How do NHS Hospital boards govern for quality improvement?

North Thames
Published Date: 13 Jul 2017

As part of an evaluation of a board-level quality improvement (QI) intervention CLAHRC researchers compared board approaches to governing for QI, mapping characteristics of boards with higher levels of QI maturity.


Health systems world-wide increasingly hold boards of health care organisations accountable for quality of care they provide. Associations between board practices and the quality of patient care are well-known; however little is known about how boards govern for quality improvement.


We conducted fieldwork over 30 months in 15 English healthcare provider organisations - interviewing board members, observing meetings and scrutinising papers and documents.
We analysed the data using a QI maturity framework developed from existing evidence of links between board practices and quality of care.
The framework (Fig 1) helped us to understand how healthcare organisation boards enact governance of QI.

We mapped variation in how boards did this and constructed a measure of QI governance maturity.


  • Explicitly prioritizing QI
  • Balancing short term (external) priorities with long term (internal) investment in QI
  • Using data for QI, not just quality assurance
  • Engaging staff and patients in QI
  • Encouraging a culture of continuous improvement

Clinical leaders appeared to play an important role is enabling these characteristics