Focus areas for building effective Governance Systems for Healthcare Organisations

Introduction

HIQA often note that they believe that there is a clear link between good governance and better outcomes for service users. The former Chief Inspector of Social Services and Director of Regulation, Mary Dunnion, detailed that

“Regulation has shown that in order for any provider to deliver and sustain a good service there must be effective governance and management. The provider must have robust governance arrangements in place in order to ensure that a safe, quality service is being run” (HIQA, 2015).

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.

In this blog we discuss some of the governance failures identified in HCI’s Research Paper and provide some guidance on building effective governance systems for healthcare organisations.

Governance findings identified in HCI’s Research Paper

The key governance failings identified in HCI’s Research Paper that were central to the systematic failures that facilitated catastrophic patient outcomes include:

• Misdirected guidance of the governing body, for example focusing on financial issues and paying insufficient attention to the risk indicators in relation to the quality of service delivery.
• Having complex governance arrangements and a large number of committees involving the same members, many of whom also had full-time clinical responsibilities, leading to conflicting roles.
• Inexperience in governance whereby the Board did not reflect the diversity of knowledge, skills and competencies required to carry out the full range of oversight responsibilities.
• Lack of clear lines of accountability and responsibility, conflicting roles and inaccurate job descriptions.
• Poorly developed clinical governance, resulted in no formal oversight of safety or quality matters in clinical services.

Focus areas for building effective Governance Systems for Healthcare Organisations

The integration of corporate and clinical governance is recognised as being of the utmost importance for all health system changes (HSE, 2014). As a result, governance is central to all regulation frameworks, as reflected in ISQua’s Guidelines and Principles for the Development of Health and Social Care Standards, the function of which relate to implementing policy, setting targets or goals for the future through planning and budgeting for the organisation’s range of services, establishing processes for achieving those targets, allocating resources to accomplish those plans and ensuring that plans are achieved by organising, staffing, controlling and problem-solving (ISQua, 2015). To achieve this function effectively, the governing body must:

• Be appropriately structured: The governing body must be appointed in a formal, rigorous and transparent manner (NHS, 2014). The body must ensure that there are clear lines of accountability and responsibility at all levels, including individual, team and service levels, with overall executive accountability for the quality and safety of the services delivered clearly allocated (HIQA, 2012). Formal and rigorous evaluation of the body’s own performance must be completed on an ongoing basis (NHS, 2014).
• Be experienced: The governing body, and its committees, should have the appropriate balance of skills, experience, independence and knowledge of the organisation and the service provided to enable them to discharge their respective duties and responsibilities effectively (NHS, 2014). HIQA’s Safer Better Healthcare standards incorporate as a requirement the need for those involved in governance to have the skills and competencies necessary to provide effective assurance of high quality, safe and reliable healthcare (HIQA, 2012)
• Provide appropriate guidance: A well-governed service is clear about what it does, how it does it, and is accountable to its stakeholders (HIQA, 2012). The Body needs to be able to deliver prudent and effective leadership and effective oversight of the organisations operations to ensure it is operating in the best interests of patients (NHS, 2014).
• Be knowledgeable of both the needs of patients and the regulatory requirements: The governing body must strive to ensure that the care provided reflects the patient’s needs and is consistent and reflective of current, evidence based best practice, while adhering to the regulatory requirements of the sector.
• Have appropriate involvement in the service: This includes providing the required resources, understanding the organisational processes relating to the services provided, being actively supportive of the Quality and Safety Management Systems in place and understanding the outputs from each of these systems. All members of the workforce should be supported to exercise their personal and professional responsibility for the quality and safety of the services they are delivering. (HIQA, 2012).
• Monitor, evaluate and respond to data: Understanding the quality and safety of a healthcare service requires a comprehensive approach to collecting, analysing and discussing relevant data that is reflective of service indicators (HSE, 2014). The governing body must ensure appropriate action to taken to address the identified risks. This is further addressed in 9.4 Risk Management.
• Effectively communicate: The governing body must be accessible to all internal and external stakeholders, including patients, staff and regulatory authorities through an effective communication framework. The communication framework should ensure staff are kept informed about key decisions made at Board level, including any changes that may be forthcoming in the service, and work towards engagement with patients, families and the public (HIQA, 2016). An effective communication framework is central to supporting a culture of safety.
• Recognise inter-dependencies: Good governance arrangements acknowledge the inter-dependencies between organisational arrangements and clinical practice and integrate these to deliver high quality, safe and reliable care and support (HIQA, 2012). The review of the inquiries reflected that governance must illustrate a balance of skills across the sector to ensure it is can be truly considerate of the risks associated with the provision of care.
• Share and Learn: Sharing information and experiences among health service providers leads to and supports a learning environment (HSE, 2014). To support learning, HIQA specified that Irish healthcare settings need to take proactive steps in analysing previous reports, reviews and investigations and apply system wide learning to increase safety and benefits for patients (HIQA, 2016).

Conclusion

As mentioned, good governance often correlates to better outcomes for service users. Where Governance fails 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 systems, helping them to ensure effective oversight and improve the quality and safety of services.

If you would like support in reviewing your governance arrangements, HCI has the necessary expertise to. For more information contact HCI at 01 629 2559 or info@hci.care.

References

HIQA, 2015. Report of the investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise. [Online] Available at: https://www.hiqa.ie/sites/default/files/2017-01/Portlaoise-Investigation-Report.pdf

HSE, 2014. Report of the Quality and Safety Clinical governance Development Initative

ISQua, 2015. Guidelines and Principles for the Development of Health and Social Care Standards, 4th Edition Version 1.2,

NHS, 2014. The NHS Foundation Trust Code of Governance

HIQA, 2012. National Standards for Safer Better Healthcare

HIQA, 2016. Review of progress made at the Midland Regional Hospital, Portlaoise, in implementing recommendations followings HIQA’s investigations. [Online] Available at: https://www.hiqa.ie/sites/default/files/2017-02/MRHP_Review_Report.pdf

Download the Research Paper