Policy Governance in the NHS

September 3, 2009

The Association of Certified Chartered Accountants (ACCA) has published an article on Policy Governance in the NHS.

Policy Governance is a highly organised approach to board efficiency. Policy Governance starts from directors’ agreement about their board’s purpose and culminates in a set of standing controls that the board constantly uses and improves upon to get its job done. 

Using Policy Governance equips boards to:

- display leadership – from their own agenda, not the executive’s
- think as many; act as one
- secure their organisations within rigorously monitored bounds of safety and ethics
- make purpose number one
- find time and space to focus on the future
- have one concise living document that integrates all they need to say
- empower their executives to be their best
- have brief clear regular information about all they need to control.

Policy Governance is described by Sir Adian Cadbury as the most conceptually coherent model of board governance that currently exists. BPs board governance principles (see www.bp.com) are based on Policy Governance. Several NHS organisations are currently implementing the Policy Governance approach to board governance, including Southend University Hospital NHS foundation trust, Hereford Hospitals NHS trust and Leicestershire Country and Rutland Community Health Services.

Read the article Policy Governance in the NHS click here.

For further information on Policy Governance click here.


Implementing Policy Governance – Board efficiency in practice. Intermediate level seminars in Manchester and London

August 28, 2009

Caroline Oliver is running two 2-day intermediate level Policy Governance seminars in Manchester and London.

The Manchester event is for NHS participants only and will take place on 30 September and 1 Octber at Manchester Business School.

The London event is open to participants from any sector and will take place on 28/29 October at Birkbeck, University of London.

Each event costs £250 plus VAT per delegate and includes a working lunch on both days.

For a detailed course outline and to reserve a place, visit Caroline’s website here.


NHS Governance 2009 conference a success

June 29, 2009

The Health Service Journal’s (HSJ) annual NHS governance conference held over 3-days at Earls Court in London this week attracted over 300 delegates across the different days, with some attending two or all three days.

The conference was a great success with a host of excellent speakers plus good audience participation during panel sessions, etc.

The general state of chaos and confusion around governance and management was a key issue to come out of the event. The speaker from the new Care Quality Commission added to the confusion by saying that “governance relates to consistent management, cohesive policies, processes and decision rights for a given area of responsibility.” This is a new definition that does not align with the myriad definitions already in place in various NHS guidance documents, and does not conform to key thinking about governance. Interestingly, another speaker coined a ‘new’ governance term at the event. Professor Paul Stanton spoke about “intelligent governance.” Healthcare Governance Review looks forward to the day that the subject of governance in the NHS will be addressed ‘intelligently’ by the Department of Health and associated agencies and bodies, including the new Care Quality Commission!

The presentations from the event should be posted on the web for free download by 3 July. When available, download the presentations by clicking here.


Ownership and boards – a short article

April 19, 2009

Internationally renowned  board and Policy Governance specialist Caroline Oliver believes boards are very special in that they have a specific purpose, which is to serve those who put them there – i.e. the organisation’s ‘owners’.

She has written an article titled ‘Ownership and boards’ in which she clearly and succinctly sets out why ‘ownership’ matters; provides assistance to boards to help them identify their owners;  differentiates between owners and other stakeholders; and provides insights into ‘making ownership count.’

According to Oliver, ”……ownership is where board leadership starts and where it must come back to in terms of accountability. With a clear common definition of ownership your board will be able to lead together and with confidence. And, with your whole organisation’s future at stake – the work involved in identifying your ownership has to be worth it.”

Read the full article Ownership and boards here.


Looking at the problems at Mid Staffordshire NHS foundation trust through a Policy Governance lens

March 23, 2009

Caroline Oliver, a World authority on building high performing boards using the Carver Policy Governance model, has responded to the situation at Mid Staffordshire NHS foundation trust (see below) with a short article titled ‘Danger – Targets at Work’.

According to Caroline, the main problem in the NHS currently is that  ”assurance systems are often assuring the wrong things, by which I mean that they are assuring compliance with matters of means rather than ends.”  

Healthcare Governance Review believes that had the Mid Staffordshire board been focused on ends (i.e. organisational purpose) rather than fixated on various means issues, the outcome for many patients who allegedly died unnecessarily might have been very different.

