Hospital Board Oversight of Quality and Patient Safety: A Narrative Review and Synthesis of Recent Empirical Research

• Published in: The Milbank quarterly 2013-12, Vol.91 (4), p.738-770
• Main Authors: MILLAR, ROSS, MANNION, RUSSELL, FREEMAN, TIM, DAVIES, HUW T.O.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Boards of directors; Corporate governance; Cross-sectional analysis; Discourse; Empirical evidence; Empirical Research; Governing Board; governing boards; Government and politics; Health care industry; Health care organizations; Health care quality; Health policy; Health services; Hospital Administration; Hospitals; Hospitals - standards; Humans; Industrial safety; Instrument panels; Leadership; Medical sciences; Narratives; Nonprofit hospitals; Observational studies; Original; Patient care; Patient Safety; Patients; Public health. Hygiene-occupational medicine; quality improvement; Quality of care; Quality of Health Care; Regulation; Safety; Safety measures; Sociology; Sociology of health and medicine; Surveillance; Surveys; trustees; U.S.A; United States
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/1468-0009.12032

Context: Recurring problems with patient safety have led to a growing interest in helping hospitals' governing bodies provide more effective oversight of the quality and safety of their services. National directives and initiatives emphasize the importance of action by boards, but the empirical basis for informing effective hospital board oversight has yet to receive full and careful review. Methods: This article presents a narrative review of empirical research to inform the debate about hospital boards' oversight of quality and patient safety. A systematic and comprehensive search identified 122 papers for detailed review. Much of the empirical work appeared in the last ten years, is from the United States, and employs cross-sectional survey methods. Findings: Recent empirical studies linking board composition and processes with patient outcomes have found clear differences between high- and low-performing hospitals, highlighting the importance of strong and committed leadership that prioritizes quality and safety and sets clear and measurable goals for improvement. Effective oversight is also associated with well-informed and skilled board members. External factors (such as regulatory regimes and the publication of performance data) might also have a role in influencing boards, but detailed empirical work on these is scant. Conclusions: Health policy debates recognize the important role of hospital boards in overseeing patient quality and safety, and a growing body of empirical research has sought to elucidate that role. This review finds a number of areas of guidance that have some empirical support, but it also exposes the relatively inchoate nature of the field. Greater theoretical and methodological development is required if we are to secure more evidence-informed governance systems and practices that can contribute to safer care.