Department of Applied Health Research, University College London, London, UK.
The Florence Nightingale Faculty of Nursing& Midwifery, Kings College London, London.
BMJ Qual Saf. 2017 Dec;26(12):978-986. doi: 10.1136/bmjqs-2016-006433. Epub 2017 Jul 8.
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).
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.
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.
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.
全球卫生系统越来越要求医疗保健组织的董事会对其提供的护理质量负责。先前的实证研究发现，某些董事会做法与更高质量的患者护理之间存在关联；然而，对于董事会如何为质量改进（QI）进行管理，人们知之甚少。
作为对董事会层面组织发展干预措施进行更广泛评估的一部分，我们在英格兰的 15 家医疗服务提供者组织中进行了为期 30 个月的实地工作。我们的数据包括董事会成员访谈（n=65）、董事会会议观察（60 小时）和文件（30 套董事会会议文件、15 份董事会纪要和 15 份质量报告）。我们使用从董事会实践与护理质量之间的联系的现有证据中开发的框架分析了数据。我们绘制了董事会实施 QI 治理的变化情况，并构建了 QI 治理成熟度的衡量标准。然后，我们对组织进行了比较，以确定具有成熟 QI 治理的组织的特征。
我们发现，在治理 QI 方面成熟度较高的董事会具有以下特征：明确优先考虑 QI；在短期（外部）优先事项与长期（内部）对 QI 的投资之间取得平衡；将数据用于 QI，而不仅仅是质量保证；让员工和患者参与 QI；并鼓励持续改进的文化。这些特征似乎主要得益于董事会层面的临床领导者。
本研究有助于更深入地了解董事会如何治理 QI。具有成熟 QI 治理的组织的特征似乎得益于积极的临床领导。未来的研究应该探讨董事会层面的临床领导者的传记、身份和工作实践，以及他们在全组织范围内 QI 方面的作用。
