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November 06, 2009
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Sue Ducat

New Survey Shows Quality Not A Top Priority For Nearly Half The Nation's Hospital Boards

Bethesda, MD - Health Affairs today published a study surveying a nationally representative sample of board chairs in 1,000 U.S. hospitals. The results found that just half the boards rated quality of care as one of their two top priorities and only a minority reported receiving training in quality. This is the first national study of board chairs linked to quality performance.

Hospital Governance And The Quality Of Care
By Ashish K. Jha and Arnold M. Epstein
Author affiliations:
Jha and Epstein are affiliated with the Harvard School of Public Health

In identifying the factors that affect the quality of hospital care, leadership and governance have emerged as areas of particular interest. Since boards of directors could have an impact on quality of care, this study evaluated how hospital leadership values quality. The authors collected their data during the winter of 2007-08 by randomly selecting 1,000 institutions from a group of over 3,000 nonprofit acute care hospitals that reported quality data to the Hospital Quality Alliance (HQA) in 2007. They reached out to their board chairs, and achieved a response rate of 78.3 percent.

Of those surveyed, a little over half identified quality as one of the two top priorities for board oversight, and only 44% reported that quality of care was important for evaluating the performance of the chief executive officer (CEO). For 63% of the institutions, quality performance was consistently an agenda item at board meetings, compared to financial performance, which was consistently on the agenda at 93% of the hospitals.

In contrasting hospitals that had scored well in on quality measures with their lower-performing counterparts, the data revealed major differences in attitudes, priorities, and activities around quality of care. "Our data provide clear evidence of an association between an engaged board and high quality care, although we cannot yet pinpoint a causal link," said Ashish Jha, the study's lead author. "Most boards have primarily focused on financial issues, mistakenly assuming that their hospital's quality of care is adequate. Major opportunities exist to shift the knowledge, training, and practices of hospital boards to promote a focus on safe, effective care."

This project was funded by the Hauser Center for Non-Profit Governance at Harvard Law School and the Rx Foundation.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2009 Project HOPE–The People-to-People Health Foundation, Inc.