Governance and Regulation: New journal with special issue dedicated to ‘healthcare and new governance’

 

A relatively new journal from Blackwell Publishing, Regulation & Governance, seeks ”to advance discussions between various disciplines about regulation and governance, promote the development of new theoretical and empirical understanding, and serve the growing needs of practitioners for a useful academic reference.” The March 2008 edition (Vol. 2 Issue 1) is a special issue dedicated to ‘healthcare and new governance.’ All editions of the journal are currently freely accessible at: www.blackwellpublishing.com/journal.asp?ref=1748-5983&site=1

McKinsey research makes link between NHS management and performance

New research conducted jointly by McKinsey and the London School of Economics and Political Science (LSE) points to a link between key management practices, on the one hand, and better health care and higher hospital productivity, on the other. The study, based on an assessment of 126 NHS and other hospitals across the United Kingdom, strongly suggests that improved operational effectiveness, performance management, and talent management are associated with lower rates of infection in hospitals, lower readmission rates, more satisfied patients and more productive staffs, and better financial margins. Moreover, the study indicates that stronger leadership by doctors in the way hospitals are managed could play a particularly significant role in improving them.

According to McKinsey, given the continued pressure on the public sector everywhere, these findings should interest policy makers and health care leaders striving to improve medical systems elsewhere in the world. 

For further information, click here.

On being a ‘careful and diligent’ director – sleeping through a board meeting is no defence in court!

An interesting article in the Sydney Morning Herald’s ‘Business Day’ explores whether too much is being asked of company directors. Given current market troubles, the specific question is asked ‘How much effort is required to prove in court that you have been a careful and diligent director?’

Apparently, in 1870 the British Court of Appeal handed down an edict: sleeping through a board meeting is no defence if things later go wrong. The case, against a certain Lord Fermoy, who was a director of Land Credit Company of Ireland, has been frequently quoted since – “I am exceedingly reluctant in any way to exonerate directors from performing their duty, and I quite agree that it is their duty to be awake, and that their being asleep would not exempt them from the consequences of not attending to the business of the company,” said Lord Hatherley in the decision.

Whilst it is hard to imagine a company director in 2008 trying this approach, the issue at the heart of the case still resonates today says Elizabeth Sexton, writing in the Sydney Morning Herald. According to Sexton, “many judges and parliamentarians [in Australia] and around the world have tussled with what type of defences should be available to directors of troubled companies…….[and] If Australia in in for a new round of corporate losses and collapses, the rules on corporate governance will be in the spotlight.”

The full article can be viewed at http://business.smh.com.au/in-the-line-of-duty/20080222-1u19.html

National clinical governance standards needed for New Zealand ambulance services

A patient complaining of abdominal pain called an ambulance, was visited by two paramedics, and was assessed as having a tummy bug. He later died at home from a ruptured abdominal aortic aneurysm. The paramedics were found to have recorded none of the patients vital signs. Instead, they told the patient about the “current virus going around” and advising him to rest and take panadol.

Now, calls are being made a coroner and by the Green Party to urgently develop national standards for ambulance services. According to Green health spokeswoman, Sue Kedgley, “it is extraordinary that there [are] no national clinical standards governing the provision of ambulance services……Ambulance officers [are]not regulated as a profession …..and there [is] no national clinical governance committee and this must change.”

For more information, see: www.stuff.co.nz/4411454a6160.html

Maidstone and Tunbridge Wells NHS Trust seeks Head of Quality and Governance at £75k

In the wake of the Clostridium difficile debacle, Maidstone and Tunbridge Wells is advertising in the Health Service Journal (21 february 2008) ”An exciting opportunity…for a talented and highly motivated individual to take the lead role on Quality and Governance within the Trust.” The individual will provide “comprehensive high-level support to the Trust Board” and other relevant boards and committees. Further, the individual will provide “strategic leadership and direction for the development, implementation, monitoring and improvement to ensure that the Trust operates to the highest standards of governance [and risk management].” An annual salary between £60,669 and £75,114 (Band 8D) is offered.

Interested individuals can apply online at www.jobs.nhs.uk quoting reference number 359-NG697

In England, do ministers and civil servants really understand NHS governance? – unlikely!

