Loughborough University postgraduate programme in healthcare governance – next intake November 2012

This well established and popular part-time postgraduate programme in healthcare governance, run by Loughborough University School of Business and economics, will take its next intake in November 2012.

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.

Concern over Chinese hospital management (and governance) following disposal of live baby as stillbirth

Healthcare Governance Review editor Professor Stuart Emslie runs an annual masters module in risk management and clinical governance for, typically, 150-200 senior medical doctors and administrators across China. The students undertake a Master of Hospital Administration, which is jointly run by Flinders University in South Australia and Nankai University in China.

A few weeks ago a live baby was inadvertently ‘disposed of’ by clinical staff in a hospital in southern China, very close to where Stuart was running his module in Guangzhou. The China Daily reported a problem with ‘hospital management’ and ‘medical ethics’ (click here). Some of the students were familiar with the staff involved in the incident and, as part of the module, carried out a mini root cause analysis (RCA) into the incident, citing fundamental root causes as inadequacies in management and clinical governance. One of a number of fishbone diagrams describing contributing factors and root causes regarding the baby disposal incident (apologies – we have yet to receive the written translation, but will post it when it arrives – Ed.).

Andrew Lansley advocates ‘Accountable Care Organisations’ in NHS

As reported in the Health Service Journal today (16 November 2011 – click here) the Secretary of State for Health, Andrew Lansley, has “…….advocated the model of accountable care organisations, most commonly, although not exclusively, associated with the US healthcare sector. These are networks of providers which are given a pooled budget for patients’ care and are monitored on their performance and quality.

Mr Lansley said accountable care organisations could be beneficial “in so far as they bring hospital and community services together, in order to create an organisational form that is more integrated”.

But he added: “They have to do it in a way that doesn’t create monopolistic services that don’t offer patients choice.”

For further information on accountable care organisations (ACOs) read Achieving integrated care. Lessons from the US and the UK to improve quality and affordability in healthcare – produced by Matrix Knowledge Group – click here.

Readers might also be interested in a YouTube video on governance of ACOs in the USA – click here.

Andrew Lansley comments on publication of Department of Health ‘risk register’

As reported in the Health Service Journal today (16 November 2011 – click here) the Secretary of State for Health, Andrew Lansley, responding for the first time to the Information Commissioner’s judgement that the Department of Health (DH) should publish its “register” setting out the risks of the reforms, said the DH had yet to decide whether to appeal the decision.

But he said: “There’s a great danger if it’s published… it will tend to mislead. It will give an impression… there was an expectation [that all the risks would be realised]. The purpose [of the document] is to get open, honest internal reporting so all necessary mitigating actions can be taken.”

Does your organisation make public its organisational risk register?

Notable quote: ‘Leadership matters more than size and organisational uniformity’

According to the Health Service Journal (16 November 2011 – click here), Andrew Lansley, Secretary of State for Health in England believes that “The NHS is obsessed with size and organisational uniformity. In truth leadership matters more.”

CQC cites ‘governance and management’ failings at Barking, Havering and Redbridge University Hospitals NHS Trust

The Care Quality Commission (CQC) has published a report on ‘serious failings’ at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUHT). The report focuses mainly on the quality and safety of care provided at King George Hospital and Queen’s Hospital.

Of particular interest to Healthcare Governance Review is the finding in the report that “Trust governance systems are reported as weak and corporate governance is underdeveloped. Governance systems have recently changed, but lines of communication in the new structure are unclear and there is a risk of duplication or issues being missed. The trust was reliant on external reviews to identify issues, and while it held extensive performance information, this was not used to drive change. There was a lack of learning from incidents, with investigations identifying recurring themes.”

This report provides interesting reading, and lessons, for the governance and management of any provider organisation.

Download the report Investigation report Barking, Havering and Redbridge University Hospitals NHS Trust here.

HFMA issues governance (management?) guidance for clinical commissioning groups

The Healthcare Financial Management Association (HFMA) has issued a useful briefing document exploring governance arrangements for clinical commissioning groups as statutory bodies.

Perhaps rather misleadingly titled Governance: Managing a Corporate Organisation (‘governance’ and ‘management’ are two quite separate issues – Ed.) the document “looks at the arrangements commissioning groups may need to establish to ensure they avoid failure, can meet their statutory responsibilities and operate in the public interest. It considers where their accountabilities may lie and what can be learnt from existing NHS organisations and the way in which they fulfil their own accountability requirements. It looks at:
● Governance standards and what happens when things go wrong
● What it means to be accountable
● What accountability might look like for commissioning groups
● Key roles and responsibilities
● The practical implications.”

Whilst the title of the document might suggest to some that HFMA don’t know their governance from their management, they do define ‘governance’ in the document as “[being] concerned with how an organisation is run – how it structures itself, how it is led, how it is held to account and how it justifies its actions or decisions.” (OK – you decide whether they know the difference! Ed.)

