Chest
MEDICAL ETHICSResponsibility for Quality Improvement and Patient Safety: Hospital Board and Medical Staff Leadership Challenges
Section snippets
The Legal and Regulatory Contexts for Boards' Activities
In not-for-profit (NFP) hospitals, the roles and responsibilities of governing boards are complex, interconnected, and critical to institutional viability and to fulfilling their community obligation.8 NFP hospital governance boards are legally bound to the fiduciary duties of care, loyalty, and obedience.1, 9 Historically, the interpretation of those duties varied widely in accordance with local culture and reflected the flexibility of state statutes.
Wide variation still exists in the level of
Model for a Meaningful Safety Scorecard
Boards face substantial challenges in monitoring quality of care and patient safety. Current measures to evaluate progress in patient safety do not provide an adequate evaluation of services across an institution and many are of dubious validity. Without rigorous and standardized measurement, boards, hospital leaders, and medical staffs do not know whether care is really any safer than it was previously. Boards are often left monitoring what administrative staffs determine is important (or, to
Conclusions
Hospital boards face increased accountability for the quality and safety of care in their organizations. Many boards are responding admirably, and all of them can do so if they and their medical staffs are willing to adapt.
Boards must engage their medical staffs by becoming more involved in and educated about the quality of care provided in their institutions and by inviting physicians to join the governing body. Medical staff members should understand the unique duties of boards, which may
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Wachter reports having an equity interest and/or serving on paid advisory boards for PatientSafe Solutions and Epocrates; receiving fees from QuantiaMD for helping to produce a Web-based series on patient safety; receiving honoraria from the American Board of Internal Medicine for serving on its board of directors and Executive Committee; receiving honoraria for many speeches on
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Editor's note: This review addresses the 13th topicin the core curriculum of the ongoing Medical Ethicsseries. To view all articles from the core curriculum, visit http://chestjournal.chestpubs.org/cgi/collection/ medethics.—Constantine A. Manthous, MD, FCCP, Section Editor, Medical Ethics
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