Health is the most politicised of all government services. At the Department of Health, command and control is the order of the day. No surprise, then, to find that both ministers and David Nicholson, Chief Executive of the NHS at the Department of Health, appear to be attempting to directly control NHS foundation trusts in contravention of the governance arrangements under which they operate.

This issue has arisen because of serious governance failings at Maidstone and Tunbridge Wells, which resulted in some 90 patients dying from hospital acquired infections. As a consequence, the Department of Health issued instructions to all NHS hospitals, including ‘independent’ foundation trusts, on measures they should be taking to improve hospital hygiene. David Nicholson has defended the Department’s actions saying that “…..every NHS board has – as part of the NHS family – a very real duty on behalf of their patients to learn lessons from what happened at Maidstone and Tunbridge Wells to ensure it never happens again.”

Bill Moyes, Chairman of Monitor, the regulator of NHS foundation trusts, has written to David Nicholson expressing his concerns about the Department issuing instructions to foundation trust hospitals as if they were still under the Department’s direct management control. Under the new governance regime, foundation trusts are accountable to local members (owners) and are independent of the Department of Health and government.

The Guardian newspaper has published an article on the affair, which can be viewed here.

February 2008 issue of Health Care Risk Report focuses on infection control

With concerns regarding the impending Corporate Manslaughter Act becoming more prominent on board member’s and senior manager’s radar screens, it is fitting that this month’s issue of Health Care Risk Report (HCRR - Volume 14 Issue 3) should devote two articles to a ’special report’ on infection control. The first, from Professor Hilary Pickles, director of public health, and director of infection prevention and control at Hillingdon PCT, looks at the substantial risk posed to patients and organisations by infection and ‘plots a course’ for the role of the risk manager. The second article is an account, by Pat Anderson, editor of HCRR, of an interview with the Health and Safety Executive’s (HSE) healthcare-associated infection policy lead – Ian Strudley. From a governance, as well as a risk management perspective, both articles are essential reading for board members and senior managers. For example, Ian Strudley re-affirms HSE’s position that matters of clinical judgment are outwith its remit, but asserts that HSE ”will pursue investigations where patients and staff are put at risk because of poor systems of work.” And in the news section of this month’s HCRR there is a warning from the Health and Safety Executive that NHS trusts “must have a contingency plan outlining what will happen in the event of an outbreak of infection with an organism such as Clostridium difficile.”

If your organisation does not currently subscribe to HCRR then please consider doing so. A subscription form can be downloaded at www.healthcareriskreport.com

Declaration of interest: Stuart Emslie, editor of Healthcare Governance Review, is on the editorial advisory board of, and is a regular contributor to, Health Care Risk Report.

In Ireland, hospitals’ corporate structure is believed to be key to unlocking their potential

A recent article in the Irish Medical Times appears to link future performance improvements in the public healthcare system in Ireland with better hospital and health system governance. The article is based on an interview with Mr Vincent Barton, Managing Director of Prospectus, a health and social services management consultancy in Ireland. Currently, under the public system operated by the Health Service Executive (HSE) ‘there are very varied governance approaches for institutions which are all operating under the same [HSE] policy and funding framework. This is a legacy situation relating to the way in which Irish healthcare has evolved.

But, says the article, ‘Is it reasonable or fair to expect the General Manager of a major HSE hospital who is part of a multi-layered chain of command, to achieve the same levels of performance from his hospital as his peers who have the more immediate protection and guidance of a Board?’ Barton believes that public hospitals need to have their own ‘legal identity and governance structures.’ He believes that ‘the introduction of Boards in some form to major HSE hospitals, would provide the opportunity for engaging a wider range of talent in the task of governing these vital elements of public infrastructure, as well as offering the possibility of another point of engagement for the wider community with these publicly-funded institutions.

In short, the article points to better governance as an essential prerequisite to better hospital and health system performance. Read the full article at: www.imt.ie/news/2008/02/hospitals_corporate_structure.html

NHS reform is a “national mantra, not local reality” says think tank

A report published by the independent, non-party think tank Reform argues that while the Government’s commitment to NHS reform is right, it is in denial about its progress on the ground.  The report, shows that reform is the only way to unlock the value of the NHS budget but the Government’s programmes remain embryonic, and in some cases in full retreat.  The solution is an economic constitution which defines duties to create value at all levels of the service.  Such a constitution should be the central conclusion of the Government’s current landmark NHS review. Reform believes that genuine reform would bring significant improvement to the NHS in 18 months, but argues that current trends will deliver deteriorating quality at an extra cost of £20 billion per year. 

