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Good Governance: From Board to Ward (By Sarah Monaghan)

By Sarah Monaghan

1st Year Management Intern

Healthcare organisations are often described as complex systems with multiple interconnected components. To achieve the safe and high quality care these organisations strive to achieve, the multiples facets of clinical care should intersect with business principles to ensure the effective operation of the organisation. As a result healthcare organisations must implement and comply with both clinical governance and corporate governance principles.

Clinical governance is considered a subset of corporate governance, however due to the significance of managing risk and quality of patient care, it is often reviewed as its own entity. Safer Care Victoria outlines five domains of clinical governance for healthcare organisations to use as a framework when implementing their own structure:

  • Leadership and culture
  • Consumer partnerships
  • Workforce
  • Risk management
  • Clinical practice

(Safer Care Victoria, 2017)

The flexibility for organisations to define and implement their own set of clinical governance from this framework allows the model to be influenced by an organisations objectives, strategic direction and patient cohort. Throughout the internship I have observed how clinical governance frameworks are defined and implemented in an organisation and how clinical care is monitored for quality and safety through these frameworks. Supplementing this with my clinical experience I have gained an understanding of how clinical activities are governed from the ward to executive level.

Conversely, corporate governance was a principle that I hadn’t come across in a healthcare setting. The aim of corporate governance within any organisation is to ensure adequate visibility, oversight and accountability of organisational leaders to promote consumer confidence in the quality of services provided. NSW Health outlines seven governance standards:

  • Establish robust governance and oversight frameworks
  • Ensure clinical responsibilities are clearly allocated and understood
  • Set the strategic direction for the organisation and its services
  • Monitor financial and service delivery performance
  • Maintain high standards of professional and ethical conduct
  • Involve stakeholders in decisions that affect them
  • Establish sound audit and risk management practices

(NWS Health, 2020)

In Victorian public hospitals the governing body, usually the board, is responsible for ensuring good corporate governance is upheld through actions such as implementing policies, ensuring appropriate risk management and mitigation strategies are in place and overseeing the actions of the management staff. The board also appoint the Chief Executive Officer for the organisation. The principles of corporate governance are then cascaded throughout the organisation and dictate practises in corporate areas including human resources, finance, legal, risk and quality. This also extends to clinical staff who also reliant on good corporate governance to guide and facilitate service delivery and meet the needs of patients. Throughout the internship I have gained an understanding of corporate governance and when engaging in clinical work have been able to see the local impact of particular business decisions. I’ve also gained an appreciation for the importance of adhering to corporate governance principles as without these the cadence of the organisation and ability to make appropriate decisions would significantly impact the clinical care that can be provided to patients. 

How can we maintain good clinical and corporate governance throughout healthcare organisations?

  • Developing and endorsing robust policies and procedures in place with appropriate oversight and regular review
  • Establishing effective monitoring systems for performance KPIs, financial KPIs and risk management (e.g. adverse events)
  • Involving key stakeholders in meetings and decision making, including consumers where appropriate
  • Identifying and working within delegation and clinical scope with clear reporting lines. Ensuring the frameworks exist for staff to understand and work within their delegation and scope to ensure the business can run effectively and that patients are receiving the best possible care from accredited professionals
  • Maintaining a competent workforce that is empowered to escalate risks and has access to the resource required to maintain safe and high quality care

References

Safer Care Victoria. (2017). Delivering high-quality healthcare. Victorian clinical governance framework.

NSW Health. (2020). Corporate Governance & Accountability Compendium.