The document can be downloaded at www.hfma.org.uk/publications-and-guidance/

GMC survey of medical directors finds ‘improved governance and management’ a key factor in increased ‘Fitness to Practise’ referrals

The annual volume of Fitness to Practise enquiries made to the General Medical Council (GMC) has increased by 30% since 2004, by 14% since 2006 and by 11% between 2008 and 2009. Many enquiries come from Persons Acting in a Public Capacity (PAPCs), that is people acting on behalf of a public organisation, and a majority of those are from public healthcare bodies. Whilst PAPC enquiries are not solely responsible for the increase in enquiries, they are believed to be a key contributory factor, increasing from 394 in 2006 to 1,030 in 2009. Research was commissioned by the GMC to investigate, principally through contact with medical directors in NHS Trusts, Foundation Trusts, Primary Care Trusts and Health Boards across the UK and Northern Ireland, the rise in PAPC enquiries. The research report has now been published.

Reasons for the rise in referrals was an issue explored both quantitatively and qualitatively and the overall opinion was that any increase was as a result of improved systems within organisations for detecting and dealing with performance issues rather than diminishing standards by medical professionals.

More specifically the increase was attributed to three key areas:-
• an increased management ethos: maintaining high professional standards, the introduction of clinical governance systems and a procedure for reporting incidents;
• changes in general public attitudes: patients feel more empowered to complain, part driven at least by awareness of some high profile cases in the press; and
• changes in colleague attitudes: the increased management ethos has led to recognition amongst medical colleagues that performance concerns should be highlighted. There are also more effective methods to lodge confidential complaints

Download the GMC report Research into Fitness to Practise referrals 2011 here.

Open University NHS governance project

Readers may already be aware that full details, including reports, an NHS/SDO funded project on NHS governance carried out by the Open University are available on the Open University website here.

Notable quote: Boards and strategy

“The board’s role in large organisations is not to formulate strategy, but rather to set the context of strategy. It does this in a number of ways: through setting and actively reviewing the corporate definition – the ‘What business are we in’ question; through the gatekeeping function – actively assessing and reviewing strategic proposals, and often changing proposals through comment and advice..………..”

Boards at Work: How directors view their roles and responsibilities – Philip Stiles and Bernard Taylor (2002)

Can anyone help a PCT NED with her research looking at the governance contribution of PCT NEDs?

Joy Tweed is a Primary Care Trust (PCT) non-executive director (NED) and she would like to ask for your help. She’s undertaking research for her PhD at the School of Management, Birkbeck, University of London, looking at the contribution of non-executive Directors to governance within PCTs and she wishes to interview current and former PCT NEDs about their experiences of PCT governance.

Although the abolition of PCTs is planned for April 2013 this research will contribute to the debate on the NED role within the NHS and the wider public sector. It will identify the contribution NEDs can make to good corporate governance and public accountability. The research should be of benefit to Clinical Commissioning Groups as they consider the composition of their boards, the contribution an independent director can make to the work of the board and what ensures good corporate governance.

Joy is keen to contact both current PCT NEDs and those who stepped down earlier this year when PCTs moved to cluster working. If you are in contact with former PCT NEDs who may be willing to be interviewed about their experiences of being a PCT NED, please could you bring this post to their attention?

If you are willing to be interviewed please contact Joy on pctnedresearch@gmail.com

Thank you!

Healthcare Governance Review receives it’s 100,000th ‘hit’

Some time on the evening of Thursday 6 October 2011 www.healthcaregovernancereview.org recorded its 100,000th ‘hit’.

This means that since the site was established in January 2009 it has received an average of a little over 3000 hits per month.

The statistics show that the most popular day on the site was January 10 2011 with a total of 377 hits.

I’d like to say a big thank you to all of you who visit the site and do hope you will continue to find the site useful. Please e-mail me on svemslie@aol.co.uk if you have any comments or suggestions regarding the site.

Stuart Emslie, Editor.

Risk and Patient Safety 2012

Healthcare Conferences UK have announced that the twelfth annual Risk and Patient Safety conference will take place Thursday 2 February 2012 — Friday 3 February at the Cavendish Conference Centre, London

The conference will offer delegates the opportunity to hear from some of the leading speakers in patient safety, risk management and improvement, and to learn directly from a range of successful safety initiatives being implemented across the UK.

Further information will be available in due course here.

To register your interest please email kerry@healthcareconferencesuk.co.uk

Scooby Doo rated as ‘most active’ children’s TV programme

According to research published by the Department of Health (click here) Scooby Doo has been ranked as the most active children’s TV programme, ahead of Shaun the Sheep, Lazy Town, Peppa Pig, Bob the Builder and Tom and Jerry.

PCP Research Consultants analysed the top 20 children’s programmes and characters shown on UK TV channels in November and December 2010. Each character was rated on their activity levels and received marks for good behaviours such as walking short journeys and playing sport. Whilst Scooby Doo came out as the most active programme overall, the most active individual character was Sportacus in Lazy Town, followed by Scooby Doo himself.

