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Health Aff (Millwood). 2015 Aug;34(8):1304-11. doi: 10.1377/hlthaff.2014.1282.

Hospital board and management practices are strongly related to hospital performance on clinical quality metrics.

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Thomas C. Tsai ( is a research associate in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a resident in the Department of Surgery at Brigham and Women's Hospital, both in Boston, Massachusetts.
Ashish K. Jha is the K.T. Li Professor of International Health in the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health.
Atul A. Gawande is the director of Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, in Boston.
Robert S. Huckman is the Albert J. Weatherhead III Professor of Business Administration at Harvard Business School, in Boston.
Nicholas Bloom is a professor of economics in the Department of Economics, at Stanford University, in California.
Raffaella Sadun is an associate professor of business administration at Harvard Business School.


National policies to improve health care quality have largely focused on clinical provider outcomes and, more recently, payment reform. Yet the association between hospital leadership and quality, although crucial to driving quality improvement, has not been explored in depth. We collected data from surveys of nationally representative groups of hospitals in the United States and England to examine the relationships among hospital boards, management practices of front-line managers, and the quality of care delivered. First, we found that hospitals with more effective management practices provided higher-quality care. Second, higher-rated hospital boards had superior performance by hospital management staff. Finally, we identified two signatures of high-performing hospital boards and management practice. Hospitals with boards that paid greater attention to clinical quality had management that better monitored quality performance. Similarly, we found that hospitals with boards that used clinical quality metrics more effectively had higher performance by hospital management staff on target setting and operations. These findings help increase understanding of the dynamics among boards, front-line management, and quality of care and could provide new targets for improving care delivery.


Hospitals; Organization and Delivery of Care; Quality Of Care

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