Guidelines for informing the media after an adverse event

The Canadian Patient Safety Institute has published guidelines for informing the media after an adverse event. Cursory inspection of the guidelines by Healthcare Governance Review suggests that the guidelines are good and entirely applicable to the UK.

Download the Guidelines for informing the media after an adverse event here.

ACKNOWLEDGMENT – Thanks to Datix Ltd. for bringing this to our attention through their Twitter site www.twitter.com/datixltd

Free Excel Care Quality Commission standards compliance templates

For those of you whose organisation is required to comply with the Care Quality Commission’s (CQC) Essential Standards of Quality and Safety you may find the attached Microsoft Excel(TM) template of interest.

The template allows you to self assess against each of the ‘prompts’ associated with the 28 ‘outcomes’ set by the CQC and provides scoring mechanisms to track your compliance.

The template also allows you to log details of evidence and also actions. In relation to actions to comply with CQC standards, there is also a neat little ‘actions status’ tool that monitors whether actions have been completed, are late, have been aborted or are not yet due.

Four versions of the template are attached – two for Excel 2003 and two for Excel 2007. For each of the two Excel versions there is a ‘demo’ template that provides an insight into the functionality of the tool and there is a ‘fresh’ copy of the template that you can put to immediate use within your organisation.

Please report any problems with using any of these templates to stuart@healthcaregovernance.co.uk

Download the templates by clicking on the links below:

CQC_V1.1_2003_demo

CQC_V1.1_2003

CQC_V1.1_2007_demo

CQC_V1.1_2007

Effective Governance Models for GP Commissioning Consortia

The Health Service Journal (12 August 2010) contains a short article by Adrienne Fresko and Sue Rubenstein (authors of ‘The Healthy NHS Board: Principles for Good Governance‘) on GP governance.

The article starts by asking “How will GP consortia be held accountable for their commissioning activities?” and ends by suggesting that “Developing a spectrum of models to support and inform local GPs and their partners could help to produce local arrangements reflecting the kind of robust governance arrangements that – in the words of The Healthy NHS Board – will give us all “confidence that health and healthcare are safe in their hands.”

Read the full HSJ article here (registration may be required).

Meanwhile, a project has been initiated by the National Leadership Council (NLC), and is supported by the Department of Health. The aim is to generate a spectrum of governance models to inform GPs as they develop local arrangements. To facilitate this, the NLC have asked Foresight Partnership, supported by King’s Patient Safety and Service Quality Research Centre, to look at ways in which these principles of good governance might apply and be adapted to GP Commissioning arrangements.

For the opportunity to contribute to the debate about how to ensure robust governance for GP Commissioning Consortia please join Foresight Partnership’s new Governing GP Commissioning discussion forum.

Leadership needs of medical directors and clinical directors

According to the Kings Fund, the National Health Service (NHS) is facing one of the toughest financial periods of its history during which it will need to maintain the quality of care. Clinical leadership will be critical as the service faces this challenge.

The King’s Fund has a wealth of experience in developing the skills of leaders in the NHS, and is constantly adjusting its approach to meet the needs of those leaders. With this in mind, they conducted a survey of clinical and medical directors to find out what skills they believed they need to face these challenging times.

Leadership needs of medical directors and clinical directors includes the following findings.

• Both medical and clinical directors embrace the quality agenda articulated by Lord Darzi in High Quality Care for All (Darzi 2008), and are committed to preserving it.
• Both medical and clinical directors are eager to work with their managerial colleagues as equal partners to maintain clinical quality, ensure patient safety and improve patients’ experience in the face of reduced resources. They see an urgent need for clinicians and managers to share a single mindset on maintaining quality efficiently.
• Clinical directors believe that they are largely cut off from the decision-making and planning processes, and view this as a critical challenge that must be overcome.
• Clinical directors and medical directors have high levels of confidence in their influencing, negotiation and communication leadership skills, and in their ability to use resources to maintain the quality of care.

The publication Leadership needs of medical directors and clinical directors can be freely downloaded here.