Based on the research, the Department of Health’s ‘Change4Life’ initiative is teaming up with super hero Sportacus from Lazy Town to inspire children around the country to ditch their junk food and tuck into more ‘Sports Candy’ (i.e. fruit and vegetables!).

IRM launches risk appetite & tolerance guidance

The Institute of Risk Management (IRM) has produced a guidance paper to provide guidance to directors, risk professionals and others in relation to that part of the UK Corporate Governance Code that states that “the board is responsible for determining the nature and extent of the significant risks it is willing to take in achieving its strategic objectives”. However, the IRM hopes that the guidance will have far broader resonance with anyone interested in the subject of Risk Appetite and Risk Tolerance [including those in healthcare Ed.].

Either the executive summary or the full guidance paper Risk Appetite & Tolerance can be downloaded here.

Why do Boards fail?

An interesting short article in The Independent (1 September 2011) reflects on “…some spectacular corporate governance failures [and] argues that it is time to put boards under the same performance criteria as other management teams.”

Read the article Why do Boards fail? here.

NHS Scotland issues draft new clinical governance and risk management standard

Healthcare Improvement Scotland has issued, for consultation, a draft Healthcare Quality Standard, which is their new core clinical governance and risk management standard. Healthcare Improvement Scotland has responsibility for setting quality standards for clinical governance and risk management, which will provide an assurance that healthcare organisations are providing high quality healthcare. They also have responsibility for monitoring their compliance.

The new standard will replace the existing clinical governance and risk management standard and is set at a strategic level. It will be used to test the arrangements that healthcare organisations have in place to deliver against the Healthcare Quality Strategy quality ambitions.

Healthcare Improvement Scotland will link these arrangements to patient experience and outcome, through their evidence-based, condition specific standards and measures (from “Board to patient”).

Download the latest draft clinical governance and risk management standard, and previous versions of the standard, here.

Good management of NHS staff improves quality and reduces cost says research

The Department of Health (DH) has published findings of DH-funded research carried out by Aston University Business School.

The research shows that: "Good management of NHS staff leads to higher quality of care, more satisfied patients and lower patient mortality. Good staff management offers significant financial savings for the NHS, as its leaders respond to the challenge of sustainability in the face of increasing costs and demands" [and readers will be well aware that it takes good board oversight of management, i.e. good governance, to ensure good management of NHS staff – Ed.]

The researchers took the wealth of data contained in NHS staff survey results. They analysed how, over time, the experience of NHS staff at work links with performance measures that illustrate the quality of care that NHS trusts deliver.

The reports suggest that good management needs to be based on the staff engagement ‘star’ model. The model shows that staff engagement is increased by achieving in five principal areas;

• delivering a healthy, safe work environment,
• ensuring every role counts,
• promoting great management and leadership,
• supporting personal development,
• enabling involvement in decision making.

This new evidence shows that all organisations need to continually focus on improvements that will help increase their levels of staff engagement, as this will improve the quality of the services they provide.

The final report NHS Staff Management and Health Service Quality – Results from the NHS Staff Survey and related Data and all associated reports can be downloaded here.

Latest newsletter from the Good Governance Institute

The Good Governance Institute’s latest newsletter highlights the following work done, or being undertaken by the Institute:

• Governance of GP Clinical Commissioning Groups
• Governance of flexible working
• Governance of telehealth
• Safeguarding adults
• Cycle of business for clusters
• Diversity and inclusion
• Developing boards
• Boards appetite for risk

To access the latest newsletter, click here.

‘Effective Governance Models for Clinical Commissioning Groups’

Foresight Partnership, supported by King’s Patient Safety and Service Quality Research Centre, were commissioned by the National Leadership Council to develop a development tool to look at ways in which the principles of good governance might apply and be adapted to Clinical Commissioning Groups in the light of the Government’s response to the listening exercise. The development tool and its accompanying literature review and case studies have now been published.

These can all be downloaded here.

What makes an excellent NHS foundation trust?

Research carried out by specialist healthcare management consultancy Finnamore, who were awarded the coveted title ‘Consultants of the Year 2010’ by HealthInvestor magazine, has identified, from a survey of NHS chief executives, their views on the fundamental question, ‘What makes an excellent Foundation Trust’?

According to Finnamore, “What this research begins to reveal are the characteristics of “great” in the NHS environment and the challenges that will be encountered along that journey. From our experience, FTs that will become “great” – and consequently be those that will thrive – will be those that seize the initiative on four fronts:

• Transform services to become the “Right Shape and Right Size”.
• Focus on quality to reduce costs.
• Focus on patient satisfaction to secure, or indeed grow, their income base.
• Adopt a more commercial attitude to how they develop services, broaden their base and reduce their reliance on NHS income alone.”

Read the Finnamore Foundation Trust Survey 2011 Summary report here.

Readers may be interested in other Finnamore reports on their site here.

Healthcare Governance Review is grateful to Finnamore for giving permission to link to their website.