Hospital boards are responsible for plenty of high-level duties, and while their overall role may vary depending on an organization's size and type, quality and safety should be infused into all of the areas they oversee, according to the former chief quality officer at Massachusetts General Hospital in Boston.
"With today's financial and workforce challenges, it's easy to see how boards might focus on the most urgent issues, but quality and safety issues are always important," Elizabeth Mort, MD, former senior vice president of quality and safety and chief quality officer at MGH, said in an interview with the AHA.
All hospitals are in the business of patient care, and it's up to boards to set the tone and communicate their organization's commitment to high quality, safe care.
"It starts at the top," Dr. Mort said. "[The board's] role can be to shape the vision, purpose and support management in the required operations and in setting the culture, a culture of safety, a just culture and a culture that supports inclusion and psychological safety. That’s the big picture."
Four ways boards can positively influence quality and safety at their organizations, as outlined by Dr. Mort:
- Consider whether your organization's mission statement clearly mentions quality and safety, whether there are safety and quality experts on the board, whether board agendas include updates on quality and safety, and whether there is a quality committee on the board to oversee work with the senior team.
- Have each board committee make investment and management decisions with the potential effects on quality and safety in mind.
- Ensure quality and safety goals are set annually, "in the same way institutions have financial and operational plans," she said.
- Understand the key quality and safety metrics and indicators hospitals are judged on for leading ranking and rating calculations, such as Leapfrog safety grades and CMS star ratings. At the same time, don't solely rely on these measures. Additional information to consider include safety reports, serious reportable events and safety culture surveys.
"These scores are often easier to grasp, but I would caution any board from being comfortable with high marks on one or two, as there may be important performance gaps that are not visible," Dr. Mort said. "Even the top-rated institutions have opportunities to improve quality and reduce patient harm."