Understanding corporate governance of healthcare quality: a comparative case study of eight Australian public hospitals

Abstract

BackgroundPatients are sometimes harmed in the course of receiving hospital care. Existing research has highlighted a positive association between board engagement in healthcare quality activities and healthcare outcomes. However, most research has been undertaken through surveys examining board engagement in a limited number of governance processes. This paper presents evidence of a comprehensive range of processes related to governing healthcare quality undertaken at the corporate governance level. This provides a more detailed picture than previously described of how corporate governance of healthcare quality is enacted by boards and management.MethodsA comparative case study of eight Australian public hospitals was undertaken. Case studies varying is size and location were selected from two Australian states. Data collection included a review of key governance documentation, semi structured interviews with board members and senior management and an observation of a board quality committee meeting. Thematic analysis was undertaken to identify processes related to key tasks in governing healthcare quality.ResultsTwo key tasks in the corporate governance of healthcare quality, evaluating healthcare quality and overseeing quality priorities, were examined. Numerous processes related to these two tasks were found. Case studies, while found to be similar in engagement on previously identified processes, were found to differ in engagement in these additional processes. While generally low levels of engagement in processes of overseeing quality priorities were found, cases differed markedly in their engagement in evaluating healthcare quality processes. Additional processes undertaken at some case studies represent innovative and mature responses to the need for effective corporate governance of healthcare quality. In addition, a group of processes, related to broader governance taskwork, were found to be important in enabling effective corporate governance of healthcare quality.ConclusionThe work of governing healthcare quality, undertaken at the corporate governance level, is redefined in terms of these more detailed processes. This paper highlights that it is how well these key tasks are undertaken that is important in effective governance. When processes related to key tasks are omitted, the rituals of governance may appear to be satisfied but the responsibility may not be met. Boards and managers need to differentiate between common approaches to governance and practices that enable the fulfilment of governance responsibilities. This study provides practical guidance in outlining processes for effective corporate governance of healthcare quality and highlights areas for further examination.

Implementation of the Nursing Services Management Model in 16 hospitals

“…In this scenario, health councils and hospital leaders from the international community warn of the awareness of risks and responsibilities in assuming attitudinal changes in management leadership that clearly impact the quality and safety of work (2) . Studies recommend and request hospital managers to take responsibility for management results and quality care (2)(3) . Setting priorities and disseminating strategic goals is directly related to high hospital performance, the core of hospital management (3) .…”

“…Studies recommend and request hospital managers to take responsibility for management results and quality care (2)(3) . Setting priorities and disseminating strategic goals is directly related to high hospital performance, the core of hospital management (3) .…”

“…Actions and efforts have been observed in scientific evidence. Today, however, it is necessary to investigate and evaluate different aspects of management, such as: the difficulties faced by managers; the results of leaders on quality improvement; practices and engagement to ensure effective care; time spent reviewing management models; frequent use of sources and guidelines of studies based on evidence and methodologies available for decision making; areas and organizational structures that deserve more attention; among other elements relevant to the performance of these professionals (2)(3) .…”

“…The means, in turn, are managerial instruments that act in the coordination, supervision, communication, observation and delegation of the processes for the realization of nursing practices in an organized manner, with a systematized team, in search of the best results (6) . Hospitals that conduct performance monitoring obtain significantly higher scores in the care process and lower rates of adverse events than services that do not (3) . It is clear, therefore, that nursing managers should be in a privileged position to recommend models, structures, procedures, policies and work the organizational climate of the institutions.…”

The Engagement Level of Board Members and Associated Health Care Quality in Public Health Centers of Addis Ababa, Ethiopia, 2018

“…In South Africa, the board members tend to forget their responsibility on the health care system because most of them are a politician and fail to perform what the community needs in the health care quality systems. 6 In Ethiopia, the study showed that the lack of commitment of board members to meet regularly and to attend meetings with motivations was insufficient. In some cases, board members' were over devoted to more than one board and members were too busy to arrange their governing board tasks.…”