Caroline states that “the work of boards in healthcare really matters.” Further, she believes that “the immediate hope for progress in terms of distinguishing ends from means lies with NHS boards who are the only people at local level who have the authority to require an ends focus and to hold themselves and their organisations accountable for the fulfillment of same. When boards define ends they are defining their organisation’s real bottom line – the criteria against which everything they do should ultimately be judged. When boards define ends they are providing meaningful leadership. Yes they need to ensure that everything about the organisation is legal, prudent and ethical, but without ever losing sight of the organisation’s purpose.”

You can read Caroline’s full article, Danger – Targets at Work, on her website here.


Measuring What Matters – Creating a Board Dashboard

February 28, 2009

The following article was published by Caroline Oliver on the Charity Channel. Caroline has kindly given permission to reproduce the article here on Healthcare Governance Review.

They say that you get what you measure. At board level, measuring what matters is vital because setting the right direction is so much at the heart of the board’s responsibility. But, at the board level, it is also vital to measure only what matters be cause boards have so little time to govern so much. Both of these points I would suggest lie behind the typical board’s attraction to things like KPI’s (key performance indicators) and balanced score cards. It is surely every board’s dream to be able to look at a single piece of paper and see exactly where their organisation is on everything that matters. The question is, is it really just a dream?

I don’t believe having such a dashboard has to be just a dream but I do believe it has to be extremely carefully designed in order to avoid some critical pitfalls. Let us think of governing an organization as analogous to flying an airplane and think of the board’s information challenge as similar to that faced by a pilot. Airplane pilots have a dashboard upon which they can see exactly where they are on key measures to do with getting to their destination such as direction, and distance as well as internal and environmental measures to do with their safety along the way such as engine temperature and coming weather systems. What is critical for the dashboard to be effective is that it is designed from the pilot’s perspective because although the pilot is responsible for everything on the plane once it is in the air, he or she cannot view everything at once. Indeed the more information the pilot has the more likely it is that he or she will miss something vital.

For boards this means that it is essential that any dashboard that gets created is created from their perspective rather than from the perspective of managers. And what this means is that the board’s perspective about what matters must be clear by which I mean explicitly stated in the form of well-organized written expectations.

I say “well organized” for one of the ways that can make it easier for the board as pilot to comprehend its dashboard is if like things are grouped together. The most important expectations from the board’s perspective are those that define the organization’s destination. Notice that what matters here is not what the organization is doing – for then you will only end up measuring busyness. What matters here is defining whose lives should be different and how and with what cost-efficiency if the organization is to be deemed successful by the board. The next most important expectations I would suggest are those that govern the organization’s exposure to internal and external risks in terms of prudence and ethics. The final group of expectations would be those that govern the operation of the board itself which could be divided between those that govern the board’s role and conduct and those that govern how the board delegates to others and monitors the proper use of that delegated authority.

To sum up, continuing with the airplane analogy, a pilot’s dashboard display needs to be grouped around matters to do with progress towards the plane’s destination, matters to do with internal and external risks it might need to deal with along the way, and matters to do with the conduct of the pilot and his or her delegation to, and monitoring of, the crew.

The problem with many of the scorecards and KPI’s that boards use is that they are designed from the perspective of managers rather than governors. Thus, they display the information that managers think that boards should know rather than the information that boards have determined for themselves that they should know. Secondly they may not clearly distinguish between measures that track progress towards the organization’s destination and measures that track everything else – leading to the often seen problem of organizational airplanes busily flying round in circles. Thirdly, it can simply produce too much stuff so the board cannot clearly see what it has and has not got and therefore might just as well have no information at all.

Which brings me back to the issue of keeping the sheer amount of information down to a manageable level when you are accountable for everything. Having the board’s expectations appropriately grouped from a board rather than management perspective certainly helps but it doesn’t do the entire trick. There is another critical point about keeping the number of board expectations down to a number that a board can realistically track. Going back to our pilot…. let us take one indicator by way of example, engine temperature. An engine could overheat for all sorts of reasons, the vast majority of which the pilot would not be expected to fix directly. Overwhelming the pilot with indicators about all the potential causes of engines overheating, given that the pilot does not have the expertise to read those indicators and do anything with them does not make a lot of sense. What the pilot needs to know is whether the engine operating at the right temperature. Knowing more only becomes necessary if it is not and the pilot needs to call on expert help to get it fixed. Similarly the board does not need to know about all that goes into meeting their expectations – what they need to know is whether or not their expectations are being met and to get their Chief Executive on the case of fixing things if not.