CEO ‘unfairly sacked for whistleblowing’ wins £1.2m compensation

According to the Daily Mail, John Watkinson, ex-CEO of Royal Cornwall Hospital NHS trust, has won compensation for being unfairly sacked over his determination to lobby against plans for specialist upper gastrointestinal cancer services to move out of Cornwall to neighbouring Devon.

An employment tribunal found he was sacked as CEO because he was about to blow the whistle and was highly critical of the trust and the Strategic Health Authority.

Mr Wilkinson is reported as saying that the who issue “has revealed a bullying culture  and readiness to ride roughshod over public concerns [in the NHS in the South West].”

For further information, read the Daily Mail article here and a previous Healthcare Governance Review post here.

Quality of Board Governance in Nonprofit Healthcare Organizations in the USA

Readers may be interested in the following freely available article from The Internet Journal of Healthcare Administration – a US-based peer reviewed electronic journal.

The article, by Alla O. Adams MSPH, MSHA, Ph.D. Candidate at the School of Human Services Capella University and published in 2005, is titled Quality of Board Governance in Nonprofit Healthcare Organizations.

According to the Abstract, “The quality of board governance has become a life-saving necessity to healthcare organizations. This article raises a number of issues regarding the quality of board governance in nonprofit healthcare organizations. These include effectiveness of board governance linked to organizational performance, board accountability to communities served, how to be an effective chairman, how board self-assessment changes the governance process, developing effective information systems in ways that respect the governance roles and responsibilities, policy formulation regarding finance matters and quality of care, and the red flags of poor governance. Finally, this article discusses the essential factor contributing to the board: executive relationship.”

Read the full article here.

The Kings Fund on ‘Putting Quality First in the Boardroom’

Here at Healthcare Governance Review we obviously missed publication, in April this year, of an excellent Kings Fund document on quality and patient safety in the boardroom.

In 2009, The King’s Fund and the Burdett Trust for Nursing set out to ‘bring the ward to the board’, emphasising the role of the nurse executive in ensuring that boards are as fully engaged with the clinical quality agenda as they are with financial performance. As leaders of the largest part of the NHS workforce, nurse executives have considerable power to influence the patient experience and the ability to provide an understanding of the standard of clinical care delivered by a trust.

Building on the findings of From Ward to Board, the publication produced after the first phase of work in 2009, Putting quality first in the boardroom is based on observations of nurse executives and their boards at six NHS trusts. The report starts by examining what is meant by the term ‘clinical quality’ and why it has the potential to be marginalised in the boardroom. It goes on to consider the dynamics of the boardroom and the role of the nurse executive.

The main observations of the report relate to board members’ behaviour and attitudes to the question of discussing and improving clinical quality. To focus effectively on the business of caring, board members need to ensure that they have the time and training to develop their understanding of the issues around quality assurance and improvement. Nurse executives also need to move from their traditional role of ‘doing’ to one of enabling others. Successful nurse executives are skilled facilitators who know when to intervene; they have a key role in engaging frontline clinicians in the boardroom task of measuring and assuring the quality of care.

In drawing together the findings, the authors suggest the following ten action points for boards to ensure that they engage more effectively with the quality agenda.

1. Set the context for engaging in quality – be clear about what it means for your organisation, define its relevance to different aspects of the business, and be prepared for the fact that engaging with quality may at times be an uncomfortable experience.
2. Shape the culture and tone of your organisation so that clinical quality becomes the top priority – the board needs to adopt the right behaviours and leadership style,
and communicate the value it places on quality to managers and staff, patients
and families.
3. Develop a strategy for quality improvement  or, at the very least, make explicit commitments in relation to quality.
4. Have a dedicated quality sub-committee of the board to oversee quality assessment, quality improvement and quality assurance, and to provide assurances to the board that these tasks are being fulfilled effectively.
5. Pay attention to dynamic administration, including the length of meetings, the volume of papers, and appropriate breaks. If the basics are not right, the board will not be in a position to give its full attention to quality.
6. Review the use of sub-committees and ensure that the correct breadth and depth of information regularly reaches the board.
7. Put quality at the top of the agenda for board meetings and devote at least 25 per cent of time to discussing quality issues.
8. Draw on a mix of both qualitative and quantitative data to form a rich picture of the quality of care being provided by your organisation, including using patient stories and information from ward ‘walkabouts’.
9. Make good use of clinical executives on the board and clinical leaders throughout the organisation to drive the quality agenda.
10. Develop the board’s capability to understand and promote quality improvement – non-executives in particular may need support to do this, but also executive directors who do not have a clinical background. This may require building knowledge and skills in quality improvement approaches, quality assurance systems and skilling up in data analysis.

