Notable quote: Making sense of NHS governance

"The ideas, principles and mechanisms constituting governance in the NHS derive from an amalgam drawn from corporate governance, public governance and a variety of other sources. The resulting miscellany presents directors, managers and senior clinicians with a considerable sense-making challenge."

Richard Holti and John Storey – Clinical and non-clinical executive directors’  Sense-making of the new governance arrangements in the NHS. Download here.

Notable Quote: Sir Stuart Burgess on the board’s conundrum

“How do you equate the total accountability of the board for all that the organisation does with the practical impossibility of knowing everything that is being done in the board’s name?”

Sir Stuart Burgess, quoted in Corporate Governance Countdown

Notable quote: Happy boards

“A happy board is probably not effective.”

Dr Graham Rich, CEO, University Hospitals Bristol NHS foundation trust

Notable quote: The Tories on NHS accountability

According to Andrew Lansley, Conservative shadow health secretary writing in the Health Service Journal 8 October 2009, a Conservative government “…..will require accountability at all levels for results, measured in terms of patient outcomes rather than distorting targets.”

If the rhetoric can be realised, Healthcare Governance Review believes that this approach would significantly help strengthen NHS governance.

Notable quote: A doctor’s view on patient quality and outcomes

 

“In the twenty first century most doctors and nurses still haven’t got much of a clue about the quality of care we’re providing, the effect we have on you, what happens to you after you’re discharged, whether we’ve made your life better or worse or even if we’ve killed or cured you. We operate and consult in a vacuum, with virtually no feedback, just muddling through and hoping for the best.”

Dr Phil Hammond, 2002. Trust me, I’m a doctor. Metro Publishing, London

Notable quote – NHS boards and the law

“Many trust board members cannot be sure that their hospital is operating within the law.”

Audit Commission, 2009 (Taking in on trust)

Notable quote – clinical governance

“A good clinician will make consistently good clinical decisions, but having a system of effective clinical governance means there is a structure to ensure that this is not by chance, but follows from good recruitment, continuing professional education and clinical audit. Such a system will enable good performance to be sustainable and to be spread across the organisation.”

Owens, D (2005) Good integrated govenance should start from the top and spread to every aspect of the organisation if high quality care is to be sustained. Health Service Journal 9 June 2005 pp35-37

Notable quote – boards and managers

“Boards and Managers……do not own the business but sell their skills to act on behalf of the owners, and do not produce personally but are indispensible in making others produce through motivation.”

Cultural constraints in management theories. New management reader. Routledge, Open University, 1996

Notable quote: Management Vs (clinical) governance

“The relationship between the governing body and the front line is in essence clinical governance……..management is about running the business, governance is about seeing it run properly.”

Adrian, A (2000). Clinical and corporate governance – salvation or just jargon? Australian Nursing Journal Vol 17 Issue 10

Notable quotes – corporate governance

Readers are encouraged to reflect on the following quotes in the context of the governance of public sector healthcare organisations.

“People get religion of sorts about ethics and corporate governance in down markets. When things are going well, they tend to forget about it.” James A Allen. 

“With the trillions of dollars that have been wiped out of pension plans and other savings, investors have come to understand they need to pay attention to the governance of corporations — from compensation to board structures. If they don’t, the cost is going to come out of their pockets. They’ve got to be engaged.” Stephen M Davis.

These quotes were taken from a USA article on executive pay. Read full article here.

Notable quote: Organization complexity and perceptions of risk

“……..risk, rather than being a linear, objective and manageable concept, is actually created, re-created and constructed. The construction of risk takes place within the constant sense-making that occurs in organizational life. Risk is, therefore, a complex phenomenon, and one that cannot be fully subjected to objective and rational analysis. Indeed, because risk is created through the ways in which reality is constructed by members of the organization, such risks are not ‘real’ but rather based on assumptions and perceptions.”

Steve McKenna, CEO, Singapore Institute of Commerce
For further information, click here.

Notable Quote – Governance and ethics

“At its core, governance is using ethics to address the major issues an organization faces.”

Ritvo R A, Ohlsen, J D and Holland, T P (2004). Ethical Governance in Health Care. AHA Press. Chicago, USA.

 

Notable quote: Active boards….

“Just asking questions is passive. Active boards lead by setting comprehensive standards for the organisation and constantly monitoring against those standards – asking ‘where are we up to?’ on each and every one.”

Caroline Oliver (click here)

Notable quote – Improvement

“Improvement is a continuous process and for health care especially, it’s one where the target is constantly moving.”

Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission, USA

Notable quote: On the accountability of doctors…

“It is difficult to make doctors accountable for their actions as they are used to a great deal of autonomy, public esteem and respect. They are used to being in control.”

John Tingle, Health Care Risk Report, November, 2008

Notable quote: NHS boards and organisational performance

“What difference do boards make? Connecting the structure, roles and behaviours of boards with evidence of impact on organisational performance is beset by theoretical difficulties and weak evidence, but it is worth the effort.”

Naomi Chambers, Health Service Journal, 7 Nov 2008 (Click here for full article).

Notable Quote – “Governance is a serious job………..”

“Governance is a serious job, with serious consequences, and boards need to acknowledge the importance of that job and devote reasonable time to learning it.”

The Governance Coach – Vol. 13 No. 2 June 2008 – download the full newsletter 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.]

Notable Quote – Dr John Carver on governance and board effectiveness

“A carefully crafted, conceptually rigorous purpose of governance………..forms the heart of board effectiveness.”

Dr John Carver. Boards That Make a Difference, p. xxviii

Notable quote – On CEO turnaround……

“Chief Executives who move on every two or three years cannot possibly achieve transformation – turnaround maybe, but not sustained high performance in which all members of staff are engaged and energised.”

Stephen Ramsden, Chief Executive, Luton and Dunstable Hospital NHS foundation trustHealth Service Journal, 20 March 2008, p.26.