Quality Oversight: The Changing Role of the Not-for-Profit Hospital Board

The United States’ healthcare delivery system is undergoing an unprecedented transformation. The implementation of the Affordable Care Act, the increasing focus on value, along with the introduction of new health technologies and the empowered consumer have brought about a fundamental shift in how care is delivered and paid for in this country.

In light of this shift, as well as continued challenges to their missions, non-profit hospitals and healthcare systems across the country are looking to transform their organizations. Among the many areas of change, organizations are increasingly focusing their attention on quality and patient safety. In response to the intensified focus on quality measurement and reporting across the healthcare industry, CEOs and board leadership teams together are striving to determine how best to leverage board assets in quality oversight and where to draw the distinction between governance and management. While the role of the board varies, appropriately, among organizations, most agree that boards need to engage differently around the oversight of quality and patient safety.

Defining Healthcare Quality

In order to have a meaningful conversation about quality of care and client safety in the boardroom, it is imperative to first and foremost define what is meant by “quality.” Boards pursuing the journey to enhance their effectiveness in quality oversight would be well served to spend time at a retreat or quality committee meeting discussing precisely what is meant by “quality and client safety” in their organizations.

In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century.  In this seminal publication, a six-pronged definition of healthcare quality was put forth that is generally considered to be the most complete and widely accepted. According to the Institute of Medicine, quality in healthcare is defined as care which is:

  1. Safe and avoids inflicting injuries to patients from the care that is intended to help them.
  2. Effective by providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit, thus avoiding underuse and overuse, respectively.
  3. Client-centered by providing care that is respectful of and responsive to individual client preferences, needs, and values and ensuring that client values guide all clinical decisions.
  4. Timely and reduces waits and sometimes harmful delays for both those who receive and those who give care.
  5. Efficient by avoiding waste of equipment, supplies, ideas, and energy.
  6. Equitable by providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

Regardless of the definition one chooses to apply, organizational leaders should carve out time to discuss and confirm a common understanding of what quality is for their particular organization.

At Via Healthcare Consulting, we specialize in providing information and tools for boards and CEOs in their work around enhancing the board’s effectiveness at providing quality oversight. Because governance involves exercising accountability by setting policy and overseeing implementation, we focus on what boards can do and how they can adapt to a new, more engaged, and transparent governance model. We also offer suggestions for how boards can partner with the staff leadership on the issue of quality oversight and demonstrate how boards can build or enhance their accountability for and knowledge about the safety and quality of patient care.

Call or email us today for more information about how we can help.

Erica M. Osborne, MPH

eosborne@viahcc.com or 760-683-8303