Download Putting Quality First in the Boardroom here.

New Centre for Governance at the University of Greenwich

Sir David Walker, author of the Walker review of corporate governance in UK banks, has launched the new Centre for Governance, Risk and Accountability at the University of Greenwich.

The centre will specialise in risk management and modelling, corporate governance and compliance, and corporate social responsibility and is intended to be “a focus of excellence to create a virtuous circle of learning and enterprise between industry, the public sector and academia.”

In his launch speech, Sir David had a particular message for boards in terms of their involvement in formulating strategy, He said “As I see it, the chief executive should be at the beginning and end of the [strategy development] process. It is for the executive to launch a strategic proposition; to be followed by challenge and rigorous review in board discussion leading on to a board conclusion on the course to be followed; and then, at the end of the process, full empowerment of the chief executive to implement the agreed strategy.”

Further details on the new centre, together with a copy of Sir David’s launch speech, can be found here.

Distinguishing governance from management – a view from the USA

Barry S Bader, a distinguished board governance consultant in the United States, has a great website on boards and writes on various board matters.

Barry has published a paper providing his views on the differences between governance and management.

Here at Healthcare Governance Review, we are constantly concerned about the fact that the National Health Service by and large does not seem to understand the difference. To many NHS organisations, ‘governance’ is the new term for ‘management’ and you’ll find many organisations with a ‘head of governance’ and a ‘governance department.’

Barry states that “What is the difference between governance and management?” is by far the question that not-for-profit executives and directors ask most often. He further says that “Effective boards understand the difference between governing and managing; dysfunctional boards do not.”

In his paper he sets out his views on board and management roles and provides a useful ‘Seven guiding questions’ to help boards and managers differentiate between governance and management.

Barry’s paper Distinguishing Governance from Management can be freely downloaded on his ‘Great Boards’ website here.

Loughborough University Postgraduate Programme in Healthcare Governance – Next intake October 2010

This well established and popular part-time postgraduate programme in healthcare governance, run by Loughborough University Business School, will take its next intake in October 2010.

The programme accepts anyone interested in healthcare governance and with suitable qualifications and/or experience to undertake postgraduate level study. It is not always a necessity to have a first degree.

Students can study for a postgraduate certificate, postgraduate diploma or Master of Science (MSc) degree in healthcare governance. The full MSc degree takes a minimum of 2 years by part-time study and includes modules on corporate governance in healthcare, clinical governance (including patient safety) and managing healthcare risk, together with a dissertation on any healthcare governance related topic.

For further information, click here.

BMJ masterclass – Improving quality in your GP Practice: London, 1 December 2010

The British Medical Journal (BMJ) is running an event for GP partners, managing partners and other GPs with an interest in quality improvement; Practices working towards the RCGP Quality Practice Award; Practice managers and practice business developers; GP trainees and junior doctors interested in quality improvement; Nurses and pharmacists working in primary care management roles; and other healthcare professionals and managers with an interest in quality improvement at BMA House on Wednesday 1 December 2010.

The masterclass, developed in association with the NHS Institute for Innovation and Improvement, will help you identify areas in your practice where you can improve quality and safety by working smarter, not harder. Throughout the presentations and small group workshops, they will give you tips and tools that you can use in your practice.

You will leave the masterclass with greater confidence in leading your team effectively and with plans for improvement in your own surgery.

