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Governance in New Zealand Public Healthcare Services. Governance is governance. Same principles – Accountability Probity Transparency Fiduciary Duty No matter what the context. Governance. The making of decisions in good faith Independence of mind With the skills, diligence and care - PowerPoint PPT Presentation
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Governance in New Zealand Public Healthcare Services
Governance is governance
• Same principles –
• Accountability
• Probity
• Transparency
• Fiduciary Duty
No matter what the context
Governance
• The making of decisions in good faith
• Independence of mind
• With the skills, diligence and care
Taken on behalf of others
Governance
The structures of governance are –• Audit• Laws• Guidelines• Codes• Principles
Which support decision-making on behalf of others
Governance
By contextualizing governance we obfuscate decision-making
We limit the opportunities to get a common understanding of
governance
Disparities in Understanding
• Management
• Reduction in professional status’
• Control over practice
• Power plays
• Elastic and multifaceted
Governance appears as..
• Structure
• Process
• Behaviour
• Carrot and Stick
• Reinforcement of rules
• Guidelines
Clinical Governance
• Focus on Quality Assurance
Principles of accountability, transparency and duty have limited operationalisation
Trust
Focus on audit and compliance
= Lack of trust to undertake professional roles
Crisis in trust
www.bbc.co.uk/radio4/reith2002/lectures
Paradox
The trust in directors, managers and clinicians as stewards of the organisation is paradoxically opposed to the “sacred duty of trust” which clinicians accept as the fiduciary duty to make decisions in the best interests of their patients.
Governance in Healthcare services
“Governance is the decision made on behalf of others within a given and accepted relationship of trust. Decision-making in governance in healthcare services is firstly characterised by professional maturity which enables accountability, quality and safety which assures probity, power and tension which supports transparency and balancing the duty of utility and the duty of care which compliment fiduciary duty. Secondly, governance decisions are supported by the structures of law and policy and within the context of time.”
Governance operationalised
Professional maturity -accountability
Quality and Safety -probity
Power and conflict -transparency
Duty of utility balanced with the duty of care-fiduciary duty
Professional Maturity
• Education and credibility
• Experience and credibility
• Leadership
• Skills
• Metaliteracy
Quality and Safety
• Guidelines
• Rules
• Audit
• Professional thesis
• Professional morality
• Institutional memory
Power and tension
• Symbolic and social power
• Trust
• Collective responsibility
• Democratisation of healthcare
Duty of Care-balance-Duty of Utility
• Economic rationality
• Ideologies and philosophies
• Personal and professional cultural power
• Professionhood
• Conflicts of Interest
Ideas for the future of Governance in NZ Healthcare services
Implications of the framework
Transparency of personal and professional experience
• Code of Healthcare Services governance
• Common definition of governance in healthcare services
Impact in Law and Process
• ACE s
• Balanced boards
• DHB and Clinician engagement
• Clinical networks
• NZ Health Tribunal
• Intersectoral engagement
