While the board will probably not personally be using the tools and techniques of continuous quality improvement, they should be briefed in what these tools are and how the hospital and medical staff are using these tools to improve performance. One quality improvement tool of particular interest to the board is benchmarking. Using comparative data to identify problem areas and/or opportunities for improvement should be a high priority for the board. Likewise, introduce the board members to the clinical practice guidelines being developed by medical professional societies. The board should encourage the use of practice guidelines to evaluate and improve the quality of patient care.

Orient the board to the "systems" focus of continuous quality improvement, emphasizing that improvements in hospital functions and processes are the goal. Don't let the board forget they are still legally responsible for the competency of practitioners and staff, and because of this, quality data for individual clinicians will be still maintained and evaluated. However, in general, even when individuals are suspected of marginal performance, the first area of investigation will focus on process improvements designed to improve that individual's performance.

Clarify the role of the governing board in supporting the quality management process. At a minimum, the governing board should undertake the following activities:

* foster the concepts of quality improvement in health care through their personal commitment to the success of the quality program;

* define the organization's commitment to continually improving the quality of patient care and services in the organization's mission statement;

* incorporate the findings from quality assessment and improvement activities in strategic, program, and resource planning;

* participate in education concerning the approach and methods of continuous quality improvement in health care organizations;

* establish priorities for organizationwide quality improvement activities in conjunction with the organization's administrative and medical staff leaders;

* commit to the provision of financial support for the quality program so that administration and the medical staff have the necessary resources for education, services, equipment, information management and personnel required to support quality assessment and improvement activities;

* receive regular reports of organizationwide quality assessment and improvement activities, using this information to ensure compliance with the intent of the program and to effect constructive change; and

* participate in a review of the effectiveness of the quality program in achieving desired priorities and quality improvement goals.

The governing board should also be involved in celebrating the success of performance improvement projects. Include board representatives in recognition or "quality celebration" ceremonies. When board members visit the hospital, encourage them to speak individually with staff involved in successful improvement projects. Governing board members must "walk the talk" just as much as administrative and medical staff leaders.

The hospital governing board can be a powerful ally in advancing the goals of the hospital quality management program. You may find that many of the members already have had experience in total quality management in their professional businesses and have been wondering why quality management is only just "catching on" in health care. Educating the governing board about their role in the hospital's quality management process is the first step toward creating a dynamic, collaborative partnership.

Copyright 1998 by Brown-Spath & Associates.

Address comments or correspondence to: Brown-Spath & Associates, PO Box 721, Forest Grove, OR 97116; email: Patrice@brownspath.com.