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Medical Ethics |

Responsibility for Quality Improvement and Patient Safety: Hospital Board and Medical Staff Leadership Challenges

Christine A. Goeschel, RN, MPA, MPS; Robert M. Wachter, MD; Peter J. Pronovost, MD, PhD
Author and Funding Information

From the Department of Anesthesiology and Critical Care, Quality and Safety Research Group (Ms Goeschel and Dr Pronovost), The Johns Hopkins University School of Medicine, Baltimore, MD; the School of Public Health and Tropical Medicine, Health Systems Management (Ms Goeschel), Tulane University, New Orleans, LA; and the Department of Medicine (Dr Wachter), The University of California-San Francisco, San Francisco, CA.

Correspondence to: Christine A. Goeschel, RN, MPA, MPS, The Johns Hopkins Quality and Safety Research Group, 1909 Thames, Baltimore, MD 21231; e-mail: cgoesch1@jhmi.edu


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

For editorial comment see page 10

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):171-178. doi:10.1378/chest.09-2051
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Concern about the quality and safety of health care persists, 10 years after the 1999 Institute of Medicine report To Err is Human. Despite growing awareness of quality and safety risks, and significant efforts to improve, progress is difficult to measure. Hospital leaders, including boards and medical staffs, are accountable to improve care, yet they often address this duty independently. Shared responsibility for quality and patient safety improvement presents unique challenges and unprecedented opportunities for boards and medical staffs. To capitalize on the pressure to improve, both groups may benefit from a better understanding of their synergistic potential. Boards should be educated about the quality of care provided in their institutions and about the challenges of valid measurement and accurate reporting. Boards strengthen their quality oversight capacity by recruiting physicians for vacant board seats. Medical staff members strengthen their role as hospital leaders when they understand the unique duties of the governing board. A quality improvement strategy rooted in synergistic efforts by the board and the medical staff may offer the greatest potential for safer care. Such a mutually advantageous approach requires a clear appreciation of roles and responsibilities and respect for differences. In this article, we review these responsibilities, describe opportunities for boards and medical staffs to collaborate as leaders, and offer recommendations for how boards and medical staff members can address the challenges of shared responsibility for quality of care.

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