Developing high performance healthcare boards in practice: from anecdote to evidence-based performance improvement Stuart Emslie Assistant Director, London Centre for Corporate Governance and Ethics, Birkbeck, London University Visiting Fellow, Healthcare Governance and Risk, Loughborough University Business School Formerly Department of Health Head of Controls Assurance for the NHS in England
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Developing high performance healthcare boards in practice: from anecdote to evidence-based performance improvement Stuart Emslie Assistant Director, London.
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Developing high performance healthcare boards in practice:
from anecdote to evidence-based performance improvement
Stuart Emslie Assistant Director, London Centre for Corporate Governance and Ethics,
Birkbeck, London UniversityVisiting Fellow, Healthcare Governance and Risk, Loughborough University Business School
Formerly Department of Health Head of Controls Assurance for the NHS in England
Thought for the day #1
"I've never seen a distressed organization that could not be traced
back to ineffective governance." Larry Scanlan, President & COO,
The Hunter Group, USA
‘Governance’ in healthcare• Board• Care• Clinical • Commissioning• Community • Converged • Corporate• Direct • Educational• Enterprise• Environmental• External• Financial• Governance between organisations• Health and Social Care• Health• Healthcare• Hospital• Indirect• Information• Integrated• Internal
• Board adopts some explicit goals for itself, distinct from goals it has for the total organisation
• When faced with an important issue, board “brainstorms” and tries to generate a whole list of creative approaches or solutions to the problem
• Before board reaches a decision on an important issue, it requests input from persons likely to be affected
• Board acknowledges responsibility for ill advised decision.
• etc.
Findings cont…..• Boards really can make a difference• Need improvements in methods for
evaluating board effectiveness• Benchmarking is an important driver in
board performance improvement• Boards need a governance ‘operating
system’ – “It’s easier to change a board’s behaviour through system and process changes that enable board members to act differently, than through exhortation.” (Chait, Holland and Taylor).
Paul Stanton is “influenced by the work of John Carver whose Policy Governance model is admirably
clear……”
CHRE………”we looked at available key publications on governance and on the guidance specific to health.
Having done so, we felt that John Carver’s Boards that Make a Difference (Third Edition 2006) offered the most relevant and sensible advice, focussed on the public/not
for profit sector, and widely respected.”
Policy Governance [is a] fully integrated and coherent system of governance, a significant advance in
management thinking, as near a universal theory of governance as we at present have."
Sir Adrian Cadbury
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, 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
June 2008 – Characterisiticsof an effective board……
“It’s easier to change a board’s behaviour through system and process changes that enable board members to act differently, than through exhortation.” (Chait, Holland and Taylor).
Take home message…..
Anecode is fine, but if you are looking for robust organisational