Clear Lines of Authority Help Power Health Care Excellence

Blurred roles and responsibilities are among the obstacles that can impede a hospital or health care organization’s path to improvement, said Elizabeth Mort, M.D., vice president and chief medical officer at The Joint Commission.

Speaking on May 4 at the American Hospital Association’s 2025 Annual Membership Meeting in Washington, D.C., Mort’s presentation, “Driving Performance Excellence Through Strategic Board and CEO Leadership,” stressed that CEO and board alignment is crucial for achieving performance improvement in health care.

While every provider strives to consistently deliver top quality care to all patients, Mort noted that “the difference between high-performing organizations and really high performing organizations” is management’s approach to how things get done.

“Even the best hospitals have blind spots, and even the best hospitals could potentially have a preventable adverse event the next day,” she said. “It’s not enough to be a 5-star, or top tier in US News [& World Report], because while that tells you something, it doesn't tell the whole picture, so how do you know how you're doing?”

The bottom-line issue, Mort proposed, is settling on who is responsible for quality and safety. While every health team member has a role to play, the ultimate lines of responsibility must converge in a way that is clear and drives performance improvement. It is the job of the CEO and the board to map out the structure, whether the responsibility falls to the chief quality officer, chief nursing officer, chief medical officer or someone else.

Whatever the job title, “they should be the ones working with you to figure out what you should be doing, to help you prioritize all the data,” Mort advised. “It's really important that you sit as a CEO and look at all your folks. And ask yourself, how are we organizing for performance excellence?”

As she wryly observed about overlapping roles and responsibilities, “The best way to starve a dog is to ask two people to feed it.”

Mort focused on how boards and CEOs can elevate the importance of operations and paying close attention to quality and safety issues. She cited a 2018 study of 11 highly ranked Massachusetts hospitals that found adverse events were identified in about 25% of patients — most common were related to adverse drug events — and of those, about 25% were preventable.

“There are a lot of adverse events that are happening in your organizations that we're not putting on all those dashboards,” Mort warned, advising CEOs and board members to think carefully about investing in ways to better capture revealing metrics that may otherwise be inadvertently overlooked.

Mort, who previously served as chief quality officer for Massachusetts General Hospital, reminded her audience of senior health care leaders representing care providers nationwide that there is a lot of opportunity for reducing preventable patient harm.

“I think the biggest job we all have is how to prioritize it, fund it. Push it out there, measure it.”

She also touched on the Patient Safety Structural Measure, an attestation-based gauge used by the Centers for Medicare & Medicaid Services to assess whether hospitals demonstrate a structure and culture that prioritize patient safety by implementing 25 proven strategies and prevention practices, rather than relying solely on outcomes like infections or falls. The regulation became effective on Aug. 1, 2024, and the first scores will be reported in the fall of 2026.

“I think this will give you all an opportunity to have some discussions about what you're doing and how you can improve the workforce. It’s really, really important,” Mort said.

Hospitals and health systems are showing improvements in ambulatory care and in chronic and preventive care. Mort suggested boards and CEOs can spread the progress across more service lines by streamlining their internal organization to ensure that responsibility for quality and safety is not scattered among too many leaders.

In closing, she shared with her audience a favorite quote from tennis legend Arthur Ashe:

“You’re in different settings. You all have different resources, you all have different communities. But start where you are.”