Hospitals with boards and management practices that actively monitor quality and patient safety, as well as budgets and finances, have higher quality outcomes, researchers find.
Hospital boards that place quality and patient safety higher on their agenda somehow improve the performance of front-line management and clinical quality outcomes, a recent study has found.
"Conceptually, everybody understands that good leadership at the board level matters," says Thomas Tsai, MD, a surgical resident at Brigham and Women's Hospital and research associate at the Harvard T.H. Chan School of Public Health and the lead author of the study published in the August 4 issue of Health Affairs.
"But this is one of the first papers to empirically show the connection between hospital board and management practices. We also demonstrate that both hospital boards and managements practices are then, in turn, related to the clinical quality of a hospital."
Thomas Tsai, MD |
Exactly how hospital boards impact clinical performance is unclear and needs to be further investigated, Tsai says.
Characteristics of Quality-focused Boards
Survey questions used in the study were placed in two categories—the composition and attributes of the board, and the board's actions. The first category examined whether boards:
- Listed quality as a frequent agenda item
- Valued clinical quality as a priority
- Contained members experienced with quality
- Were engaged in quality issues
The second category focused on what the board was actually doing to improve quality. Researchers wanted to know about:
- The use of dashboards to study quality measures and outcomes
- The setting of goals and dissemination of these goals throughout the hospital
- CEO evaluation and remuneration based on safety measures and outcomes
- The use of data for feedback, incentives, or awards
High quality hospitals with better management had boards that were more engaged with dashboards, data, and frequent discussions on quality and patient safety, Tsai says.
Importance of Front-line Managers
The study did not look at the relationship between boards and the C-suite. Instead, it examined the relationship of boards to front-line management practices and the quality of care delivered.
"Managers of hospitals were defined as clinical service leaders and represented a diversity of professional backgrounds including physicians and nurse managers," the study says. "Mid-level and front-line managers were selected because they were senior enough to have an overview of management practices, yet still be involved in day-to-day operations and, therefore, more likely to have a direct relationship with care delivery in each hospital."
Front-line managers were deliberately included to see how leadership decisions regarding quality filter down and impact delivery of care, Tsai says.
An 'Underappreciated Opportunity for Quality Improvement
Quality and patient safety initiatives usually focus on clinical provider outcomes. But the results of this study show there is a definitive link between hospital boards, front-line management, and quality of care.
"The data suggests this is an underappreciated opportunity for quality improvement," he says. "We need to think beyond focusing only on clinicians to thinking about how the overall hospital organization is aligned with clinical quality metrics."
For example, if a hospital has a high surgical infection rate, it may not be enough to just target improvement efforts on individual surgeons or revamp guidelines in the OR, Tsai says. "We may need to think more broadly about hospital culture and whether we should be thinking about managers and boards reviewing this type of quality data as well."
Surgeon Scorecard Needs Improvement
"Our goal is that this study will motivate future research and provide an opportunity to improve the quality of management practices in hospitals," Tsai says.
Janet Boivin, RN, is senior quality editor at HealthLeaders Media. 
