[This article was originally published in Healthcare Quarterly 13(4)]

They don't spend a lot of time treating patients. And they're seldom included on grand rounds. But health services boards of directors still have a significant role to play in quality and patient safety. Their responsibilities for quality go beyond those of boards in many other settings and so, therefore, does their need for specialized education and training. As Maura Davies, chief executive officer (CEO) of Saskatoon Health Region, has pointed out, "There is increasing awareness that health services boards cannot abdicate their responsibilities for ensuring quality and safety and need to take specific actions to address these duties" (Davies 2010: 37).

Many jurisdictions are recognizing this necessity and taking steps to clarify the accountability of boards. For example, the Excellent Care for All Act (Government of Ontario 2010) tabled in the Ontario legislature in spring 2010, makes explicit the requirement for boards to develop a quality plan and establish mechanisms such as quality committees to take responsibility for quality and patient safety goals.

The Canadian Health Services Research Foundation (CHSRF) and the Canadian Patient Safety Institute (CPSI) are working together to provide boards with the skills and training they need to carry out these responsibilities. They have sponsored research to determine the drivers of effective governance for quality and patient safety (see the full research report by Baker et al. [2010b] at www.chsrf.ca and their related article [2010a] in Healthcare Quarterly). And they have developed a comprehensive education program and tool kit, based on these drivers, for health services boards and senior executives. The tool kit (available at www.patientsafetyinstitute.ca) compiles best practice resources that can be adapted and applied within an organization to improve governance practices.

The education program offers more than simply information. Building on the evidence from the reports by Baker et al. (2010a and 2010b), the advice of a program design team that included members of the original research team and input from experienced health services governors and Accreditation Canada, the program provides a hands-on approach that is relevant to the specific context and experiences of members of health services boards. Highly interactive sessions provide the skills and knowledge board members need to create a quality and safety plan and promote an organizational culture focused on quality and safety.

To date, governors from 10 organizations and four regional health systems have participated in pilot sessions intended to gauge the effectiveness of the program and determine ways of strengthening the content and format. Sessions were led by experienced governors and included a presentation on the drivers of effective governance:

• Governance skills and roles
• Knowledge of quality and patient safety
• Measurement of quality and patient safety
• Information on quality and patient safety
• Relationships between board senior leadership and clinical leadership
• Assessing and improving the quality and patient safety culture

Participants gained an understanding of the type of information and indicators they need to implement effective governance practices and received a copy of the Effective Governance for Quality and Patient Safety tool kit. Most of all, however, the participants, whose joint organizations cover a population of 1.7 million and represent almost $3 billion in health services, valued the opportunity to share stories among peers, calling it one of the most powerful elements in the program.

Session leader Joan Dawe, former chair of Eastern Health in Newfoundland and Labrador, recounted how, as board chair, she was called to testify before a public inquiry into the breast cancer hormone receptor testing. She made a conscious decision, as part of her testimony, to apologize to patients and families who had been affected by the problems the inquiry was examining. The inquiry led to the development of apology legislation in the province, more detailed policies on disclosing and dealing with adverse events and a crisis management plan that articulates the roles of various persons, including the board of directors.

Jim Nininger spoke of the challenges of being appointed to an entirely new board at The Ottawa Hospital after all members of the previous board had been dismissed. He underscored that a solid relationship between board members and the CEO is essential to effective governance for quality and safety. In his case, the new board members, working with recently appointed CEO Jack Kitts, used the fresh start as an opportunity to build a relationship based on trust, mutual respect and a shared vision for excellence.

These and other stories provided participants with a better understanding of the types of challenges they may face and of the vital role health services boards can play in raising the quality and safety of care at their institutions.

The sessions were more than simply an opportunity to share and learn. At the end of each session, participants identified specific actions they would undertake to improve their governance practices. CHSRF and CPSI, in collaboration with other partners, have agreed to follow up on these action plans and identify resources that will assist participants and their organizations in carrying out these commitments.

Participants appreciated the focus on skills acquisition and encouraged CHSRF and CPSI to keep the sessions focused on practical applications. They remarked, "We came away with many ideas on how to improve our practices," and, "The program provides information and strategies that could be useful across the country."

In keeping with these comments, in fall 2010, CHSRF and CPSI will seek out partnerships with local hosts to provide the program to governors and executives across Canada. The result will be health services boards with the skills and resources they need to implement a focus on quality and safety of care.

For more information and/or to pursue a partnership for the Effective Governance for Quality and Patient Safety Education Program, please contact Michele Menard-Foster at michele.menardfoster@chsrf.ca.

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