Boards of trustees need to develop the understanding that quality and patient safety are a primary fiduciary responsibility. In addition to being an ethical imperative, quality of care and patient safety can have significant financial impact on an organization, from claims and lawsuits to the effects of pay-for-performance programs.
At Johns Hopkins Medicine, trustees started by asking the really tough questions, such as: “How many people did we harm here last month?” Engaging in these conversations will send a clear signal throughout the organization that the board is committed to patient safety. It has become well-accepted that board meetings begin with a discussion on quality and patient safety, with as much time spent on this as on financial discussions.
Without physician buy-in, patient safety efforts often fall flat. 
Hospital leaders must model the behavior they want staff to adopt for patient safety, says the Center’s executive director. 
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