Patient and public involvement: the challenges facing NHS boards

In an article in the Health Service Journal (HSJ – 26 September 2008), Robina Shah, chair of Stockport NHS foundation trust, talks to Joan Saddler, the national director of patient and public affairs, who appears very clear about the role of boards in enhancing the visibility of patients and the public.

“Many boards believe in the concept of patient and public involvement and engagement,” says Ms Saddler in the article,  ”but they struggle with implementation. Successful boards will eventually find solutions to critical and complex problems, therefore ensuring the organisation has the skills, as well as the will, to embed patient and public engagement.”

She goes on to say that “Patient and public involvement is not difficult, but it requires complex planning. Boards currently have a range of important drivers that the system has previously lacked. These include an emphasis on patient experience in the key operating framework targets, an emphasis on quality and personalisation of care in Lord Darzi’s report, and the real operational levers the world class commissioning framework can facilitate.”

Read the full article here.

Patient safety roundup – September 2008

September has seen a flurry of activity relating to patient safety in England - perhaps spurred by the deadline of 22 September for submissions to the Health Select Committee’s investigation into patient safety (read previous Healthcare Governance Review post here).

Of particular note is the launch of www.patientsafetyfirst.nhs.uk- the new website for the national patient safety first campaign. The campaign has been “created to change the culture within the NHS; to one that makes the safety of patients the highest priority and makes all avoidable death and harm unacceptable.” According to the website, ”the Patient Safety First Campaign seeks to provide NHS staff with the knowledge and support they need to take simple steps to improve the safety of patients in their care.” You can register on the website to show your support for the campaign.

Also of note is an article in the Health Service Journal (15 September 2008) that finds that there is a “massive level of under-reporting of patient safety incidents by GPs. According to the article, “acute trusts log 3,000-4,000 patient safety reports [to the National Patient Safety Agency] every day. But general practice, where 95 per cent of all NHS activity occurs, including the writing of nearly 800 million prescriptions last year, logs just 2,500 a year – a mere 0.4 per cent of the total.” The article provides a useful overview of patient safety reporting in primary care and can be accessed here.

McKinsey has published an excellent account of the US Institute for Healthcare Improvement’s (IHI) 100,000 lives campaign, which aimed to save 100,000 patients from death associated with preventable errors in healthcare over an 18 month period between 2004-2006. Read the McKinsey article The ergonomics of innovation here.

Also in the USA, the IHI is running an event in Boston on 6 and 7 November looking at the role of board in quality and safety. Titled From the Top: The Role of the Board in Quality and Safety, the conference explore the following key issues:

- Does your board do a better job overseeing finances than quality and safety?
- Could your board send a stronger signal to the organization that it is really serious about achieving quality and safety aims?
- Is your board overwhelmed by quality data and unable to determine what to do with it?
- How can your board more effectively engage with physicians in your quality and safety agenda?
- How will your board handle a sentinel (i.e. serious) event?

For further information on the IHI boards event, click here.

The IHI has also made available an article on board engagement in patient safety. Titled A new challenge in patient safety: Transforming leadership infrastructure through widespread board engagement, the article principally reports on the IHI’s ‘Boards on Board’ campaign, which is part of the IHI’s 5 million lives campaign. The article can be freely downloaded here.

Finally, in this roundup of patient safety matters, readers might like to remember that the Patient’s Association is holding a conference dealing with patient safety and boards in Harrogate on 6 October. For further information, see previous Healthcare Governance Review post here.

Connecting governance culture and hospital performance improvement

A freely downloadable ‘trustee workbook’ from the American Hospital Association’s Centre for Healthcare Governance encourages hospital boards to examine board culture and the board’s capacity to sustain a comprehensive hospital performance improvement programme.

The workbook suggests that boards review the following questions to understand their role and analyse their capability as a leader of performance improvement. The workbook further suggests that the board could also use these questions as a guide for discussing the organization’s performance improvement program.

