Governance: The Future of Primary Care

National Primary Care Conference 2014

John Sweeney, CEO

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“Where there is no vision,

the people perish” (Proverbs 29:18)

What is Governance?

Governance

Line Management Structure

Teams and Committees

Control:, Monitoring & Evaluation

Roles and Responsibilities

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What is Governance?

“The individual(s), group, or agency that has ultimate

authority and responsibility for:

• establishing policy,

• maintaining quality of care and

• providing for organization management and planning” (JCI, 2012)

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How do we know its important?• Central to all Regulation frameworks

– Core to the ISQua Principles for Healthcare Standards

• Ensures requirements are:

– Driven from the top down

– Resource supported

– Embedded in culture – engagement by staff

– Implemented system wide

– Monitored and evaluated

– Communication & Transparency

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National Quality Standards for

Residential Care Settings for Older People in Ireland

Safer Better Healthcare

National Standards

Prevention & Control of HCAI

Governance

National Standardsfor Residential Servicesfor Children and Adults

with Disabilities

Governance: Central to Regulation

HIQA Investigations

Governance: Central to Regulation• Residential & Disabilities:

– Theme 1 & 7 Governance, Leadership and Management

• Prevention and Control of HCAI’s:– Standard 1: Governance and Management

• HIQA Investigations– Central Focus on Governance and Management, e.g.

Portlaoise Hospital Investigation (TOR): “Investigate and assess how local, regional and national clinical and corporate governance arrangements are supporting the safety and quality of services at the Hospital.”

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HIQA Inspection Findings relating to Governance undertaken against the

National Standards for the Prevention and Control of Healthcare Associated Infections

(HCAI)

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• “There was a lack of environmental auditing carried out. The lack of auditing is of concern, and suggests a lack of governance and management of these issues by the management team”

• “An effective surveillance programme is essential for the hospital - surveillance programme had ceased due to resource issues”.

• “There was no evidence that feedback was received by the Infection Prevention and Control Committee and the Infection Prevention and Control Team regarding many of the issues brought to the attention of the Board of Management”.

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HCAI: HIQA Findings reliant on Governance

• “There was no multidisciplinary hygiene audit team in place”

• “There is no budget allocated specifically for the Prevention and Control of Healthcare Associated Infection Team (PCHCAI)”.

• “The lack of a named accountable person for the coordination of the PCHCAI surveillance programme poses a serious risk to patients of acquiring HCAIs”.

• “Poor audit results were relayed to the Board of Management, however, reciprocal quality improvement initiatives were not initiated”.

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HCAI: HIQA Findings relating to Governance

• “The lack of a named accountable person for the coordination of the PCHCAI surveillance programme poses a serious risk to patients of acquiring HCAIs”.

• “Poor audit results were relayed to the Board of Management, however, reciprocal quality improvement initiatives were not initiated”.

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HCAI: HIQA Findings relating to Governance

Safer Better Healthcare Standards:“A vision for high quality, safe healthcare”

“Provides a roadmap for improving the quality, safety and reliability of healthcare”

(HIQA, 2012)

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• Theme 5 Leadership, Governance and Management

– Clear accountability arrangements

– Formalised governance arrangements

– Maintain a publicly available Statement of Purpose

– Set clear objectives and develop a clear plan for delivery of services

– Have effective management arrangements

– Promote and strengthen a culture of quality and safety

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Safer Better Healthcare: Governance

• Theme 5 Leadership, Governance and Management

– Workforce exercise their personal and professional responsibility

– Systematic monitoring for identifying and acting on OFI’s

– Services provided on behalf of providers are monitored

– Services are compliant with relevant legislation

– Services act on standards and alerts, recommendations and guidance

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Safer Better Healthcare: Governance

• Report of the review of the governance arrangements as reflected in the safety, quality and standards of services at UL Hospitals

– The Authority has used the National Standards to identify specific features that should be in place in acute hospitals to achieve safe, high quality governance, the absence of which would be a cause for concern (HIQA, 2014).

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Safer Better Healthcare: HIQA Findings

• Compromised corporate and clinical governance.

• Absence of meaningful analysis and discussion of patient complaints, trends in clinical incidents, adverse events and the prevention and control of Healthcare Associated Infections at Board level.

• Resources are not being optimally used.

• Inconsistent implementation of integrated care pathways.

• Inadequate structures, systems and processes in place to effectively manage and implement the programme to prevent and control Healthcare Associated Infections.

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Safer Better Healthcare: HIQA Findings

Governance for Others

– The Future for Us?

Royal Australian College of General Practitioners (RACGP): Standards for General Practices

Clinical Governance is central to the Standards

• Organisations are responsible for continuously improving the quality of services and safeguarding high standards of care

• Ensures the accountability of individuals

• Empowered and participative team

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• Governance is central to the framework of all regulation.

• Where there is poor governance, elements act in isolation and the systems become fractured.

• Future of Governance: driven by the future of Regulation: Governance at its core.

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In Review…

Thank You

www.healthcareinformed.com

• Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise; Terms of Reference. Health Information and Quality Authority (March, 2014).

• International Principles for Healthcare Standards, 3rd Edition. A Framework of Requirements for Standards. International Society for Quality in Healthcare (ISQua, 2007)

• Joint Commission International Accreditation Standards for Long Term Care, 1st Edition (JCI, 2012)

• National Standards for the Prevention and Control of Healthcare Associated Infections. Health Information and Quality Authority (HIQA, 2009)

• National Standards for Safer Better Healthcare. Health Information and Quality Authority (HIQA, 2012)

• Report of the review of the governance arrangements as reflected in the safety, quality and standards of services at UL Hospitals. Health Information and Quality Authority (HIQA, 2014).

• Standards for General Practices. Royal Australian College of General Practitioners (RACGP, Amended May 2013)

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References