Good governance is a pre-requisite for legitimacy

A blame-free reporting and management culture was in the best interests of patients and those delivering services, Aidan Horan, Director, Consultancy, Training & Development Directorate IPA told the HMI Annual Conference.

Aidan Horan
Aidan Horan, Director, Consultancy, Training & Development Directorate IPA

Speaking on “Contribution of Effective Governance,” he said we lived in an imperfect world. As human beings we all made mistakes and no system was perfect. However, everybody working in the delivery of healthcare owed it to their patients and to themselves to do all that they could to minimise errors and maximise quality.  The best way to do this was to accept and describe honestly where and how mistakes and failures occurred in order to learn and to improve.

Good governance was a pre-requisite for legitimacy, credibility, reputation and authority.

Governance was the processes, structures and procedures in place to ensure that persons and organisations charged with responsibilities by government, shareholders or members carried out those responsibilities to the highest standards.

The authorities had to evaluate the risk appetite within their organisations and whether this had implications for governance

Corporate governance was the system by which organisations directed and controlled their functions in order to achieve organisational objectives, managed their business processes, met required standards of accountability, integrity and propriety and related to their external stakeholders.

Clinical governance was a framework through which organisations were accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (Scally and Donaldson 1998).

Integrated governance could be described as systems, processes and behaviours by which health service organisations led, directed and controlled their functions in order to achieve organisational objectives, safety and quality of service and in which they related to patients and carers, the wider community and partner organisations. (Department of Health, UK 2006).

Horan said the Commission on Patient Safety and Quality Assurance recommended that governance arrangements across the system should enable a connected and integrated approach at local, regional and national levels that ensured that good governance was in place and that learning occurred and was disseminated effectively.

The Commission agreed that the vision or framework around which the Irish health system should be based was ‘Knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes.’  The values underpinning this framework included openness, patient centredness, learning, effectiveness and efficiency, good governance, leadership, evidence-based practice, accountability and patient/family involvement.

He said it was important to acknowledge that despite our best efforts, medicine would never be a risk free enterprise. What we must do in our efforts to make the system as safe as possible for patients and staff was to ensure that we had the right checks and balances in place.

Risk Appetite was defined as the amount of risk an organisation was prepared to accept or retain in the pursuit of its core priority objectives.  The authorities had to evaluate the risk appetite within their organisations and whether this had implications for governance.