Care Quality Not a 'Top Priority' for Nearly One-Half of U.S. Hospital Boards

A new study published in Health Affairs suggests that slightly more than one-half of a nationally representative sample of U.S. hospital board chairs identified care quality as one of two top board priorities, Modern Healthcare reports. Researchers from the Harvard School of Public Health surveyed 922 randomly selected U.S. nonprofit hospital board chairs from facilities that reported quality data to the Hospital Quality Alliance (HQA) in 2007. The survey was conducted during 2007 and 2008 with a response rate of 78.3 percent. The researchers calculated overall summary scores on quality for each facility based on performance on 19 evidence-based practices for care in acute myocardial infarction, heart failure and pneumonia. According to the findings, slightly more than one-half of the respondents identified clinical quality as a top priority for board oversight, and board chairs of high-performing facilities, defined as those in the top 10 percent of quality scores, made this choice more often than chairs of low-performing hospitals. Only 44 percent of facilities reported that care quality was important for evaluating their chief executive officer's performance. Meanwhile, quality performance was on the agendas of every board meeting in 63 percent of hospitals, compared with financial performance, which was on the agendas of every board meeting in 93 percent of facilities. Revealing a "lack of awareness of their hospital's relative quality performance," respondents from 66 percent of hospitals rated their institutions as performing better or much better than the typical U.S. hospital, according to Joint Commission core measures or HQA measures. Among low-performing hospitals, defined as those in the bottom 10 percent of quality scores, specifically, no respondents said their performance was worse or much worse than the typical U.S. facility, and 58 percent rated their performance as being better or much better. Noting the "less-than-optimal focus" on quality and large variations between high- and low-performing facilities, the researchers suggest that hospital governing boards "may be an important target for intervention for policymakers hoping to improve care in U.S. [facilities]" (Evans, Modern Healthcare, 11/7/09 [subscription required]; Health Affairs release, 11/6/09; Jha et al., Health Affairs, 11/6/09 [subscription required]).

(c) RWJF 2009