Effective Governance for Quality and Patient Safety in Canadian Healthcare Organizations

by G. Ross Baker, Jean-Louis Denis, Marie-Pascale Pomey, Anu Macintosh-Murray | Jan 01, 2010

Key Messages for Decision Makers

Board chairs and CEOs at both regional and organizational levels (hospitals, long-term care and other settings)

  • Board chairs and trustees should add quality and patient safety expertise to the skills matrices and competency profiles for board members. They should seek to recruit at least one member, and perhaps more, who has expertise in healthcare quality or similar expertise in other industries.
  • Board chairs and quality committee chairs should develop a plan for board and quality committee members to broaden their knowledge and skills in quality and patient safety. Boards should also explore other approaches, such as generative governance (engaging in deeper inquiry and exploring root causes).
  • Board chairs and CEOs should consider conducting external reviews of their current approaches to the governance of quality and safety, including processes and the adequacy of current quality and patient safety goals.
  • Healthcare boards should establish specific quality and patient safety goals as prominent components of the strategic plan and hold CEOs accountable for the achievement of those goals. Boards need to participate as full and informed partners in the development of strategic goals and plans.
  • Boards need access to relevant and informative measures of safety and quality to assess current performance and target improvement strategies.

Policy makers in provincial and territorial governments

  • Boards need to deepen their expertise in quality and safety, build governance skills, and receive better and more usable information about current performance. Few regions or healthcare organizations have the resources to independently develop these skills and knowledge. Strategic investments by governments in educational development could greatly enhance current governance skills related to improving quality and patient safety. Some educational programs already exist and could be strengthened. New resources could support program development and educational costs borne by boards.
  • Governments, together with quality councils and other experts, could help develop a database of measures and sample dashboards – a visual presentation of summarized data used to track performance improvements – that would support regional and organizational boards. Some of this information can be accessed from the Canadian Institute for Health Information (CIHI) and other databases, while other information has to be developed locally using decision support and measurement expertise. Governments should also explore the development of a competency profile for board members that could help inform selection of Regional Health Authority (RHA) and other board members.
  • Governments should assess whether targeted resources could help RHAs and delivery organizations develop greater capabilities for improving care and care delivery processes so that these organizations can achieve the goals set by government and local governance.
  • Funding should be allocated to research that identifies the ways in which board and leadership activities support improvements in quality of care and patient safety. This research should include longitudinal studies that can assess the impact of new initiatives and interventions over time.