Table 1

Common challenges facing hospital boards and recommended mitigation strategies

ChallengeMitigation strategyRecommendation
Measures and data are overwhelmingFocus on a strategic set of key indicatorsInclude a finite and concise set of measures in a scorecard, with explicit alignment to strategy. This approach will avoid distraction by extraneous goals, inclusion of ambiguous measures, data overload and fatigue. Moreover, for internal organisational review at the board level, one should avoid indicators that are difficult to understand in terms of concrete patient impact (ie, an absolute number of serious safety events may be preferred over a rate per 1000 patient days), regardless of the reporting required by external agencies for accountability purposes.
Misinterpreting dataTell a clear storyEach performance graph should be presented with a clear narrative, highlighting what the indicator measures, the key take-away message (mentioning a difference or improvement only if it is statistically significant), distance from the target, the factors driving the results, and what is being implemented organisationally to achieve the desired result.
Understanding performance within organisational contextSummarise with a briefing noteInclude a briefing note which puts the scorecard and its indicators into context with organisational priorities and plans, provides key messages to be derived from board review of the scorecard, and includes some generative questions for board consideration.