1. Is your board enthusiastic about its own self-assessment process? Are board goals or an action plan for improvement developed based on the board’s performance evaluation survey?
2. Does your board have a formal process to evaluate the CEO’s performance in meeting predetermined goals? Do board members talk to the CEO about the evaluation in detail?
3. Does the board review and discuss a comprehensive, organized set of data, such as a scorecard or dashboard, to measure organizational performance improvement?
4. Is there a systematic board education process, including periodic retreats, with a focus on global health care trends and strategic issues? How does the board monitor and measure each trustee’s ongoing participation in board education?
5. Is the board’s work aligned with that of the CEO, its corporate structure, physicians and the community served? Do internal politics have a negative impact on the board’s tenor?
6. Does the board use its systematic performance monitoring mechanism-such as scorecards-and its education on global issues to develop a strategic position for the hospital?
7. Has the board analyzed the health care organization’s motivations for supporting performance improvement? Are there sustainable, intrinsic reasons to improve? Are the hospital’s public image, external requirements or financial concerns major drivers?

The workbook can be freely downloaded here.

Building an exceptional board – Effective practices for health care governance

The American Hospital Association’s Center for Healthcare Governance has published a report on building an exceptional healthcare board.

In 2007, the Health Research and Educational Trust (HRET), with funding from Russell Reynolds Associates and the Center for Healthcare Governance, convened a Blue Ribbon Panel to examine critical issues facing health care boards and practices that lead to exceptional governance. The BRP report includes the panel’s recommendations in specific areas, as well as sample tools and resources to implement them. It is intended to foster broader dialogue and sharing, among healthcare organizations and their boards, of perspectives and resources to further strengthen and improve health care governance.

Panel members included chief executives and board members of hospitals and health care systems, governance researchers and consultants and others with expertise in leadership and governance. They identified and focused their deliberations on five areas they believed were critical to effective governance:

- Being an Accountable Board: Earning and Maintaining the Public’s Trust;
- Building and Sustaining a Proactive and Interactive Board Culture;
- Laying a Foundation for Effective Decision-Making: Board Meetings and Information for Governing;
- Focusing the Board on Key Governance Priorities; and
- Clarifying Authority and Responsibility: The Buck Stops Where?

The report can be freely downloaded by clicking here.

Listen to John Carver talking about ‘Reinventing Your Board’

Dr John Carver is arguably the world’s most published author on non-profit board governance. An ex-health system CEO in the USA, his seminal book, Boards That Make A Difference, has sold over 100,000 copies worldwide and his governance model has even influenced BP’s governance approach.

In this interview in the USA, Dr Carver talks about ‘Reinventing Your Board’, which is the title of another of his books, which is co-authored with his wife Miriam Mayhew Carver.

Access the interview by clicking here and scrolling down the CONTENT LIBRARY to access ‘Reinventing Your Board’ dated ‘9/11/08′ – (NB: American date convention, i.e. 11 September 2008!). Note that you can also download the file to your own computer for later listening, but beware – it’s a very large file (25Mb).

Balancing an NHS board – getting ‘board dynamics’ right

An article in the Health Service Journal by Jo Davis, chair of Birmingham Children’s Hospital foundation trust, believes that “Board dynamics are potentially the most powerful, unseen and misunderstood force influencing a trust’s decision-making and strategy. Appointing the right mix of non-executive directors for a particular board is” she says ”often the most important and difficult part of creating the best dynamic. For a chairman, getting that right is therefore an act of crucial importance.”

Ms Davis believes that “Selecting the right person and giving them the right induction will go a long way towards achieving the best possible balance at board level. And it will make the chairman’s job that much easier once those board meetings are under way.”

To read the full article, click here.

October Patient’s Association event puts patient safety at the top of the board agenda

The Patient’s Association is running a one day conference for NHS board members, in particular non-executive directors, which aims to put patient safety at the top of board agendas.

The event is being held in Harrogate on 6 October 2008. Speakers include Lord Darzi, the Chief Medical Office, the CEOs of the Healthcare Commission, NHS Appointments Commission and National Patient Safety Agency, Stephen Ramsden, part-time director of the National Patient Safety Campaign, and Karen Taylor, Director of Health Value for Money Audit at the National Audit Office.

