errors, and The Joint Commission’s core measures at least quarterly
  • Establish quality goals
  • Publicly disseminate quality performance measures
  • Have moderate or substantial expertise in quality
  • Evaluate the CEO in part based on quality criteria.

Unfortunately, the headlines are that just 44% of boards rank quality as one of their “top two priorities,” and that just 32% boards has received training in quality.   These findings are misleading.

First off, concluding quality isn’t a board priority because it isn’t in the top two is an arbitrary judgment.  It’s probably a reflection of the financial pressures hospitals currently face.

Second, more boards do need training in clinical quality to understand how to interpret quality reports and how to engage with clinical leaders to set quality goals and exercise accountability. However, I think the survey understates the degree of education on quality boards have received. Many hospital boards have had some exposure to quality education at either conferences or as an integral part of board or committee work but didn’t consider these to be “training in clinical quality” on the survey.

Health Affairs is widely read by policy makers, and the authors “suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals.”

That is a patently bad idea even though it would generate business for consultants like me and organizations like The Governance Institute and the Institute for Healthcare Improvement, which already deliver education for boards on quality. Boards are organized in various ways, and some rely heavily on committees for oversight. Many conduct education as an integral part of their board and committee work. Requiring that every board member go to conferences to be trained and credentialed in clinical quality would be a waste of resources.

So, do look at this study for guidance on practices to enhance your board’s quality oversight work — but educate any press or policy makers who ask that some sort of mandatory board education is not what we need.

2 Responses

  1. I couldn’t agree more with you more that requiring clinical quality training for board members would be a waste of time/resources. I think that putting this level of accountability on what are mostly non-healthcare related volunteers would actually discourage them from serving on healthcare boards. The onus should fall on healthcare management teams to read and translate reports into meaningful, high-level dashboards that board members can understand and discuss.

  2. The Action for Better Healthcare blog is weighing in on the survey as well. We thought you may want to check it out. Just click here to connect to the blog at http://actionforbetterhealthcare.com/?p=223.

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