CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Health Review   
Australian Health Review
  Journal of the Australian Healthcare & Hospitals Association
blank image Search
blank image blank image
blank image
  Advanced Search

Journal Home
About the Journal
Editorial Board
For Advertisers
Online Early
Current Issue
Just Accepted
All Issues
Sample Issue
For Authors
General Information
Instructions to Authors
Submit Article
Open Access
For Referees
Referee Guidelines
Review Article
Annual Referee Index
Call for Reviewers
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with AHR
blank image
facebook   TwitterIcon

red arrow Connect with CP
blank image
facebook twitter youtube


Open Access Article << Previous     |     Next >>   Contents Vol 37(5)

The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria

Marie M. Bismark A B, Simon J. Walter A and David M. Studdert A

A University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia. Email: swalter@unimelb.edu.au, d.studdert@unimelb.edu.au
B Corresponding author. Email: mbismark@unimelb.edu.au

Australian Health Review 37(5) 682-687 http://dx.doi.org/10.1071/AH13125
Submitted: 18 June 2013  Accepted: 5 September 2013   Published: 4 November 2013

 Full Text
 PDF (354 KB)
 Export Citation

Objectives To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area.

Methods This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond.

Results Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service’s quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board’s level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be ‘moderately useful’ or ‘very useful’. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service.

Conclusions Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful.

What is known about the topic? There is an emerging international consensus that effective board leadership is a vital element of high-quality healthcare. In Australia, new National Health Standards require all public health service boards to have a ‘system of governance that actively manages patient safety and quality risks’.

What does this paper add? Our survey of all public health service Boards in Victoria found that, overall, boards are engaged in an impressive range of clinical governance activities. However, tensions are evident. First, whereas some boards are strongly engaged in clinical governance, others report relatively little activity. Second, despite 8 in 10 members rating quality as a top board priority, few members regarded boards as influential players in determining it. Third, although members regarded their boards as having strong expertise in quality, there were signs of knowledge limitations, including: near consensus that (additional) training would be useful; unfamiliarity with key national quality documents; and overly optimistic beliefs about quality performance.

What are the implications for practitioners? There is scope to improve board expertise in clinical governance through tailored training programs. Better board reporting would help to address the concern of some board members that they are drowning in data yet thirsty for meaningful information. Finally, standardised frameworks for benchmarking internal quality data against external measures would help boards to assess the performance of their own health service and identify opportunities for improvement.


[1]  Rudd K, Swan W, Roxon N. A national health and hospitals network for Australia’s future. Canberra: Commonwealth of Australia; 2010.

[2]  Australian Commission on Safety and Quality in Health Care. Safety and quality improvement guide standard 1: governance for safety and quality in health service organisations. Sydney: ACSQHC; 2012. Availabl at http://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard1_Oct_2012_WEB1.pdf [verified March 2013]

[3]  National Quality Forum. Hospital governing boards and quality of care: a call to responsibility. Washington, DC: National Quality Forum; 2004.

[4]  Conway J. Getting boards on board: engaging governing boards in quality and safety. Jt Comm J Qual Patient Saf 2008; 34: 214–20.
| PubMed |

[5]  Braithwaite J, Travaglia JF. An overview of clinical governance policies, practices and initiatives. Aust Health Rev 2008; 32: 10–22.
CrossRef | PubMed |

[6]  Baker GR, Denis JL, Pomey MP, MacIntosh-Murray A. Designing effective governance for quality and safety in Canadian healthcare. Healthc Q 2010; 13: 38–45.
CrossRef | PubMed |

[7]  Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res 1997; 32: 491–510.
| CAS | PubMed |

[8]  Vaughn T, Koepke M, Kroch E, Lehrman W, Sinha S, Levey S. Engagement of leadership in quality improvement initiatives: executive quality improvement survey results. J Patient Saf 2006; 2: 2–9.

[9]  Jiang HJ, Lockee C, Bass K, Fraser I. Board oversight of quality: any differences in process of care and mortality? J Healthc Manag 2009; 54: 15–30.
| PubMed |

[10]  Joshi MS, Hines SC. Getting the board on board: engaging hospital boards in quality and patient safety. Jt Comm J Qual Patient Saf 2006; 32: 179–87.
| PubMed |

[11]  Jha A, Epstein A. Hospital governance and the quality of care. Health Aff 2010; 29: 182–7.
CrossRef |

[12]  Department of Health. Annual report 2011–2012. Melbourne: Department of Health; 2012. Available at http://docs.health.vic.gov.au/docs/doc/Department-of-Health-Annual-Report-2011-12 [verified September 2013]

[13]  R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2012.

[14]  Department of Health. Quality of care reports 2011–12 recommended reporting. Melbourne: Department of Health; 2012. Available at http://docs.health.vic.gov.au/docs/doc/27224D7FD4D839F3CA257A17000A28E8/$FILE/Quality%20of%20care%20reports%20-%20recommended%20reporting%202011-12.pdf [verified March 2013]

[15]  Department of Health. Victorian patient satisfaction monitor year 11 annual report July 2011 to June 2012. Melbourne: State Government of Victoria; 2012. Available at http://www.vpsm.com.au/dnld/VPSM%20Annual%20Report%202011-2012.pdf [verified March 2013]

[16]  Australian Council for Safety and Quality in Healthcare. Open disclosure standard: a national standard for open communication in public and private hospitals following an adverse event in healthcare. Canberra: ACSQHC; 2003. Available at http://www.safetyandquality.gov.au/our-work/open-disclosure/the-open-disclosure-standard/ [verified March 2013]

[17]  Australian Commission on Safety and Quality in Healthcare. Australian charter of healthcare rights. Sydney: ACSQHC; 2008. Available at http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Charter-PDf.pdf [verified March 2013]

[18]  Tregoning S. Hospital board structure: changing form and changing issues. Aust Health Rev 2000; 23: 28–37.
CrossRef | CAS | PubMed |

[19]  Eckerson W. Performance dashboards: measuring, monitoring and managing your business. New Jersey: John Wiley and Sons; 2011.

[20]  Walshe K. Understanding and learning from organisational failure. Qual Saf Health Care 2003; 12: 81–2.
CrossRef | CAS | PubMed |

[21]  Healy J, Braithwaite J. Designing safer health care through responsive regulation. Med J Aust 2006; 184: S56–9.
| PubMed |

[22]  The Health Roundtable. Annual report 2012. Terrigal, NSW: The Health Roundtable; 2012.

[23]  Cannell JJ. Nationally normed elementary achievement testing in America’s public schools. How all fifty states are above the national average. Educ Meas 1988; 7: 5–9.
CrossRef |

[24]  Svenson O. Are we all less risky and more skillful than our fellow drivers? Acta Psychol 1981; 47: 143–8.
CrossRef |

[25]  Margolin FS, Hawkins S, Alexander JA, Prybil L. Hospital governance: initial summary report of 2005 survey of CEOs and Board Chairs. Chicago: Health Research and Educational Trust; 2006.

[26]  Braithwaite J, Healy J, Dwan K. The governance of health safety and quality. Canberra: Australian Council for Safety and Quality in Health Care; 2005.

[27]  Davies HT, Nutley SM, Mannion R. Organisational culture and quality of health care. Qual Health Care 2000; 9: 111–9.
CrossRef | CAS | PubMed |


 Comment on this article

(required - never shown publicly)

*Comment field is limited to 1500 charactersCommenting Guidelines  
Notify me of new comments via email.
Notify me of replies via email.
Legal & Privacy | Contact Us | Help


© CSIRO 1996-2014