To what degree is the governance of Dutch hospitals orientated towards quality in care? Does this really affect performance?

INTRODUCTION: Changing health care systems and market competition requires hospital boards to shift their focus towards a systematic governance of the quality of care. The objective of our study was to describe hospital governance and the quality orientation in the Netherlands. Also we wished to investigate the relationship with hospital performance. MATERIALS AND METHODS: The chairs of both the boards of trustees and the management boards from all 97 Dutch hospitals were asked to participate in a cross-sectional study between November 2010 and February 2011. In this period data on their quality orientation were collected using a web-based survey. Data on hospital performance over the year 2010 were obtained in July 2011. RESULTS: A mixture of reforms and national guidelines increased the emphasis on quality governance in Dutch hospitals. Our results show that boards of trustees and management boards had a reasonable quality orientation. Boards were familiar with quality guidelines, received a reasonable amount of information related to quality and used this for monitoring quality and policy-making. However, we found no association between their quality orientation and hospital performance. CONCLUSION: There was a growing awareness of the quality of care among boards of trustees and management boards; yet some boards still lagged behind. Quality orientation is an important asset because receiving, reviewing and responding to the quality of their performance should provide opportunities to improve quality. However, we were not able to find a relationship between quality orientation and hospital performance. Future research should investigate how boards can develop quality management systems which in turn could enable medical professionals to optimise their delivery of care and thus its quality.