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Framework for Effective Board Governance of Health System Quality

The IHI Lucian Leape Institute’s research scan on board governance of health system quality, evaluation of governance education in quality, and expert interviews made it clear that board members, and those who support them, desire a clear and consistent framework to guide governance of all dimensions of quality beyond safety, including identification of the core processes and necessary activities for effective governance of quality.

This white paper includes:
Framework for Governance of Health System Quality: A clear, actionable framework for oversight of all the dimensions of quality.
Governance of Quality Assessment: A tool for trustees and health system leaders to evaluate and score current quality oversight processes and assess progress in improving board quality oversight over time. [*online tool also available]
Three Support Guides: Three central knowledge area support guides for governance of quality (Core Quality Knowledge, Core Improvement System Knowledge, and Board Culture and Commitment to Quality), which health system leaders and governance educators can use to advance their education for trustees.
The framework, assessment tool, and support guides strive to reduce variation in and clarify trustee responsibilities for quality oversight, and also provide practical tools for trustees and the health system leaders who support them to govern quality in a way that will deliver better care to patients and communities.

How to Cite This Paper: Daley Ullem E, Gandhi TK, Mate K, Whittington J, Renton M, Huebner J. Framework for Effective Board Governance of Health System Quality. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. (Available on


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