The report – NHS reform: National mantra, not local reality - is essential reading for anyone interested in NHS governance at national or local levels. Download the report here.  

Good governance takes ‘centre stage’ at NHS chairs’ conference

The 2008 Chairs Conference was held in London on Tuesday 29 January. Over 400 chairs represented trusts from across England at the conference, where speakers included the Rt. Hon. Alan Johnson and Ann Keen MP.

The aim of the conference, organised by The Appointments Commission in association with Monitor, the Department of Health, the NHS Confederation and the NHS Institute for Innovation and Improvement, was to enable trusts to explore what makes an effective board and the factors needed for good governance.

Podcasts and copies of the presentations are available on the NHS Confederation website – click here.

 

 

Patient safety – it’s about good governance and management says Healthcare Commission

The Healthcare Commission is urging NHS boards in England to heed the lessons of its investigations into serious healthcare failings. The Commission has produced a ‘learning from investigations’ report based on 14 investigations into failures involving serious patient safety risk. According to the Commission, “A common trend has been NHS trust boards concentrating on some of their activities, such as the delivery of targets or mergers, at the expense of others…..trust boards need to [deliver on objectives] and deliver on the basics of quality of care and safety.” Whilst the report does not come up with new findings, it nevertheless very usefully reinforces the importance of good governance and management. The report can be downloaded at: www.healthcarecommission.org.uk/_db/_documents/Learning_from_investigations.pdf

Governing the NHS (in England) – Kings Fund report on alternatives to an independent board

An independent NHS board has been advocated by a number of commentators, who believe it will reduce both micromanagement and day-to-day political interference in the running of the NHS in England. This paper from teh Kings Fund argues that an independent board would be limited in its ability to achieve these aims. It suggests a number of alternative options to an independent board that build on the increasing operational independence the recent reforms have offered. These options would, according to the Kings Fund, help secure a better balance between public accountability and local autonomy within a more devolved health care system.

The report can be freely downloaded here.

Canadian ‘Essentials Certificate in Health Care Governance’

The Ontario Hospital Association is Canada is renowned for its keen interest in healthcare governance matters. On 29 February 2008 their ‘Governance Centre of Excellence’ is running a one day ‘Essentials Certificate in Health Care Governance.’ Designed for new and prospective board trustees, the program is designed to help delegates strengthen their leadership skills and orient them to the important role of hospital or health care organisation trustee.

 For further information, including brochure download, click here.

Canadian healthcare governance debate: Will local community boards survive in Ontario?

Why did the Ontario government decide to keep independent governance Boards in the Ontario healthcare system? Western Canadian models of integrated healthcare delivery systems got rid of local governance years ago when they created regional delivery models. Will the Ontario government continue to maintain independent local governance as a key feature of an integrated regional healthcare system? One of the key questions that has been raised as the system undergoes transformation to a regionally integrated model is “Will local governance survive?”

This question was the subject of the Institute of Public Administration of Canada’s “Healthcare Leaders’ Dialogue on Governance Renewal” held on January 16, 2008. The IPCA asked whether local community Boards be eliminated, or should they be transformed to align with the fundamental transformation of the health care system.

To provoke thinking on the topic, a background paper was produced entitled “How can Local Healthcare Governance Survive?” (free download at website below). The paper should be of interest to anyone, internationally, concerned with local healthcare governance matters.

www.ipac.ca/HealthCareLeadersForum

Getting boards on board with quality and patient safety

Following the success of their 100, 000 lives campaign, the Institute for Healthcare Improvement in the USA has set the ambitious goal of trying to protect 5 million patients from “incidents of medical harm” during 2007 and 2008. One of the non-clinical objectives of the campaign is to “Get boards on board by defining and spreading the bestknown leveraged processes for hospital boards of directors, so they can become far more effective in accelerating organizational progress toward safe care.” Two specific board performance indicators have been defined:

1. Boards in all hospitals will spend at least
   25% of their meeting time on quality and
   safety issues.
2. Boards will have a conversation with at
   least one patient (or family member of a
   patient) who sustained serious harm at their
   institution within the last year.

For further information click here.