If you or a loved one is having a heart attack, your most pressing concerns probably include how quickly you can get to the hospital and the quality of care you’ll receive. You’re probably not thinking about the hospital’s board room, even though quality of care for heart attacks and many other conditions may be determined in large part by decisions made there.

Several studies show that hospital boards can improve quality and can make decisions associated with reduced mortality rates. But not all boards do so.

”Most board members are community leaders, serving on the board to support fund-raising goals,” said Ashish Jha, a Harvard physician. “They don’t think it’s their job to hold management accountable for performance. Board members often feel like clinical quality is physicians’ jobs, and they don’t want to step on doctors’ toes.”

The trouble with this perspective is that boards, and other hospital management, can influence care in ways that individual physicians cannot. They can promote protocols that ensure that crucial information is conveyed to the right people at the right time. They can establish systems so that equipment and supplies are available when needed. They can set expectations for a culture of high performance, not just from individuals but from teams of them that must work together. And they can require quality to be monitored against goals with incentives to push it toward those targets.