Boards that use the Policy Governance® approach, the principles and practice of which form the basis for much of this article, have a further tool for keeping the number of their expectations to a reasonable number and thus their dashboard comprehensive but capable of being understood. That tool is the Policy Governance policy architecture that starts from the broadest level in each area of board concern and gets progressively more specific until the point at which the board is agreed that it can responsibly accept ‘any reasonable interpretation’ of what it has already said.

So, having a board dashboard does not have to be a dream, but it is no quick and easy thing to establish if you are going to be sure that you are measuring what matters. For, if want to be as certain as possible that you are measuring what matters you need to be sure that your dashboard:
- starts from a comprehensive set of well written and well organized board expectations.
- distinguishes matters to do with progress towards your destination from matters to do with what might happen along the way
- gives you what your board must know in order to know if its expectations are being met – and no more.

Note: Policy Governance® is the registered service mark of John Carver. Used with permission. The ® after Policy Governance is a symbol used to protect the integrity of the principles and practices that make up the Policy Governance model. Its use does not imply any financial obligation to the service mark owner. The authoritative website for the Policy Governance model can be found at www.carvergovernance.com


One day introductory Policy Governance seminar by Caroline Oliver – 22 April, Oxford

February 18, 2009

Caroline Oliver will be running a one day Policy Governance seminar for NHS board members on Wednesday 22 April in Oxford.

Policy Governance is, according to Sir Adrian Cadbury, the most conceptually coherent and integrated system of governance for boards. Southend University NHS foundation trust are using Policy Governance and other NHS organisations are beginning to follow.

The cost of the seminar is £75 (+VAT), which includes a working lunch.

Caroline is running the same seminar in Yorkshire on 11 March, but it is booked out.

Places in Oxford are limited. To reserve your place and explore the programme for the day click here.


Forthcoming HSJ Governance Challenge and 5th annual NHS Governance conference

February 14, 2009

Looking ahead to 2009 and beyond, immense challenges can be seen which will test even the most robust NHS governance systems. The Health Service Journal (HSJ) has lined up a number of exciting events in March and June. Click here for further information on the HSJ Governance Challenge and pre-study day Fundamentals of NHS Governance (24/25 March 2009 in Birmingham) and click here for details about the 5th annual HSJ NHS Governance Conference (23-25 June, London). Don’t miss these important events.


View presentations from HSJ conference ‘Intelligent information for effective governance’

January 29, 2009

The Health Service Journal conference Intelligent information for effective governance, held on 22 January 2009 in London, attracted around 170 people and was a great success.

Speaker presentations are now available for viewing by clicking here.


One way to govern – a short Policy Governance article by Caroline Oliver

January 28, 2009

Caroline Oliver, international board governance specialist and author of three books on John Carver’s Policy Governance model, has recently published a short article on Policy Governance.

The article begins with Caroline saying that “Successful governance provides a mechanism for people to direct and control the organisations we create to make the differences we desire and thereby take our societies forward. Whether we are talking about national governments, public organisations, for-profit organisations or non-profit organisations – governance is what makes their wheels go round.”

Read the rest of Caroline’s article here.


New book for boards – Getting Started with Policy Governance

January 10, 2009

Caroline Oliver, author and co-author of a number of books on Policy Governance, has a new book that EVERYONE concerned with board governance in healthcare should read.

Getting Started with Policy Governance – Bringing Purpose, Integrity, and Efficiency to Your Board is, according to Geraldine Peacock, former chair of The Charity Commission,  “…..a great read…..comprehensive, accessible, and fills a big gap in the market.”

Policy Governance was developed by Dr John Carver, whose seminal book for public and non-profit organisations - Boards That Make a Difference – is by the far the World’s largest selling book on board governance, with over 100,000 copies sold.

Carver’s Policy Governance approach was commended in the Department of Health’s recent publication on Implementing Trust, Assurance and Safety (click here for further information) as providing “….the most relevant and sensible advice, focussed on the public/not for profit sector, and widely respected.”