The Healthcare Commission will be chairing a safety masterclass session for board members titled “Prioritising safety – How can your trust improve?”

For further information, click here.

Notable quote on making systems work……..

“Even the best-designed systems can be trumped by the power of personality.”

Click here for source.

[As my granny used to say, "Systems make things happen, but its people that make it work." - Ed.]

NAO study – Tackling Healthcare Associated Infections in Hospitals

The National Audit Office (NAO) is undertaking a study to review progress made by the NHS in tackling healthcare associated infections in hospitals since publication of its previous study on the subject in July 2004.

According to the NAO, tackling healthcare associated infections in hospitals is a key priority for the National Health Service. Around 8 per cent of patients have such an infection, the majority caused by bacteria or viruses and affect the urinary tract, surgical wounds, lower respiratory tract, skin and bloodstream. In 2006-07 there were over 6,000 cases of MRSA and 55,000 cases of Clostridium difficile.

The NAO has published two reports on the subject. The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England (February 2000) had a significant impact in raising the profile of this important issue and highlighted the need to improve prevention, management and control. Improving patient care by reducing the risk of hospital acquired infection (July 2004) reviewed progress against NAO and Committee of Public Account’s recommendations and noted that improvements were at best patchy and that serious challenges remained. Healthcare associated infections continue to be an issue within many hospitals.

This study will review progress made since the last NAO report. It will look at how well the centrally driven initiatives have been developed and implemented and will focus on the successes at trust and ward level and the impact on staff, patients and the public. It will examine the roles, responsibilities and relationships of the Department, the many arm’s length bodies that have a specific role in managing healthcare associated infection and the individuals at trust level who have specific responsibility for infection prevention and control. We will also seek to identify the effectiveness of various intervention strategies and the extent to which previously identified barriers and constraints have been overcome.

For further information, click here.

NHS carbon strategy consultation deadline extended to 30 September 2008

The consultation deadline for the draft Carbon reduction Strategy for the NHS in England has been extended until 30 September.

The Strategy is the first output of the new NHS Sustainable Development Unit, created “to provide the leadership, the support, and the ammunition NHS organisations need to do their bit.”

The strategy is needed to address climate change imperatives. The NHS is the largest public sector contributor to climate change, responsible for some 18 million tonnes of carbon dioxide production per annum.

The NHS Carbon Reduction Strategy is the first step in taking forward a sustainable development programme in the NHS in England.

The strategy document shows where NHS carbon dioxide emissions are coming from and proposes clear actions for reducing that carbon footprint. It stresses that is the organisations and people of the NHS who are responsible for the carbon, so it is up to the NHS to reduce it.

To download the strategy document and/or feedback a personal or organisational response to the NHS Carbon reduction Strategy, click here.

Readers might like to view the response to the strategy from the Environment Agency, which can be accessed here.

HSJ Event – Intelligent Information for Effective Governance, January 2009, London

The Health Service Journal (HSJ) has issued advanced notification that it is running the above event on 22nd January 2009 at Earls Court Conference Centre, London SW5. The sub-title for the event is Developing smart reporting systems to empower strategic decision making at Board level.

According to the HSJ, “Good governance is underpinned by intelligent information. Understanding what information is required to support strategic decision making at Board level is imperative. Especially following the launch of the new NHS performance framework, and with the emerging threat of the NHS failure regime.”

The HSJ says that “This unique and timely new national forum has been specifically designed for all senior managers with reporting responsibilities at Board level, IT specialists, and for NHS Board Members themselves. Book your place today to gain the tools and guidance you need to ensure accuracy, quality and relevance of information presented to NHS Boards.”

For full details of HSJ’s comprehensive programme click here.