Specifically, you will learn about:

Improvement through working harder or smarter?

360 degree practice appraisal

System solutions to human problems

Making change easier

Measuring improvement

Engaging, enthusing, and leading your team

Creating an action plan for your practice.

For further information and to register for the masterclass, click here.

BMJ masterclass for anyone with an interest in GP commissioning – London, 30 September 2010

The British Medical Journal (BMJ) is running an event for GPs, practice managers, nurses and pharmacists working in primary care management roles, PCT managers and others with an interest in GP commissioning at BMA House in London on Thursday 30 September.

The masterclass aims to “educate, inform, and equip you with the skills to tackle the challenges facing all GP practices in the coming years” and you will learn about:

The new GP commissioning landscape and its stakeholders

Forming and successfully working in a commissioning consortium

Commissioning for outcomes – NHS outcomes framework and NICE quality standards

Commissioning based on patient reported outcome measures and the patient experience

Assessing the health needs of a population

Contracts for commissioning

Learning from practice based commissioning and GP fundholding

What the changes mean for you.

For further information and to register for the masterclass click here.

Becoming a healthy NHS board – 1 day London event, 14 September 2010

Healthcare Events are running their “6th National Conference” on NHS boards at the Cavendish Conference Centre, London on 14 September 2010.

This one day conference chaired by Andrew Corbett-Nolan Director The Good Governance Institute and Fellow Open University Business School will focus on the two broad themes of governance for quality and the delivery of productivity and efficiency through process. Following the Francis report of the Mid Staffs Inquiry. The conference will provide NHS Boards with the information they need to review their standards and governance systems. This will enable them to act on their responsibilities around the development of early warning systems and help them to understand the Board’s role in shaping a positive organisational culture. The conference also provides a chance to learn the lessons from year one of Quality Accounts and Care Quality Commission registration, and an opportunity to examine the currently developing new frameworks around governance.

Topics include:

• The Healthy NHS Board – Understanding and applying the principles of good governance
• Meeting the Quality, Innovation, Productivity and Prevention Challenge
• Learning lessons from the first year of Care Quality Commission registration and Quality Accounts

• Disinvestment – Making difficult decisions to free up resources
• Quality Governance – Developing the structures and processes that allow Boards to lead on trust-wide quality performance

• Developing effective Early Warning Systems
• The role of the Board in shaping a positive organisational culture

PLUS workshops:

• Delivering effective governance between organisations

OR

• Maximising the effectiveness of NHS Non-Executive Directors

Keynote speakers include:

• Elisabeth Buggins Chair NHS West Midlands and Board Development Lead National Leadership Council
• Stephen Thornton Chief Executive The Health Foundation and Deputy Chair Monitor
• Edward Donald Chief Executive Royal Berkshire NHS Foundation Trust
• Irene Gray Chief Operating Officer University Hospitals of Bristol NHS Foundation Trust

Download a copy of the conference brochure here.

Oxford paediatric cardiac surgery services review finds serious deficiencies in risk management and clinical governance

It is, perhaps, noteworthy that the origins of the development of ‘clinical governance’ lie in the well known inquiry into paediatric surgery carried out at the Bristol Royal Infirmary between 1984 and 1995. The Bristol inquiry published its report in 2001 and here we are, almost 10 years later, with a report on a review of paediatric surgery at Oxford Radcliffe Infirmary following the death of four babies within three months of each other that cites, amongst other things, deficiencies in clinical governance arrangements within the trust.

Whilst all findings of the review are important to Healthcare Governance Review readers, there are two key findings that are of particular relevance:

1. The clinical governance structure within the trust was found to be “complex and fragmented.” In particular, “the review team found it difficult to grasp the entire number of committees and their respective reporting lines……[which] lays itself open to confusion and there is  significant risk that key risks get missed and are not escalated in a timely manner to ensure appropriate action is taken.”