Dr Jay Bevington of Deloitte’s (formerly associate director of board development at the National Clinical Governance Support Team) says “What a truly outstanding and thought-provoking book! It changed how I work with boards overnight and forever! If we all took the advice within the pages of this book, then organisations would deliver greater value to their owners and be better places to work.”

John Bruce, chair of Southend University Hospital NHS foundation trust says “For boards wanting to raise their game, this book is very thought-provoking and helpful. It’s a must for all board members. Board chairs – ignore it at your peril!”

Caroline’s book is currently priced at £15.83 on amazon.co.uk and can be found here.

Declaration of interest: Stuart Emslie, editor of Healthcare Governance Review, is CEO of the UK Policy Governance Association, a non-profit organisation dedicated to advancing owner-accountable, ethical and effective governance using the Carver Policy Governance model.


Building effective NHS boards – UKPGA/Birkbeck ‘Policy Governance’ event a resounding success!

October 27, 2008

The joint UK Policy Governance Association (UKPGA) and London Centre for Corporate Governance and Ethics (LCCGE) at Birkbeck, University of London, event on 22 October 2008 appears to have been a resounding success.

Almost 40 people turned up at Birkbeck College in London to hear how Policy Governance can help NHS organisations build truly effective boards.

For an independent view of the event, please read the MAC Partnership blog here.


No Authority? Then No Accountability – the ‘Policy Governance’ view of the NHS Constitution

October 27, 2008

The consultation on the proposed NHS Constitution closed last week.  According to the MAC Partnership in London, “the UK Policy Governance Association (UKPGA) said it all……”

The UKPGA submission focused on two key aspects: accountability and local determination of needs. Those have to sorted out first before service users can be clear about what their entitlements to services are. But the NHS Constitution lacks a statement of accountability – ie there is no answer to the question “to whom is it accountable and for what and how is that accountability to be exercised?”

Read the MAC Partnership’s view on all of this here.


Listen to John Carver talking about ‘Reinventing Your Board’

September 27, 2008

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).


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

September 7, 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.


Implementing Trust, Assurance and Safety – DH publishes guidance on building effective boards

September 5, 2008

The Department of Health (DH) has published Niall Dickson’s final report and the DH’s own response to his recommendations in relation to enhancing confidence in healthcare regulators.

A significant dimension to the report relates to the development of effective boards.

At Appendix 3 of the publication is a report on the characteristics of effective boards by the Council for Healthcare Regulatory Excellence (CHRE). The CHRE report is based largely on John Carver’s book Boards That Make a Difference, which, they say, “offered the most relevant and sensible advice, focussed on the public/not for profit sector, and widely respected.” The CHRE offer, based on Carver’s work, “12 key principles of an effective board” as follows:

1. The board should determine the purpose and values of the organisation, and review these regularly
2. The board should be forward and outward looking, focussing on the future, assessing the environment, engaging with the outside world, and setting strategy
3. The board should determine the desired outcomes and outputs of the organisation in support of its purpose and values
4. For each of its desired outcomes and outputs, the board should decide the level of detail to which it wishes to set the organisation’s policy
5. Any greater level of detail of policy formulation should then be a matter for the determination of the chief executive and staff
6. The means by which the outcomes and outputs of the organisation are achieved should be a matter for the chief executive and staff; the board should not distract itself with the operational matters
7. The chief executive should be accountable to the board for the achievement of the organisation’s outcomes and outputs
8. In assessing the extent to which the outcomes and outputs have been achieved, the board must have pre-determined criteria which are known to the chief executive and staff
9. The board should engage with its ownership regularly and be confident that it understands its ownership’s views and priorities
10. The membership of the board should be capable and skilled to represent the interests of the ownership; this should not be done in a tokenistic way
11. Information received and considered by the board should support one of two goals – to enable decision making, or to fulfil control and monitoring processes
12. The board must govern itself well, with clear role descriptions for itself, its chair, and its members, with agreed methods of working and self-discipline to ensure that time is used efficiently

Paul Stanton, former Director of Board Development at the National Clinical Governance Support Team, has recently stated in a Health Service Journal article, that his own thought on good governance are “influenced by the work of John Carver, whose model of ‘policy governance’ is admirably clear……….” (see Healthcare Governance Review post here).

Download a copy of the publication Enhancing Confidence in Healthcare Professional Regulators – Niall Dickson’s final report and DH response to the recommendations here.