The rapidly increasing demand for health care in the province of Ontario has led to greater numbers of patients turning to Emergency Departments of public hospitals for the care they need. Management quality of Emergency Departments measured by patient outcomes is likely symptomatic of management quality of the hospital and ultimately that of the hospital board. This study is a first to our knowledge in connecting the management quality with board composition of hospitals. Performance was assessed by ascertaining which activities were present then the performance of those activities, in terms of patient outcomes, was assessed. Data was collected from the Ministry of Health of Ontario reporting all 109 hospitals over 3 years and from the histories of board members. The effect of activities on patient outcomes was evaluated with activities having a positive effect on patient outcomes classified as critical activities. Performance of critical activities was compared with board composition and skills. 3 links were found between boards and performance, boards with members having operational turnaround skill competencies had superior performance, boards with entrepreneurs and medical staff had a positive effect, and boards with politicians had a negative impact on performance. Therefore boards of hospitals in Ontario should be constructed so that members can provide superior governance leading to better patient outcomes. This study revealed both activities which had no or negative impact and the absence of proven best practice activities. This is an issue of quality of management as board competency can be assessed by activity presence and the performance of those activities.
