7 Key Focus Areas for a Governance Review

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Effective governance is central to all health and social care services. The role of Governance lies with the most senior entity of the organisation, eg Board of Directors or Registered Provider. They are the person or entity who have ultimate responsibility for the delivery of services. They must set the strategy, lead the organisation and oversee its performance.

At its core, good Governance means that a service is well managed. Where good governance is present, there will be better outcomes for patients. If there are problems within the service that are not being picked up on or acted upon appropriately and in a timely manner, then this is an indication that there may be problems with Governance.

In HCI’s Research Paper The Healthcare System: Will We Ever Learn? Review of the common themes arising from UK and Ireland healthcare inquiries, HCI found that throughout the inquires reviewed, Governance, or lack thereof, was identified as being central to systematic failures that facilitated catastrophic patient outcomes. It is important for organisations to determine the effectiveness and sustainability of the governance and oversight arrangements within their service. Conducting an independent governance review is a good way to assess the governance arrangements within the service and determine the overall quality and safety of the service.

In this blog we outline the key governance areas to consider reviewing as part of a Governance review.

Key Governance areas for review

  1. Organisational Structure: The organisational structure is the first thing to examine. Determine if the structures that are needed for good governance are in place and functioning effectively. Identify if there is an organisational chart that clearly shows the lines of accountability and the entity with ultimate accountability for the service.
  2. Communication Structure: An effective communication structure is central to supporting a culture of safety. As part of the governance review, identify if the organisation has a clear communication structure, so that staff are kept informed about key decisions, know who to go to for support and are aware who to raise issues with. Identify if there is a Teams and Committees chart and Terms of References. Every staff member should have a committee to go to.
  3. Organisational Culture: Does the organisation have an open and learning culture? Are incidents being reported and acted upon and learnings being communicated back to staff? Does the organisation conduct a Staff Survey on Patient Safety Culture?
  4. Quality and Safety Data: Assess if the governing body is collecting, analysing reviewing appropriate quality and safety data on a regular basis. Do they review audit report findings, KPIs, inspection reports? Determine if actions are being taken and followed up on to address any issues identified.
  5. Continuous Improvement and Lessons Learnt: Reviewing and analysing data such as incident data, complaints, audit reports findings and inspections reports is hugely important for identifying learnings. It is also crucial for the governance body to communicate the lessons learnt with staff to support a learning environment and to drive quality improvement.
  6. Risk Management: Risk management is a key element of good governance and underpins an organisation’s ability to provide safe and effective care and support to people who use health and social care services. Review the risk management process for the organisation, how are risks identified, communicated and managed? Are the risks being reviewed by senior management on a regular basis? Are actions being taken to mitigate risks?
  7. Strategy: The governing body must set the strategic objectives and operational plan for the organisation. They must have awareness of environmental changes such as change in policy or new regulations. Review the Strategic Plan and identify who developed it, is it focused on the needs of the patients / service users and how is it being monitored.


It is crucial for organisations to regularly review the effectiveness of the governing body. Where governance is failing, it can have severe consequences for service users.

At HCI we help providers of health and social care make intelligence driven decisions to attain, manage and improve quality, safety and regulatory compliance. We have almost two decades experience in supporting health and social care organisations in building robust governance arrangements, helping them to ensure effective oversight and improve the quality and safety of services.

Download the Research Paper


The Healthcare System – Will We Ever Learn?

A review of the common themes arising from UK and Ireland Healthcare Inquiries.

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