Healthcare executives knew the hospital's board was ultimately responsible for the quality of care provided. All that changed in 1999 when the Institute of Medicine (IOM) issued its landmark report. The IOM's report made it obvious that healthcare executives had to do more to ensure quality and patient safety in the US' hospitals. This is one reason why the American College of Healthcare Executives' Board of Governors approved a new Policy Statement. While the Policy Statement lists a number of steps healthcare executives can take to help ensure quality and patient safety in their organizations, the four listed are perhaps the most critical: 1. Equip the board. 2. Involve the executive leadership team. 3. Engage medical staff. 4. Listen to patients and their families.