The HSJ has announced that the following speakers have so far been confirmed:

- Joanna Davis, Chair, Birmingham Children’s Hospital NHS Foundation Trust

- Dr John Bullivant, Director, Good Governance Institute & Professor Michael Deighan, Specialist Advisor on Governance Between Organisations, Joint Authors of ‘Tensions and Issues in Governance’, Routledge 2009

- Stuart Emslie, Assistant Director, Centre for Corporate Governance and Ethics, Birkbeck London University and Visiting Fellow, Loughborough University Business School (and editor, Healthcare Governance Review)

- Rob Murray, Engagement Lead, Audit Commissions’ Trust Practice

A booking form for the event can be downloaded here and you and take advantage of HSJ’s early bird booking discount available until the 10th October 2008.

Health Care Risk Report Vol 14 Issue 9 September 2008

This issue of Health Care risk Report (HCRR), like so many others, has something for everyone.

The cause of healthcare governance is addressed in an article by Healthcare Governance Review editor Stuart Emslie. Essentially, Stuart reviews the new ‘governance between organisations’ debate paper and argues that it’s better management between organisations that is needed to improve services and reduce risks. Governance between organisations is, essentially, the “next taxi off the rank” in the wider world of ‘governance creep’.

There are three articles under the heading ‘risk management.’ The first explores how NHS trusts can use purchasing power to improve patient safety. The second argues that patients and trusts need a clearer view of the risks of infection. And the third provides guidance and advice to community nursing and other community staff on implementing the Mental Capacity Act and contains case examples.

Two legislation updates are provided. The first looks at the future of health care regulation in England, focusing on the role of the Care Quality Commission and the potential for confusion between the Commission and Monitor. The second provides an update on the Mental Health Act.

Finally there is the usual helping of helpful clinical negligence case reviews, plus an article looking at the health service ombudsman’s latest report on learning from complaints, which finds that poor communication is still a recurrent theme.

If you or your organisation do not currently subscribe to HCRR then please consider doing so. A subscription form can be downloaded here.

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.

Canadian health board is first to broadcast its meetings on the Internet

The Alberta Health Services (AHS) board in Canada has posted a video of its inagural public meeting on its website. The video provides an interesting insight into the conduct of a public health board meeting and is believed to be a ‘first’ in terms of health board openness and transparency.

The meeting, held on 13 August 2008, discussed mechanisms for public and staff input to the Board and administration, the Board member recruitment process, and general business bylaws and resolutions.

The video can be accessed here.

Find out more about Alberta Health Services here.

Foundation Trusts told to invest in governance

As reported in the Health Service Journal(18 September 2008) Bill Moyes, Executive Chairman of Monitor, regulator of NHS foundation trusts, has warned that foundation trusts (FTs) need to invest more resources in memberships and boards of governors or else the Department of Health might reassert its control if FTs cannot prove local accountability.

Dr Moyes was speaking at the Foundation Trust Network’s governance conference in Leeds. He said: “[Ministers] still do not have a model that allows them to communicate what the taxpayer wants through commissioning rather than government directive. The more accountable you are the more relaxed they will be, I would judge, about letting go.”

Read the full HSJ article here.

NB - Healthcare Governance Review editor, Stuart Emslie, was a speaker at the conference, which was very well attended. It was apparent from a number of presentations that there is significant confusion over the nature of governance in the NHS. For example, the issue of ‘governance and boards of governors’, as opposed to ‘corporate governance and boards of directors’, is one that is exercising many FTs.

Update on ‘National Inquiry’ into ‘Fit for purpose governance in the NHS’

The Centre for Innovation in Health Management at Leeds University Business School will be sharing its findings of its inquiry into boards and governance at an event to be held at Leeds University on 26 November 2008.

For further information, download the invite to the event here.

See related link here.

What does it take to be a successful NHS non-executive director?

In a Health Service Journal (HSJ) article (16 September 2008), Mike Hay, head of healthcare practice at management consultancy Hay Group, examines the skills, knowledge, behaviours and approach that successful NHS non-executive directors need.

He says that non-executives need to concentrate of five keys areas:

1. Clarify their role
2. Don’t be blinkered by good will.
3. Swap authority for influence.
4. Develop political awareness.
5. Create clarity and make decisions without all the information.

Read the full article here.

