The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria

Abstract

Objectives. To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area.Methods. This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond.Results. Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service's quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board's level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be 'moderately useful' or 'very useful'. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service.Conclusions. Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful. What is known about the topic?There is an emerging international consensus that effective board leadership is a vital element of high-quality healthcare. In Australia, new National Health Standards require all public health service boards to have a 'system of governance that actively manages patient safety and quality risks'. What does this paper add? Our survey of all public health service Boards in Victoria found that, overall, boards are engaged in an impressive range of clinical governance activities. However, tensions are evident. First, whereas some boards are strongly engaged in clinical governance, others report relatively little activity. Second, despite 8 in 10 members rating quality as a top board priority, few members regarded boards as influential players in determining it. Third, although members regarded their boards as having strong expertise in quality, there were signs of knowledge limitations, including: near consensus that (additional) training would be useful; unfamiliarity with key national quality documents; and overly optimistic beliefs about quality performance. What are the implications for practitioners? There is scope to improve board expertise in clinical g...

Governance of quality of care: a qualitative study of health service boards in Victoria, Australia

“…With respect to skills and expertise, our findings echo messages from previous studies in the USA,11 the UK23 and Australia,24 indicating that (additional) board training on quality governance would be useful. Such training should be accessible, flexible and tailored rather than assuming that ‘one size fits all’.…”

“…While some health service boards in Victoria had high aspirations and clear plans to improve care quality, others appeared to be ‘muddling through’. This resonated with findings from our earlier survey of board members from all 85 health service boards in Victoria,24 where wide variation was evident in the nature and extent of relevant activities being undertaken at the board level.…”

“…In a recent survey of board members from all Victorian health services,24 we queried respondents about whether their boards were undertaking each of 15 specific quality-related activities (eg, board regularly reviews a quality dashboard). The activities were derived from a similar list developed by Jha and Epstein11 and a review of the international literature on clinical governance.…”

Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies

“…One aspect of this is board agendas and the extent to which patient safety is discussed at board meetings. 73,74 Findings from US hospital settings suggest that having quality and safety as standing items on the board agenda provides a critical lever for engagement in quality and safety issues.…”

“…73,74 Some of this work has revealed the limited time and resources that many boards devote to such activities. US and Canadian research found a 'remarkably low' degree of knowledge among hospital boards about published quality reports and best-practice guidance in relation to safe care, 66 with many board members having only limited expertise in using and implementing such information.…”