Getting boards on board: engaging governing boards in quality and safety.

BACKGROUND: As hospitals seek to drive rapid quality improvement, boards have an opportunity-and a significant responsibility--to make better quality of care the organization's top priority. INTERVENTION: "Six things all boards should do to improve quality and reduce harm" are recommended: (1) setting aims--set a specific aim to reduce harm this year; make an explicit, public commitment to measurable quality improvement; (2) getting data and hearing stories--select and review progress toward safer care as the first agenda item at every board meeting, grounded in transparency--and putting a "human face" on harm data; (3) establishing and monitoring system-level measures--identify a small group of organizationwide "roll-up" measures of patient safety that are continually updated and are made transparent to the entire organization and its customers; (4) changing the environment, policies, and culture--commit to establish and maintain an environment that is respectful, fair, and just for all who experience the pain and loss as a result of avoidable harm and adverse outcomes: the patients, their families, and the staff at the sharp end of error; (5) learning, starting with the board--develop the board's capability and learn about how "best-in-the-world" boards work with executive and medical staff leaders to reduce harm; (6) establishing executive accountability--oversee the effective execution of a plan to achieve aims to reduce harm, including executive team accountability for clear quality improvement targets.