Center for Healthcare Governance - Monographs

The New Age of Accountability: Board Education and Certification, Peer Review, Director Credentialing and Quality

Overview:

There has been a palpable shift in the public’s attitude about and expectations for health care. More than ever, health care consumers want safe, quality, affordable health care, delivered by competent, caring health care professionals; they want hospitals and health systems to be managed with efficiency and governed with integrity—and nothing less. We are in a time that “is marked by both a greater appreciation of the importance of governance and by forces that are constantly raising the bar on board responsibilities and best practice standards.” Welcome to a new era in health care: the age of accountability.

The public outcry for accountability has by no means fallen on deaf ears. Most non-profit hospitals in this post Sarbanes-Oxley era seem to have taken some steps to improve their governance practices.3 In this expanding universe of developing and often disparate health care governance practices, there appears to be a constellation of four consistent, emerging trends that aim to increase board accountability, namely: board education and certification, peer review, director credentialing and quality.

The most obvious example of these emerging trends is the advent of hospital board and director certification programs. Various state hospital associations have begun to develop and implement these programs. In 2007, there were two such programs. By 2010, there are twelve.

Boards are also beginning to explore various forms of “director peer review” to enhance their individual and collective performance. As the challenges of hospital and health system governance increase, boards are beginning to look to new tools, like “director credentialing” to evaluate not only the skill sets and effectiveness of directors, but also to implement important functions such as board recruitment and succession planning. Finally, hospitals and health systems continue to move the quality agenda into the boardroom as they engage in serious discussions on accountability—better ways to track, measure, monitor and improve quality.

This monograph will evaluate each of these four emerging governance activities. It will begin with director education, and explore such developments as board and director certification, pay for governance (P4G), and the New Jersey mandate for governance education. It will then turn to peer review and continue with a discussion of director credentialing, before examining the ever-expanding role of hospital boards and directors in quality of care.

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