2. In relation to the preparation of a business case to expand paediatric surgical services, based principally on appointment of a new, full time paediatric cardiac surgery, “The risks inherent in the strategy were not properly recognised and….there was insufficient consideration of how to mitigate risk.”

Both these finding serve to reinforce guidance that has emanated from the Department of Health, and elsewhere, since 1999 that trusts need to simplify their risk reporting structures and need to carry out robust risk assessments, including consideration of so-called ‘clinical risks’ when preparing business cases.

Recommendation 6 in the review report states that “The Trust should implement new clinical governance systems without delay that set out explicit responsibilities service by service with a single line of accountability to the Trust board.” Whilst boards are there to govern, and not to manage, what goes on in healthcare organisations, it is important that there is a single line of accountability from services through the CEO to the board.

The trust is now facing a trust-wide investigation by the Care Quality Commission. Cynthia Bower, Chief executive of the CQC, is quoted in the Telegraph (30 July 2010) as saying: “While the report does not say that the failings caused any deaths, I am in no doubt that babies were not receiving care that was as safe as it should be.

“The trust did not handle the safety concerns raised by the surgeon in an effective or transparent way. The delay in notifying the board, strategic health authority and regulator was unacceptable. The clinical governance arrangements to identify and monitor safety risks were not up to scratch. Induction and supervision was clearly poor.

“We will conduct a full review of quality and safety standards across the hospital. This will involve inspections, interviews with patients and staff, and a review of all available data. We won’t hesitate to take action if we find similar problems exist elsewhere in the hospital.”

Download the report on the review of paediatric cardiac surgery services at Oxford Radcliffe Hospitals NHS trust here.

Read the Telegraph article here.

Notable quote – Board dynamics

“Good corporate governance results when board social dynamics, and the social system in which the board and management interact functions effectively. The subtleties of human social systems have as much to do with directors’ personal and group awareness, relationship skills and capacity for taking responsibility and being personally accountable as it does with written rules and, procedures.”

Margot Cairnes. Boardrooms That Work – A Guide to Board Dynamics. Australian Institute of Company Directors and Group of 100, 2003.

Mid Staffs seeks ‘Head of Governance’ – closing date 10 August 2010

According to Mid Staffordshire NHS Foundation Trust “Quality and safety are high on [their] agenda. We have made significant improvements in the way we deliver healthcare to patients and to the quality of care delivered. We are committed to keeping patients safe and learning from our mistakes.”

To top it all, the trust is looking for a Head of Governance. This does not mean the trust is looking for a new chair of the board of directors, but, rather, “someone who will be responsible for oversight and delivery of the Trust’s governance agenda, incorporating patient safety, risk management, information governance and clinical audit.”

The trust is looking for “someone with a sound knowledge at postgraduate level” and “a highly motivated professional who is passionate about good governance and risk management and ideally grounded in frontline experience of working in a busy hospital environment. You must be an excellent communicator with the energy and vision to motivate change in custom and practice in risk management, quality assurance and improvement across the organisation. You will have a track record of delivery and a full understanding of compliance regimes and accreditation processes and standards within the health sector.”

This is a Band 8c NHS position (£54,454 – £67,134) and the closing date for applications is 10 August 2010.

For further information, click here.

Birkbeck, University of London – Postgraduate programme in corporate governance and business ethics

As the new academic year approaches, Birkbeck is recruiting for their postgraduate (PG) programmes in Corporate Governance and Business Ethics (CG&BE).

In addition to both master of science (MSc) and Master of Research (MRes) degree options, Birkbeck has launched a PG Certificate in CG&BE. The PG certificate is a great way to learn the basics of CG&BE. It requires only 4 taught modules, taken over 1 or 2 years; and it can be followed by continuing on to the MSc.

For further information, download a brochure here - CorpGovernance_-_Top_copy.

Strong decision making is key to effective board performance says ICSA

A well-designed decision-making process is one of the most important hallmarks of a strong board, according to draft guidance launched today for public consultation by the Institute of Chartered Secretaries and Administrators (ICSA). When making decisions, boards should guard against the effects of a dominant personality, the existence of “no go” areas for non-executives and a poor line of sight to significant risk.

