Abstract
A national agenda for health care quality is unfolding but there is concern about inadequate progress on improving quality in hospitals. The 2003 Institute of Medicine report calls for transformational leadership in health care organizations to change systems and processes underlying quality. The key question is: Who will provide leadership in hospitals? A natural choice is the board of trustees on account of its legal responsibility for quality and its authority over medical staff and administration. This article describes several barriers to board leadership on quality and suggests strategies by which boards can lead the campaign for quality. Barriers include trustee ignorance, trustee insecurity, board inattention, poor board-physician communication, fragmented information on quality, traditional medical staff structure, lack of professional management of quality, and lack of investment. Strategies for hospital board leadership should include preparing to lead, self-education, visible participation in quality activities, activism, role clarification, increased informal dialogue with physicians, medical staff reform, creation of a quality management department, instituting high-quality standards, and external quality audit. Boards face a historic opportunity to transform hospital quality backed by a strong legal mandate.