Governance practices and performance in US academic medical centers

Recognition of the complex nature of modern health care delivery has led to interest in investigating the ways in which various factors, including governance structures and practices, influence health care quality. In this study, the chief executive officers (CEOs) of US academic medical centers were surveyed to elicit their perceptions of board structures, activities, and attitudes reflecting 6 widely identified governance best practices; the relationship between use of these practices and organizational performance, based on the University HealthSystem Consortium's Quality & Accountability rankings, was assessed. High-performing hospitals showed greater use of all 6 practices, but the strongest evidence supported a focus on board member education and development, the rigorous use of performance measures to guide quality improvement, and systematic board self-assessment processes. All hospitals, even those with the highest quality ratings, had major gaps in their use of best practices for CEO and board assessments. These findings can serve as the basis for developing sound board improvement plans.