Governance around quality of care at hospitals that disproportionately care for black patients

Abstract

Background: Hospital boards of directors can play a pivotal role in improving care, yet we know little about how the boards of hospitals that disproportionately serve minority patients engage in this issue.

Objectives: To examine how boards of directors at black-serving hospitals are engaged in quality of care issues and compare priorities and practices of black-serving and non-black-serving hospital boards.

Design: We identified all nonprofit U.S. hospitals in the top decile of proportion of elderly black patients ("black-serving") and surveyed their board chairpersons and a national sample of chairpersons from other nonprofit U.S. hospitals ("non-black-serving").

Participants: Board chairpersons of black-serving and non-black-serving U.S. hospitals.

Main measures: Board chairpersons' familiarity and expertise with quality of care issues, level of engagement with quality management, prioritization of quality issues, and efforts to improve quality or to reduce racial disparities in the quality of care.

Key results: We received responses from 79% of black-serving hospitals and 78% of non-black-serving hospitals. We found that board chairpersons from black-serving hospitals less often reported having at least moderate expertise in quality of care (68% versus 79%, P = 0.04) or rating it as one of the top two priorities for board oversight (48% versus 57%, P = 0.09) or for CEO performance evaluation (40% versus 50%, P = 0.05). Only 14.2% of board chairpersons from black-serving hospitals (and 7.7% of non-black-serving hospitals) agreed with the statement that disparities exist among my hospital patients, although less than 10% of all board chairpersons reported examining quality or patient satisfaction data stratified by race.

Conclusions: Board chairpersons of black-serving hospitals report less expertise with quality of care issues and are less likely to give high priority to these issues than board chairpersons of non-black-serving hospitals. Interventions to engage and educate board members in issues of quality and racial disparities may be needed to improve quality and reduce disparities in care.

Figure 1

Percentage of board chairpersons whoidentify quality of care as one of the top two priorities for board oversight or CEO performance evaluation. These results are adjusted for number of beds, hospital region, location (urban versus rural), teaching status, and ownership. P-value for the difference between top- and bottom-performing hospitals: P = 0.09 for comparison of board oversight; P = 0.05 for comparison of evaluation of CEO performance.