Blog

Governing Your Governance Policy

By Patricia Daughenbaugh

  • print
  • comment
Governance:  A process "relating to decisions that define expectations, grant power, or verify performance.  It consists either of a separate process or of a specific part of management or leadership processes".  (Source: Wikipedia)

That definition essentially boils down to oversight, measuring who exactly is looking at and regulating what, where, and how decisions get made.  I know that this seems a Mobius Strip of people peering over other people's shoulders, but the concept of governance is as old as the policies they're meant to regulate.  There are governance policies for virtually every industry and yet many hospitals haven't made governance fundamental to their day-to-day operations.   

When we talk about governance in the hospital environment we are not talking about the Board of Directors.  We are referring to the systems and structures established around departments and services that allow an organization to reach peak performance.  As a former CNO and a healthcare management consultant for the past 11 years, I believe that governance at that department level is not as productive as it could be. Governance is more than a monthly scheduled meeting or a set a rules.  An effective governance structure is inclusive, vibrant and open.
 
There are five essential components to a successful structure:
  1. Operational dashboards,
  2. Mechanisms to communicate performance and trends to the individuals who can do something about it,
  3. Decision making processes that are clearly defined,
  4. Cultural environment that encourages open honest discussion of challenges and opportunities from all perspectives (staff, physician and hospital) and finally
  5. Appropriate representation from constituents who regularly attend meetings.  These components lay a framework, which supports an organization's ability to make data driven, transparent decisions that align with the hospital's strategic goals.  

Without this structure Surgical Services Departments may be making decisions about surgeon's block schedules that effect optimal utilization of OR time or Patient Flow Committees may be focusing on process improvement efforts without results because they haven't clearly identified the root cause of the systemic problem.   

Let's dig a little deeper and examine another popular example.  Look at the formal structures that have formed in hospitals in response to the heightened emphasis on patient flow and patient safety.  It seems like a given that there must be an efficient and measurable process in place that ensures a proper care cycle, while keeping a vigilant eye on safety and quality of care, yet we find the organizations that hospitals have built up around them are weak in their governance structures, often relying on systems that may have worked years ago, but have yet to be upgraded.  It's essential to upgrade these processes to Version 2.0!

How does your hospital rate?  Be honest.  On a scale of 1 to 5, how effective is your hospitals' governance structure as it relates to its:

A)    Patient Safety Council
                (5).............................(4)...........................(3) ..........................(2)........................................(1)
       Very effective     Somewhat effective     Not Sure     Somewhat ineffective     In need of an overhaul

B)    Patient Flow Bed Huddles
                (5).............................(4)...........................(3) ..........................(2)........................................(1)
       Very effective     Somewhat effective     Not Sure     Somewhat ineffective     In need of an overhaul

C) Perioperative Services Block Scheduling Committee
                (5).............................(4)...........................(3) ..........................(2)........................................(1)
       Very effective     Somewhat effective     Not Sure     Somewhat ineffective     In need of an overhaul

Now tally your score.  If you scored less than 12 points, you need to take a hard look at the governance structure overarching your institution.

These are crucial organizational entities that, without  rigorous structure and oversight, are exercises in futility.  Without the guidance of an effective governance structure to tell them how to use information to make decisions and achieve results, best in class performance will continue to elude them. Their effectiveness could be improved by focusing on committee membership and structure and utilizing effective dashboards to make data driven, transparent decisions.  

Of course, the first step in being able to rectify these policy weaknesses is recognizing that there's an issue.    It takes a clear understanding of the benefits of a strong governance structure to be able to turn the magnifying glass inward and do a careful introspection of your current performance.  In the coming month I will go into greater detail about how to set up a governance structure for Perioperative Services and Patient Safety.

Comments






To prevent spam, please enter the words below before submitting your comment.