Getting Boards on Board: Engaging Governing Boards in Quality and Safety

Background: As hospitals seek to drive rapid quality improvement, boards have an opportunity-and a significant responsibility-to make better quality of care the organization's top priority. Intervention: Six things all boards should do to improve quality and reduce harm are recommended: (1) setting aims-set a specific aim to reduce harm this year; make an explicit, public commitment to measurable quality improvement; (2) getting data and hearing stories select and review progress toward safer care as the first agenda item at every board meeting, grounded in transparency-and putting a human face on harm data; (3) establishing and monitoring system-level measures-identify a small group of organizationwide roll-up measures of patient safety that are continually updated and are made transparent to the entire organization and its customers; (4) changing the environment, policies, and culture-commit to establish and maintain an environment that is respectful, fair, and just for all who experience the pain and loss as a result of avoidable harm and adverse outcomes: the patients, their families, and the staff at the sharp end of error; (5) learning, starting with the board-develop the board's capability and learn about how bestin-the-world boards work with executive and medical staff leaders to reduce harm; (6) establishing executive accountability-oversee the effective execution of a plan to achieve aims to reduce harm, including executive team accountability for clear quality improvement targets.