Hospital leadership can play a critical role in improving safety and quality, as highlighted in a 2009 Joint Commission sentinel event alert. A prior review found that the governance boards of high-performing hospitals had greater engagement in safety activities compared to low-performing hospitals. However, the mechanisms by which hospital management can improve safety and quality remain undefined. This study, which used survey data from a large sample of hospitals in the United States and England, advances knowledge in this area by defining the key characteristics of management and boards at high-performing hospitals. The investigators found that compared to hospitals that scored poorly on quality metrics, high-performing hospital boards paid more attention to quality and explicitly used quality metrics to assess management performance. In addition, high-performing hospitals used more effective management practices, i.e., they consistently set quality targets and had a greater focus on hospital operations. Hospitals with high management scores were also more likely to be teaching institutions. As many hospital boards still do not prioritize patient safety, these results help identify management practices that could be implemented to help improve safety and quality at the hospital level. One health system's approach to leadership emphasis on quality and safety is discussed in a past AHRQ WebM&M perspective.