DH consults on failure regime for NHS organisations

The Department of Health’s (DH) publication Developing the NHS performance regime, published 4 June 2008, announced the Government’s intention to “establish a failure regime for state-owned providers that reflects the Government’s obligations to ensure service continuity and protect public assets.”

The DH is now consulting on their proposals for such a regime and seeks views on them by 3 December 2008.

Meanwhile, according to a Health Service Journal (HSJ) report (18 September 2008), up to 92 trusts could be “culled” as part of the “NHS failure regime.” For further information, read the HSJ article here.

Download the consultation document Consultation on a regime for unsustainable NHS providers here.

UPDATE 19 September 2008 – Read Paul Dutton’s article (19 September 2008) on failing NHS foundation trusts in the Health Service Journal here.

East Sussex hospital fined £8,000 after cleaner is badly injured

The Health and Safety Executive (HSE) is urging hospitals to ensure that where electrical equipment is used in a damp environment, that suitable protective devices are used, after a hospital employee suffered severe injuries whilst operating a steam cleaner at work.

At Hastings Magistrates’ Court yesterday (12 September 2008), East Sussex Hospitals NHS Trust pleaded guilty and was fined £8,000 and ordered to pay costs of £8,466.71 for breaching the Electricity at Work Regulations 1989 and the Management of Health and Safety at Work Regulations 1999.

This follows an investigation by the HSE at the Conquest Hospital in St Leonards-On-Sea, after a cleaner suffered an electric shock from a steam cleaner. The injuries he received required surgery, and he is now unable to use his right hand. He also suffers severe headaches, deterioration in his eyesight and numbness to his face, which has had a substantial impact on his life.

Despite the manufacturer’s instruction clearly recommending the use of a Residual Current Device (RCD) with the steam cleaner, the Trust failed to supply an RCD. This device cuts the flow of electricity and mitigates the harm caused by an electric shock.

HSE inspector Liz Smith said: “As a result of the hospital failing to adequately assess th e risks inherent in operating the steam cleaner, the victim suffered a significant number of injuries including the loss of use of his right hand.

“It is well known that electricity and water do not mix and there is an increased risk of an electric shock or even death. An effective means to protect against the effects of an electric shock is to provide an RCD, which is cheap and widely available, and may save a life. If the Trust had provided an RCD, the victim would not have suffered such significant injuries, which have affected his life.

“Hospitals need to assess the risks from all electrical equipment, but particularly equipment that is used in a wet environment, and put in place suitable measures, such as RCDs, to protect their employees, as a way of reducing the risk of incidents like this happening”.

Source: COI – click here.

Building effective NHS boards – Introductory Policy Governance workshop at Birkbeck, London University – 22 October, 2008

The UK Policy Governance Association (UKPGA) in association with the new London Centre for Corporate Governance and Ethics at Birkbeck, London University, are holding a workshop on Wednesday 22 October. The event will take place in the Council Room at Birkbeck (see maps) and will focus on building effective NHS boards using Policy Governance.

The use of Policy Governance at Southend University Hospital NHS foundation trust will be a specific case study with both the Chair and CEO of the trust making presentations and participating in a ‘board governance surgery’.

The event costs £100 per delegate. Spaces are limited so it is advisable to book early. E-mail ukpolicygovernance@gmail.com to reserve your space.

For further information, download the flyer here.

Related link here.

Research report finds public release of performance results leads to improved quality of care

The Health Foundation has published a report, based primarily on research from the USA, that finds public reporting of performance results in improved quality of care.

In theory, according to the Health Foundation report, disclosing performance results increases the accountability of healthcare providers as managers will be concerned about maintaining their public image and increasing market share. It also motivates quality improvement activities in healthcare organisations, especially by targeting underperforming areas identified by the performance results. The report did indeed find that the public release of poor data was a major driving force in hospitals improving their quality of care. In New York, poor results also led to an increase in surgeons resigning.

The report also suggests that even in a country with an established market in healthcare, patient choice of hospital is not affected by poor results.

Download the report here.