ICSA was asked to develop the guidance by the Financial Reporting Council (FRC) to complement the new UK Corporate Governance Code which was issued in May. It will submit a final text later in the year for adoption by the FRC as a replacement to the existing Higgs Guidance.

The guidance is entitled “Improving Board Effectiveness”. It has been drafted by a Steering Group chaired by Sir John Egan, recent chair of Severn Trent Plc, and takes account of an initial consultation involving both investors and chairs, directors, company secretaries and professional advisers operating in the boardrooms of UK plc.

That exercise revealed overwhelming support for short, non-prescriptive guidance to help improve board effectiveness. Key issues covered by the draft guidance are:

· More emphasis on the role of the chair as critical to building an effective board

· The importance of the board’s role in creating a high-performance culture which maximises the opportunities for value creation and minimises risk

· The need to create an environment of challenge in the boardroom

· The value for companies of well-informed and high-quality board decision making

· Board composition and diversity as major factors in delivering an effective  board

· The advantages of a good training and development programme designed to improve directors’ skills, experience and knowledge

· The benefits of regular board evaluation to explore how well the board is functioning

This second stage of the consultation ends on 14 October 2010. ‘Improving board effectiveness’ is available here. It is intended that the completed draft guidance will be submitted to the FRC in November. The FRC intends to publish the final guidance by the end of 2010.

Governing change from the boardroom

UK-based international board governance expert Caroline Oliver has posted her latest article – Governing change from the boardroom.

Caroline believes strongly that boards can make the difference between an organisation becoming overwhelmed by change or navigating successfully through it. She posits that “Boards have a unique power, the power to translate complexity and change into “shared meaning” at a level that can permeate all an organisation’s relationships, activities and outcomes” and asks the question of boards “Are you using that power pro-actively to help steer a constant course, or are you too busy reacting to more immediate issues?”

Read Caroline’s latest article Governing change from the boardroom here.

NHS Appointments Commission and National Patient Safety Agency abolished in Arms Length Body cull

Bureaucracy will be cut and the functions of several organisations will be streamlined, following a review of arm’s length bodies (ALBs), published by Health Secretary Andrew Lansley yesterday. In total, the changes outlined in yesterday’s report will reduce the number of health ALBs from eighteen to between eight and ten; they are expected to deliver savings of over £180m by 2014/15.

In line with the wider reforms set out in the White Paper, Equity and Excellence: Liberating the NHS, the Department of Health’s ALB sector will be transformed to cut cost and remove duplication and burdens on the NHS.

The review has assessed whether the work of each of the Department of Health’s 18 Arm’s Length Bodies’ remains essential nationally. It also looked at whether work is being duplicated or could be better carried out by a different body.
Subject to Parliamentary approval, organisations which are no longer needed will be removed from the sector, with essential work moved to other bodies. This process will increase the ability of the organisations to do their important work in the most efficient way. It is also part of the cross-Government strategy to increase accountability and transparency, and to reduce the number and cost of quangos.

Of particular note to those interested in ‘healthcare governance’ is the abolishing of the NHS Appointments Commission and the National Patient Safety Agency.

The NHS Appointments Commission is responsible for handling the appointment of chairs and non-executive directors (NEDs) to the boards of Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and NHS trusts. Given that SHAs and PCTs are going, and all NHS trusts will become NHS foundation trusts, and therefore able to appoint their own chairs and NEDs, there will be little role for the NHS Appointments Commission. Hence its demise, with any outstanding work being transferred to the Department of Health.

The National Patient Safety Agency (NPSA) has, sadly, never met expectations originally set out for it in the Department of Health document Building a Safer NHS for Patients. From it’s establishment in 2001 it has suffered from poor CEO and board/chair leadership together with ineffective oversight from the Department of Health. The NPSA was castigated by the Public Accounts Committee (PAC) in 2006 for providing poor value for money.

For further information on which ALBs are being kept and which are being abolished, click here.