Assessment Tool Allows Health System Boards to Track Their Performance

A framework of knowledge competencies for trustees and an assessment tool to gauge board performance is anticipated by the IHI to improve health system quality and safety.

The Institute for Healthcare Improvement has developed a new governance framework and assessment tool—Governance of Quality Assessment (GQA)— that supports healthcare trustees and executives in their responsibilities to oversee quality of care by defining core processes, culture, and commitment for excellence in quality, states the IHI.

Boards that prioritize quality have been linked to higher performance in primary quality measures, but IHI research indicates there is a wide range of variability in board quality efforts.

According to research conducted by an IHI thinktank, some boards desire to have a clear framework to ensure they are on the right track.

"Most people on volunteer boards want to make sure they are working on the right things, and this is an easy tool for them to assess whether they are. It's also a great tool for discussion between the board quality chair and the CEO. We are hopeful this assessment will allow boards to identify their current state and track their progress over time," Beth Daley Ullem, faculty lead at IHI, said at last month's IHI National Forum on Quality Improvement in Health Care.

Trustees should play a major leadership role in quality and safety, Tejal Gandhi, MD, MPH, chief clinical and safety officer of IHI, said at the forum.

"Boards of trustees are critical to advance a culture of safety, establish the direction for organizations, and hold CEOs accountable. So, if the board is not engaged in quality and safety, it will be hard for organizations to reach their ultimate quality and safety goals," she said.

Assessment tool crafted
 

The GQA is robust and patient-centered, Daley Ullem said.

"The assessment covers all the dimensions of quality. It looks at the health system versus just the hospitals, and it uses a tactical and tangible framework envisioning quality through the eyes of the patient, which is actionable to board members," Daley Ullem said.

The GQA features a relatively simple format.

• It includes queries that target care settings both inside and outside the hospital walls.
   
• It is designed to generate a snapshot of 30 core processes organized in six categories.
   
• Core board processes include reviewing metrics related to care access, reviewing performance in risk-based contracts, and regular tracking of performance of primary safety metrics
   
• The scoring system allows performance review overall, by category, and by the 30 core processes.
   
• The highest possible score for the assessment is 60. 
   
• Scores 40 to 60 are rated "advanced board commitment to quality." Scores 25 to 40 are rated "standard board commitment to quality." Scores 0 to 25 are rated "developing board commitment to quality."
   
• IHI recommends that health system CEOs should use the GQA to track board performance annually.

Board quality framework forged
 

The new governance framework for health system quality and the board assessment tool are complementary—with the assessment measuring performance of some elements of the framework, Gandhi said.

The IHI governance framework features three core areas that are quality-related terminology and competencies for board members.

1. Core quality knowledge ensures that board members are adequately familiar with medical terminology, healthcare oversight, and clinical care to address quality and safety issues.

• Continuous education about healthcare quality should be a top goal to enable guardianship of quality and safety

2. Core improvement system knowledge ensures familiarity with how healthcare leaders manage improvement of clinical care.

• Trustees must know their organization's improvement methodology, which allows them to determine the adequacy of staffing, processes, and infrastructure
   
• Trustees must be acquainted with how healthcare leaders manage quality planning, quality control, and quality improvement
   
• Boards and executives should identify elements of quality improvement work in their organization and assign accountability for those elements
   
• Trustees should have analytical skills sufficient to participate in examining data and working with executives
   
• Boards should hold executives accountable for quality and participate in quality improvement activity

3. Board culture and commitment to quality

• Ensuring quality at the healthcare organization should be a preeminent issue for all board members—not just members of the quality committee.
   
• Boards should foster knowledge and target oversight expertly. With structured oversight, educated board members can provide effective participation in quality initiatives. Boards and executives should decide which issues are assigned to the quality committee and the entire board.
   
• Well-executed inquiry is an essential skill for trustees to participate in quality and safety oversight. Without interfering with the executive leadership, board members should make inquiries to leaders to verify that performance matches expectations.
   
• Boards should make a visible and vocal commitment to quality such as conducting rounds.
   
• To personalize data and humanize quality, boards should hear patient stories.