The Kings Fund on ‘Putting Quality First in the Boardroom’

Here at Healthcare Governance Review we obviously missed publication, in April this year, of an excellent Kings Fund document on quality and patient safety in the boardroom.

In 2009, The King’s Fund and the Burdett Trust for Nursing set out to ‘bring the ward to the board’, emphasising the role of the nurse executive in ensuring that boards are as fully engaged with the clinical quality agenda as they are with financial performance. As leaders of the largest part of the NHS workforce, nurse executives have considerable power to influence the patient experience and the ability to provide an understanding of the standard of clinical care delivered by a trust.

Building on the findings of From Ward to Board, the publication produced after the first phase of work in 2009, Putting quality first in the boardroom is based on observations of nurse executives and their boards at six NHS trusts. The report starts by examining what is meant by the term ‘clinical quality’ and why it has the potential to be marginalised in the boardroom. It goes on to consider the dynamics of the boardroom and the role of the nurse executive.

The main observations of the report relate to board members’ behaviour and attitudes to the question of discussing and improving clinical quality. To focus effectively on the business of caring, board members need to ensure that they have the time and training to develop their understanding of the issues around quality assurance and improvement. Nurse executives also need to move from their traditional role of ‘doing’ to one of enabling others. Successful nurse executives are skilled facilitators who know when to intervene; they have a key role in engaging frontline clinicians in the boardroom task of measuring and assuring the quality of care.

In drawing together the findings, the authors suggest the following ten action points for boards to ensure that they engage more effectively with the quality agenda.

1. Set the context for engaging in quality – be clear about what it means for your organisation, define its relevance to different aspects of the business, and be prepared for the fact that engaging with quality may at times be an uncomfortable experience.
2. Shape the culture and tone of your organisation so that clinical quality becomes the top priority – the board needs to adopt the right behaviours and leadership style,
and communicate the value it places on quality to managers and staff, patients
and families.
3. Develop a strategy for quality improvement  or, at the very least, make explicit commitments in relation to quality.
4. Have a dedicated quality sub-committee of the board to oversee quality assessment, quality improvement and quality assurance, and to provide assurances to the board that these tasks are being fulfilled effectively.
5. Pay attention to dynamic administration, including the length of meetings, the volume of papers, and appropriate breaks. If the basics are not right, the board will not be in a position to give its full attention to quality.
6. Review the use of sub-committees and ensure that the correct breadth and depth of information regularly reaches the board.
7. Put quality at the top of the agenda for board meetings and devote at least 25 per cent of time to discussing quality issues.
8. Draw on a mix of both qualitative and quantitative data to form a rich picture of the quality of care being provided by your organisation, including using patient stories and information from ward ‘walkabouts’.
9. Make good use of clinical executives on the board and clinical leaders throughout the organisation to drive the quality agenda.
10. Develop the board’s capability to understand and promote quality improvement – non-executives in particular may need support to do this, but also executive directors who do not have a clinical background. This may require building knowledge and skills in quality improvement approaches, quality assurance systems and skilling up in data analysis.

Download Putting Quality First in the Boardroom here.

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