Publication date

Hospital boards and medical specialists collaborating for quality of care.

Botje, D., Plochg, T., Klazinga, N., Wagner, C. Hospital boards and medical specialists collaborating for quality of care.: , 2012. 51 p. Abstract. In: European Health Management Association. Abstractbook EHMA Annual Conference 2012 'Public healthcare: who pays, who provides? 13-15 june 2012, Bern.

In European countries policy briefs are stressing the importance of hospital governance for the quality of care. When governing towards quality it is essential for Hospital Boards to receive the proper information to do so. In the Netherlands, the national association for medical specialists has provided suggestions about which information medical specialists should share with their Boards. The aim of the present study was to identify to what extent the Hospital Board and medical specialists focus on quality, and which sources of information are shared between them. Additionally, we investigated to what extent they collaborate for quality of care.

In our cross-sectional study in the Netherlands we sent questionnaires on governance and quality of care to the Chief Executive Officers (CEOs) and Chief Medical Officers (CMOs) of all 97 hospitals during winter 2010-2011. The self-reported questionnaires for CEOs and CMOs were fairly similar and consisted of a validated translation of an American survey on quality (Jha and Epstein, 2010). Questions were added to the questionnaire to identify compliance with sources of information to be able to determine which sources of information were shared by medical specialists, and which sources were used by the Hospital Board for policy-making. Additionally, CMOs could indicate in which areas medical specialists engaged in governance.

Out of 97 hospitals 40 CEOs and 67 CMOs completed questionnaires. The Boards that spent more time on quality during meetings scored higher on perceived expertise in quality management, were more familiar with national quality programs, and attributed a higher score to the collaboration between the Hospital Board and medical specialists. In hospitals having an information protocol, more information was shared with the Board. The number of sources shared by medical specialists and used for policy-making by the Board differed tremendously among hospitals. We also found that the amount of sources was higher when the Board's quality orientation was high. Results showed that medical specialists engaged with several areas of governance, for instance with developing and implementing protocols or quality improvement projects. CEOs and CMOs considered the collaboration between the Board and the medical specialists for the quality of care to be good.

Current policies aim for quality orientation in hospital governance and information-sharing, but thus few hospitals completely met the expectations. Although it is still unclear why compliance with policy is shortcoming, we did find hospitals with both a high quality orientation and a high amount of information being shared. Also engagement of medical specialists in governance can be considered to be a prerequisite to govern a complex institution such as a hospital. Besides, previous studies have shown that the hospital performance on quality of care benefits from a good collaboration. Could it be that if CEOs consider quality to be important, medical specialists are more likely to participate in quality too? In the Netherlands, both hospital remuneration system and contracts with health insurance companies are increasingly depending on hospital performance on quality indicators. Future research should focus on the relationship between governance and the quality performance.