Autumn Newsletter - Page 2



Apart from the role of the Company (or Board) Secretary,
(who has a particular specialism in the application of
corporate and hierarchical governance), the principles of
dynamic governance should belong to every member of
staff and every member of staff should be able to relate
exactly what it means to them in their working lives.
Soft intelligence
Hard assurance
Information flows
Dynamic governance should be in the ‘bricks and mortar’
of the trust and in ‘the way we do things’ on a day by day
basis. Governance which is dynamic, starts at ward
handover; where the whole shift-team stand up at the
ward information Board, they talk about patients, clinical
priorities, key risks, ways of working and what patients
are saying through their feedback. Responses to
problems are instigated at a local level and risks are
managed promptly and at the right levels all within a
‘permissions’ based culture. Or at Board-level where nonexecutive directors are keen to hear how the Nurse
Director ‘feels’ about safety today and they are able to
relate this to the hard assurance they are seeing.
When Boards learn to rely upon the key ingredients of
hard and soft-assurance, when they learn the importance
of feeling as well as thinking and seeing; they learn to
trust exception (and exceptional) based reporting. Their
confidence in their own handling of quality and safety
increases as they lessen their reliance upon the ‘industry
of assurance’. In addition to this the extent to which the
Board are ‘surprised’ by quality and safety failures is
reduced. The Board can become truly agile in its thinking
and strategic in its approach.
But what are the factors which inhibit dynamic
governance? There can be many and they can be deeply
corrosive to the controls which an organisation works so
hard to achieve. An organisation which has poor
leadership culture, which reports defensively and
tolerates risks at the wrong levels will likely end up in a
cyclical scenario where opportunities for learning (if
identified at all) never truly translate into improvements.
These organisations will see issues of the same causal
factors time and time again, on a year on year basis
(although they will likely rarely undertake this type of
analysis). These organisations will confuse joint
reporting with joint analysis and will really struggle to
understand the correlation between complaints, claims,
incidents and audits; information will be reviewed in
silos and non-executive directors, or lay-members, will
find it difficult to search through the tidal wave of
information, thereby reducing effective challenge.
A classic issue is the extent to which a trust exploits
the full functionality of its main electronic risk
management system (for example Datix or Safeguard).
When used effectively systems like this are excellent in
support of dynamic reporting, more often than not,
however, systems have become out of date or
unwieldy; there are insufficiently trained system ‘super
users’ or those who understand and know how to get
the best from the system. Conversely, we often see
scenarios where there is not enough ‘gate-keeping’
and governance teams are continuously patching and
working around a poorly organised system.
Organisations should employ simple steps to improve
the ‘flow’ of information and assurance such as the use
of assurance based report cards between subcommittees, committees and the board. The key is to
ensure that governance at every stage of the cycle is
as agile as possible and that there is a reasonable
assimilation of hard and soft assurance. Getting this
right not only helps to create a safe, open and learning
culture but also supports an ethos of efficiency;
something that is so often an afterthought in relation to
governance.
Ask the right questions….
1. How does governance work in your
organisation?
2. Are you ever surprised by issues or concerned
that you didn’t know something important?
3. Have you looked at your systems and
processes for governance outside of the
confines of a ‘well-led’ review or inspection?
4. Do you think that you achieve the right
balance between central control and devolved
governance?
5. Do you empower ward managers and middle
managers to own governance and to create an
environment permissible to change?
Kate is the Governance and Assurance Partner at
Niche and has worked with over 160 Healthcare
organisations nationally in supporting governance.
Kate.jury@nicheconsult.co.uk
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