In the spring of 2006, the Estes Park Institute joined this research by sending the survey tool to hospitals in their network. The Institute asked board chairs, chief executive officers (CEOs), and chief medical officers (CMOs)/chiefs of staff to complete the survey.

The 28-question survey tool was administered to four groups (board chairs, CEOs/COOs, CMOs/chiefs of staff, and middle managers) to assess common ground and gaps in perception. It asked questions relating each respondent’s view of his own commitment to/engagement in patient safety, organizational operations related to safety, hospital leadership commitment to/engagement in patient safety, hospital culture of patient safety, and barriers to patient safety.

This research recognized that optimizing quality and patient safety has garnered high priority and focus across the nation in the last several years, but that if different perceptions exist regarding a hospital’s patient safety journey, the necessary critical and courageous conversations to move beyond rhetoric are difficult, if not impossible, to have. As the role and importance of leadership engagement have become more evident, the researchers deemed it important to assess potential gaps in perceptions to be able to facilitate discussion towards common purpose and priorities and, ultimately, to develop the required common systems, structures, processes, and outcomes for patient safety from the board to the bedside.

In general, most of the 486 respondents are comfortable with their own knowledge of and engagement in patient safety. However, large gaps exist in the perceived engagement between leadership and managers at other levels. The board perceives a very active, visible level of engagement in and culture-readiness for patient safety at all levels of the organization, while mid-level managers and CMOs experience more challenges with keeping safety a priority over production goals. All groups perceive physician engagement as the greatest challenge. Middle management sees a greater opportunity for improved patient safety tools and education. There is consensus at all levels around the opportunity of hardwiring patient/family involvement in patient safety design. In terms of the barriers to patient safety, all groups ranked culture and resources, including information technology (IT) implementation, as common problems. Differences were seen with respect to other barriers. In particular, several board members responded that human error was the major barrier or that no barriers existed, whereas these responses were not found in either the CEO or CMO groups.

The results of this survey demonstrate the need for serious assessment and dialogue among the board, C-suite, physician leadership, and middle management, and greater visible evidence of leadership involvement in patient safety. In addition, the disconnect in perceptions suggests the need for more objective measurements of patient safety progress within organizations to bridge the gaps. “Flattening the organization” with surveys, such as this one, and candid conversations would go a long way toward obtaining more than a surface commitment to patient safety and quality.

The purposes of the study were (1) to determine the prevalence of board quality oversight practices and describe differences identified by hospital type and (2) to determine whether specific practices contribute to better organization-wide performance. The study was based on a January 2006 survey of CEOs of more than 4,200 not-for-profit acute care general hospitals across the U.S. to explore board practices in healthcare systems, subsidiary hospitals, and independent hospitals. Phase 1 of the analysis, completed in June 2006, linked each of the 562 responses to the organization’s performance on two scorecards: the hospital-wide scorecard measuring quality outcomes, patient safety, efficiency, financial stability, and customer response; and the quality scorecard measuring mortality, complications, patient safety, and length of stay.

The study identified common board quality practices found in at least 80% of surveyed hospitals. These included: formally-established strategic goals for quality improvement; monitoring of quality indicators; required progress reports on corrective action on quality/safety problems; investments in new technologies aimed at quality improvement; and board quality committees.

Five board quality practices correlated with a high hospital-wide composite score: CEO performance evaluation that includes objective clinical improvement and patient safety goals; board-established quality agenda; board quality committee review of patient satisfaction scores; board participation in medical staff appointments; and medical staff involvement in setting board quality agenda.

Five board quality practices correlated with a high quality composite score: CEO performance evaluation tied to patient safety goals; time spent during board meetings on quality; board quality committee chair or chief of staff presenting quality report to full board; board participation in medical staff appointments; and medical staff involvement in setting board quality agenda.

These last two areas were significant on both the hospital-wide and quality score cards.

In conclusion, this study suggests that there is a common baseline of traditional board quality practices. Generally, hospitals that followed these practices have better performance. Thus, it is not always necessary to develop new roles or add on responsibilities for board members; rather, it appears to be more important to improve existing traditional board quality practices.