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Fit for Purpose Governance in the NHS
A National Inquiry
“The effective spread of innovation is determined more by inter-personal and inter-organisational interaction than by structures and technology – like rugby, innovation spread is a contact sport.”Jonathan Lomas
Context• NHS Boards operate in a complex network
of local and national political relationships.• Boards make decisions on behalf of the
‘owners’. • A new contract is needed between people
and their services• WCC challenges Boards to find ways to
‘manage the system’ through governance.
It takes
• Legitimacy – making contested decisions
• Sustainability – how much assurance about what?
• Partnership – for the patient journey
• Multiple Perspectives – for adaptation (challenge for the sake of the task)
to govern NHS organisations
Confusion
• Between management and governance
• About the power of governance
• About the way of working assurance and innovation
• At executive level of the difference of working in the Board
• About accountability
And agreement about:
• The importance of the CEO Chair relationship
• The difficulty of governing a professional workforce
• The need for clear purpose
Our Questions
Effective in crisis
Focus on patients,
users, public
Engagementexternally
(Understanding the constraints) of professional/expert
model of organising
(Feeling powerful not) feeling powerless
Culture
DesignThoughtfully
designed
(Understand) why we are here
(Understand) who we are
Workingwith challenge
(Effective) relationship CEO – Chair
(Effective) induction and appointment
(Understand) what we expect of
each other
People
Work
Doing what?
Should be
Information
Balances limits of state and promoting the (local) organisation
Surfaces tension of focus on assurance v
focus development/progress
(Understand) tension management
v governance
Not just right people
Relating
‘What is’
Identity
Hypothesis
What’s getting in the way• Knowing how to govern for patient benefit• NHS antibodies to politics• The difficulty of securing challenge and making
the most of difference• Board processes for doing the business• Policy makers as observers not designers• How Boards view their role in reconciling the
designed in tensions in the NHS