Bismark Marie M, Walter Simon J, Studdert David M
University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia. Email: .
Aust Health Rev. 2013 Nov;37(5):682-7. doi: 10.1071/AH13125.
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.
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.
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.
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.
确定卫生服务委员会在医疗质量与安全方面开展治理活动的性质和范围，并评估委员会成员在该领域的专业知识和观点。
本研究对维多利亚州所有85家卫生服务机构的董事会主席、质量委员会主席以及从董事会中随机抽取的两名成员进行了在线和邮寄调查。70%（233/332）的被调查成员做出了回应，96%（82/85）的董事会至少有一名成员做出了回应。
大多数董事会将质量绩效作为会议议程的常设项目（79%），并至少每季度审查一次用药错误和医院感染数据（77%）。较少董事会将其服务的质量绩效与外部比较对象进行基准对比（50%），或为董事会成员提供质量方面的正式培训（53%）。82%的董事会成员将质量确定为董事会监督的首要任务，但成员们普遍认为他们的董事会在塑造医疗质量方面的作用相对较小。卫生服务机构的规模（总预算、住院人次）与其董事会在质量相关活动中的参与程度之间存在正相关。90%的董事会成员表示，质量与安全方面的额外培训将“有一定用处”或“非常有用”。几乎每位受访者都认为其所在服务机构提供的整体医疗质量与维多利亚州典型的卫生服务机构一样好，或更好。
总体而言，卫生服务委员会开展了一系列令人印象深刻的临床治理活动。然而，各董事会的参与程度参差不齐，某些知识缺陷明显，董事会成员普遍认为，与质量相关问题的进一步培训将很有用。
