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Case study

Effective board governance is the key to supercharging quality and safety across the health system

Tom Bates, Amy A. Ross, Gerald B. Hickson and Ling Zheng
Management in Healthcare: A Peer-Reviewed Journal, 10 (1), 6-19 (2025)
https://doi.org/10.69554/GCUG7875

Abstract

Governing boards are key to effectively supporting quality and safety in health systems. A health system’s governing body is ultimately responsible for the quality and safety of care provided in an organisation.1–3 As healthcare systems grow, board governance at the system level, especially as it concerns quality and safety, needs to be routinely evaluated for effectiveness and continuous alignment with the organisation’s values. Boards should be committed to structural innovations and adaptability to ensure they are continually fulfilling their mission of quality and safety oversight on behalf of the patients they serve. In 2019, Keck Medicine of USC created a new health system board governance model. While the process for establishing the new model was relatively straightforward, identifying, implementing and ensuring effective health system governance is a journey of continuous improvement. The new model has resulted in a prioritised ‘voice of the patient’, board members who are dedicated to continuously improving quality and safety, identification of essential processes to oversee key dimensions of quality and safety, creation and effective use of a quality and safety dashboard to drive plans of correction, support for everincreasing performance improvement, discovery and management of internal and external challenges, removal of barriers to effective board governance, promotion of board member alignment and commitment, and routine and deliberative evaluation of board governance effectiveness and the need for ongoing education. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.

Keywords: board governance; quality; governance; systems thinking; culture of quality and safety; quality dashboard; education; professionalism

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Author's Biography

Tom Bates Tom is currently the Chief Quality Officer for Keck Medicine of the University of Southern California (USC), a multi-hospital integrated health system that frequently cares for the sickest patients in the USA. In this capacity, he is a highly visible champion responsible for ensuring transformative robustness and excellence in the approach to quality, safety and clinical effectiveness. He is an expert in Root Cause Analyses and implementing safety solutions in matrixed, highly complex environments. He is a certified trainer in Just Culture and TeamStepps. He is a co-creator of an integrated programme that teaches faculty and staff how to continuously improve using lean and quality improvement principles. He has worked in healthcare for more than 25 years, and in that capacity, has served as a VP of Patient Care Services, Chief Nursing Officer and in various nursing management roles. He has worked as a registered nurse in a variety of care settings, including paediatrics, med-surg, telemetry and in the emergency room (ER) and intensive care unit (ICU). He is a CCRN alumnus and holds certifications in healthcare quality, healthcare risk management and legal nurse consulting. He is married with a son and daughter and loves travelling, visiting national parks, fishing and using humour to create joy in work.

Amy A. Ross received her PhD in Experimental Pathology in 1986 from the Keck School of Medicine at University of Southern California. She worked in the cancer diagnostics field for over 25 years. Her research focused on the detection of low numbers of tumour cells in the circulation of cancer patients as a means of targeting early relapse. She served as Vice President of Scientific Affairs at Nexell Therapeutics in Irvine, CA. She was elected to the USC Board of Trustees in 2015 and to the USC Health Systems Board in 2021. She was named vice chair in 2023. In her board capacity, she focuses on quality, safety and audit compliance issues. She is chair of the University of Southern California Health System Board Quality and Safety Committee. She also serves as a Director on the USC Arcadia Hospital Board and serves on the Performance Improvement Committee.

Gerald B. Hickson is the Joseph C. Ross Chair of Medical Education and Administration, Professor of Paediatrics and Founding Director of the CPPA at Vanderbilt University Medical Center. He joined the Department of Pediatrics at Vanderbilt in 1982. In 2003, he founded CPPA and from 2005 to 2020 he served as Director of Clinical Risk and Loss Prevention and from 2013 to 2020 as Senior Vice President of Quality, Safety and Risk Prevention. His research has focused on why families file suits, why a small subset of physicians by specialty attract a disproportionate share of claims, how disrespect affects team performance and outcomes of care and how to identify and intervene with high-risk clinical team members. His work has resulted in over 200 peer-reviewed articles, chapters, invited commentaries and podcasts. Under his direction, the CPPA developed PARS (Patient Advocacy Reporting System) and CORSsm (Coworker Observation Reporting System) programmes that use unsolicited patient and coworker observations as the basis for tiered interventions on high-risk clinicians. The PARS and CORSsm programmes have been implemented in over 300+ hospitals and health systems internationally. He serves as Chair of the Board of Directors of the Institute for Healthcare Improvement (IHI). He also serves on the Board of Directors of Keck (USC) Health System. Previously he served as Chair of the Board of Directors of the National Patient Safety Foundation (NPSF). He received a BS from the University of Georgia and an MD from Tulane University School of Medicine.

Ling Zheng , PhD, CPHQ, ACHE, leads the strategic integration of data-driven insights to enhance patient care, operational efficiency and clinical outcomes at Keck Medical Center of USC. With expertise in epidemiology, healthcare informatics and data science, she has a proven track record in systemwide quality dashboard design, strategic planning, performance improvement and professional practice evaluation in complex academic medical environments. She collaborates with clinical leadership, IT, quality improvement and financial teams to transform data into actionable intelligence. By developing robust analytics frameworks, she ensures high-quality data drives improvement initiatives, population health strategies and regulatory compliance. Under her leadership, the Clinical Informatics and Analytics team has implemented innovative dashboards, risk stratification models and data-driven interventions that have measurably improved patient safety, operational efficiency and health equity. Before joining Keck Medicine in 2017, she spent seven years in leadership roles at Los Angeles General Medical Center, a world-class teaching hospital and Level One trauma centre serving over 10 million residents. There, she spearheaded large-scale data initiatives, optimised clinical workflows and advanced value-based care strategies. She holds a Doctor of Epidemiology degree from the Keck School of Medicine at USC. A dedicated researcher, she has contributed to peerreviewed studies at the intersection of data science and clinical practice. Passionate about fostering a data-driven culture, she is committed to empowering clinicians, researchers and administrators with meaningful insights that drive transformative improvements in patient care and institutional excellence.

Citation

Bates, Tom, Ross, Amy A., Hickson, Gerald B. and Zheng, Ling (2025, September 1). Effective board governance is the key to supercharging quality and safety across the health system. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 10, Issue 1. https://doi.org/10.69554/GCUG7875.

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cover image, Management in Healthcare: A Peer-Reviewed Journal
Management in Healthcare: A Peer-Reviewed Journal
Volume 10 / Issue 1
© Henry Stewart
Publications LLP

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