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How do hospital boards govern for quality improvement?: A mixed methods study of 15 organisations in England
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, United Kingdom.ORCID iD: 0000-0001-8781-6675
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2017 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 26, no 12, p. 978-986Article in journal (Refereed) Published
Abstract [en]

Background

Health systems worldwide are increasingly holding boards of healthcare organisations accountable for the quality of care that they provide. Previous empirical research has found associations between certain board practices and higher quality patient care; however, little is known about how boards govern for quality improvement (QI).

Methods

We conducted fieldwork over a 30-month period in 15 healthcare provider organisations in England as part of a wider evaluation of a board-level organisational development intervention. Our data comprised board member interviews (n=65), board meeting observations (60 hours) and documents (30 sets of board meeting papers, 15 board minutes and 15 Quality Accounts). We analysed the data using a framework developed from existing evidence of links between board practices and quality of care. We mapped the variation in how boards enacted governance of QI and constructed a measure of QI governance maturity. We then compared organisations to identify the characteristics of those with mature QI governance.

Results

We found that boards with higher levels of maturity in relation to governing for QI had the following characteristics: explicitly prioritising QI; balancing short-term (external) priorities with long-term (internal) investment in QI; using data for QI, not just quality assurance; engaging staff and patients in QI; and encouraging a culture of continuous improvement. These characteristics appeared to be particularly enabled and facilitated by board-level clinical leaders.

Conclusions

This study contributes to a deeper understanding of how boards govern for QI. The identified characteristics of organisations with mature QI governance seemed to be enabled by active clinical leadership. Future research should explore the biographies, identities and work practices of board-level clinical leaders and their role in organisation-wide QI. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017. Vol. 26, no 12, p. 978-986
Keywords [en]
Governance, Leadership, Quality Improvement, adult, board of trustees, England, female, field work, health care personnel, human, identity, interview, investment, literature, major clinical study, male, maturity, organizational development, staff, total quality management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-38559DOI: 10.1136/bmjqs-2016-006433ISI: 000415980200007PubMedID: 28689191Scopus ID: 2-s2.0-85037066130Local ID: HHJIMPROVEISOAI: oai:DiVA.org:hj-38559DiVA, id: diva2:1174627
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-08-20Bibliographically approved

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Robert, Glenn

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Health Care Service and Management, Health Policy and Services and Health Economy

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