When we think about life or death moments for patients in a hospital, doctors and other healthcare providers seem like the key players in how a situation turns out. But board members and CEOs are integral to how a hospital functions and the potential for improvements that trickle down to individual patients. Problem is, many hospital boards don’t necessarily operate that way.

“Most board members are community leaders, serving on the board to support fund-raising goals,” Ashish Jha, a Harvard physician, told The New York Times. “They don’t think it’s their job to hold management accountable for performance. Board members often feel like clinical quality is physicians’ jobs, and they don’t want to step on doctors’ toes.”

Physicians can do their best in a given encounter with a patient, but boards and hospital management can influence the bigger picture – things like establishing specific protocols and systems to ensure equipment and supplies are available, putting standards in place and monitoring performance quality.

“I’m a much better doctor in a well-managed hospital where the systems are in place to help me do my best work,” Dr. Jha said. “Even a great chef can’t produce a good omelet with eggs that are stored in the freezer or the stove doesn’t work reliably.”

The problem for many hospitals, according to Dr. Jha, is that few board members are actual medical professionals, and they are usually invited by the board or chairman, as opposed to being included based on a vote from stakeholders.

The Times explained the reality of how many hospital boards function:

In general, hospital boards do not view themselves as institutional champions of quality. According to work by Dr. Jha and his colleague Arnold Epstein, only 20 percent of nonprofit hospital board chairmen reported that the board was one of the top forces for quality at their hospitals. At hospitals with low-quality scores on standards established by Medicare, only 11 percent did so. Only half of boards view clinical quality as one of their top two concerns. In contrast, financial performance was a top priority for about three-quarters of hospital boards. The analysis examined the association of boards’ priorities with a wide range of evidence-based measures of quality, including those for heart attack care.

Troublingly, most hospitals boards can’t accurately assess their institution’s quality. There’s a Lake Wobegon effect: More than half of hospitals with low quality thought they were actually above average.

So how can hospital management improve quality?

One way is to adopt “lean” methodologies, such as the ones developed by Toyota, according to health economist at Oregon Health & Science University, K. John McConnell, and his colleagues. Management practices like these include eliminating inefficiencies and variations, fostering collaboration and setting targets and tracking progress toward them.

McConnell and his team also found that hospitals have better management practices when they are facing greater competitive pressure. There could also be improvements if board members were better trained in quality care, as well as if healthcare providers where paid based more on quality than volume. (Pay-for-performance hasn’t been successful in the past necessarily, but that might have had more to do with what the established incentives and penalties were.)

The role of physicians and 0ther healthcare providers is clearly essential for patient outcomes, but research suggests that overall quality of care could be greatly improved if those sitting in the board room shifted their angle of influence.

[Photo from Flickr user reynermedia]