Chapter 7. Governance

Governance involves setting direction, making policy and strategy decisions, overseeing and monitoring organizational performance, and ensuring overall accountability for a coalition. Effective governance is about making informed organizational policy choices, such as defining the coalition's mission and goals, determining how to achieve these objectives, defining what resources are necessary and how best to secure them, and determining how to measure the coalition's overall impact.

The governing board is composed of members from the various organizations participating in the coalition. It is important, therefore, that board members be committed to making unbiased decisions that represent broad constituent interests rather than the interests of their respective organizations. It is also important to be aware of potential conflicts of interest that board members may have. Such conflicts not only can create legal liabilities but also can damage public perception and disrupt trust among participants. As with all aspects of a regional coalition, transparency and collaborative processes are essential to governing a broad-based group of constituencies.

Although characterized by unique variations, the governing structures of each Better Quality Information site share common elements, such as an executive board or board of directors and assemblies. Additionally, each has subcommittees or workgroups that focus on specific issues like finance and development and make recommendations to the larger board for action.

A brief description of two basic components of coalition governance structures follows.

Executive Committee or Board of Directors

The executive committee or board of directors is the coalition's main leadership group responsible and accountable for its conduct and performance. This governance structure typically establishes policies and directs the growth of the coalition. Therefore, equal representation from key stakeholder groups, such health plans, provider organizations, government agencies, consumer representatives, and employers, is important.

Generally, representatives are expected to represent the interests of their stakeholder groups, not those of the individuals' particular organizations.

Assemblies

Within the governance structure, the Better Quality Information sites also have created group meetings in addition to the executive committee or board of directors.

The Wisconsin Collaborative for Healthcare Quality's board of directors, for example, is responsible for furthering the work of the coalition's Collaborative Assembly, which is primarily composed of chief executive officers, chief medical officers, and senior quality executives from each member institution. The assembly meets in Madison, Wisconsin, once a month for 10 months of the year.

The Center for Health Information and Research has regular data partner meetings for entities who contribute data to the Arizona HealthQuery data system the center houses. The meetings bring together all the data partners to discuss current and future initiatives. Because of the voluntary nature of the coalition, one goal of the data partner meetings is relationship building, but these meetings also help to shape the direction of the coalition. Additionally, the center has an advisory committee to provide guidance in strategic planning efforts for the research center.

Massachusetts Health Quality Partners has established a Physicians Council so that, in addition to input from the Massachusetts Medical Society, the coalition also includes the perspective of the physician leaders of many of the physician organizations in the State. In addition to selecting representatives to participate on the coalition's board, the Physicians Council advises the Massachusetts Health Quality Partners on all aspects of its performance measurement and reporting agenda. The council meets quarterly and presents physician recommendations afterward at the board of directors meeting.

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