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The meaning of direction and control October 25, 2010

Posted by ukpga in Uncategorized.
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A UKPGA response to ‘Governing the New NHS: Issues and Tensions in Health Service Management‘ by John Storey, John Bullivant and Andrew Corbett-Nolan,1 Routledge, 2010.

The authors of the above named book report that they “are not persuaded by the ‘policy governance’ view which seeks to keep governance separate from organisational management.” They continue:

“Indeed, we suggest that many of the failings in health-care governance in both provider and commissioning trusts in recent years have stemmed from directors failing to understand the nature of health care and failing to be appropriately engaged."

They also assert the following:

"The detached gaze that justifies governance as a separate function from operational management is all very well, but the principle which separates governance from operational detail or even from management can lead to isolation from reality and into a parallel world of processes without purpose. Too much obsession and reliance on process may result in neglect of the patient experience."

"We argue that governance in health services needs to go beyond the Carver model. While recognising that the distinction between management and governance needs to be the subject of serious consideration, health-care governors need to insist on engagement with whatever information is relevant to assure themselves of patient safety and quality of service."

This response from the UK Policy Governance Association (a non-profit, public benefit organisation) starts from the generally accepted view that board governance is about direction and control. On this point we suspect the above authors would agree with us. Where we differ it seems is on how best boards can provide direction and control.

Traditionally most boards operate by examining documents and data provided by management and occasionally by external auditors. They do this in more or less detail depending on how concerned they feel about a particular topic. The level of concern varies in accordance with the calibration of individual board members’ antennae and in their response to concerns expressed to them by external authorities, staff or patients.

Thus, where the board focuses its attention at any given moment is a fairly random affair. This has the advantage that the board might thus be alerted to something really important. However it also has the very serious disadvantage that it could be missing something far more important.

The premise of Policy Governance is that every board is collectively accountable to their organisation’s legal (and in some cases, moral) ownership for everything that their organisation does and does not do. Thus it is important that, on behalf of their owners, boards set comprehensive standards for organisational accomplishment and risk management the monitoring of which enable it to keep its collective eye on everything all the time – not just some things some of the time. Policy Governance has been specifically designed with this challenge in mind.

In the absence of having an alternative to offer for meeting this challenge, the authors would do well to study Policy Governance and the reasons for its continuing popularity more closely. Of course health-care governors need to insist on engagement with whatever information is relevant to assure themselves of patient safety and quality of service but we suggest that the boards that use Policy Governance to do this in a collective, comprehensive and systematic fashion are providing far superior assurance when compared to the boards that don’t.

1 Governing the New NHS: Issues and Tensions in Health Service Management‘ by John Storey, John Bullivant and Andrew Corbett-Nolan. Published by Routledge, September 2010.

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