Elevating clinical governance as part of corporate governance
As Chief Executive of the NSW Clinical Excellence Commission, Adjunct Professor Michael Nicholl works with entities across NSW Health to foster safety cultures and improve clinical care across the state. Here he describes three things that set up health services for safety and quality success. Professor Nicholl is a retired obstetrician who has spent more than 40 years in clinical roles, with 25 of those working in healthcare safety and quality.
There is a compelling argument for all health service boards to elevate clinical governance as the most important part of corporate governance.
At the board meetings I attend, all too often clinical governance is a discrete agenda item delegated to a safety and quality committee.
But positioning clinical governance under the broader corporate governance umbrella leads to a better financial bottom line, reduced risk and staff turnover, and a better organisational reputation.
Health services are there to provide health care and the best possible outcomes. Clinical governance needs to have equal prominence to those other elements of governance that districts and hospitals have such as financial governance, risk governance and workforce governance.
The literature and health service performance point to three things that are crucial in positioning clinical governance correctly: systems that prioritise clinical governance at board level; interpreting data meaningfully, and engaging skilled people.
Adjunct Professor Michael Nicholl
1. Systems and processes
Systems and processes should be put in place to ensure clinical governance has sufficient prominence in health services.
For example, rather than relying on the safety and quality committee to provide the board with a report or the minutes of their discussions, the committee should provide a brief that synthesises information and identifies important issues for the board’s consideration.
These systems and processes should be reviewed every 12 months and there should be regular evaluation of how well the health service performed during the year.
2. Data
Every governance meeting should be data informed – there should be multiple data sources and these should be interpreted and contextualised.
It is important that all board members have the skills to interpret the data and understand what to focus on.
There’s no point having board papers that are full of tables, column graphs and raw numbers with no interpretation or thought behind what these actually mean.
Instead of than looking in the rear-view mirror all the time, we need to try to work in a way that’s more proactive. Rather than a series of static reports, put one piece of data together with another to provide a richer story – triangulate the data not just with patient experience but with staff experience to obtain the whole picture.
3. Skilled people
Systems and data can only go so far – it is crucial that you have people with the right skills, qualifications and experience to implement good clinical governance.
People working in the health system need focus on risk and maximise their efforts in the areas that need attention.
There’s a cognitive piece where we’ve got to get people curious about putting those structural and data pieces together in a way that adds value.