December 5, 2011
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.).
November 16, 2011
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.
November 16, 2011
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?
November 16, 2011
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.”
November 1, 2011
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.
November 1, 2011
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/
October 30, 2011
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.