Good governance

Good governance

This week’s blog explores all things governance within health and social care services.

Good governance is not just about completing an audit or analysing an accident. It runs through every part of how a service is managed. Alright well in some cases. Not so well in others.

I see governance as a regular and honest look at all aspects of service delivery. Where issues are being identified, addressed and clearly documented to show what has changed as a result. It is not about perfection. It is about oversight and improvement.

A dictionary definition of governance is the way in which an organisation is managed at the highest level, and the systems used to do this.

So what should we actually be looking at?

What are people who use the service saying? What are relatives telling you? What feedback are staff and external partners giving?

What are your key indicators telling you?

• Accidents, incidents, complaints, audits and surveys all hold information. Are there trends? Are there repeated issues? And importantly, what are you doing with that information?
• When you walk around your service as a leader, how does it make you feel?
• Would you recommend your service to someone you love? If not, why not?
• What are external indicators telling you? Your last inspection by the Care Quality Commission, a local authority quality monitoring visit, feedback from commissioners. Do these align with your own view of the service, or are there gaps?

What does the regulation say

Regulation 17 of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 sets out expectations for good governance.

In simple terms, providers must have effective systems and processes in place to assess, monitor and improve the quality and safety of care. This includes the experience of people using the service and the management of risk relating to health, safety and welfare. Governance systems must not stand still. They must be reviewed and improved over time.

How do I know if I am getting it right?

We have the regulator. We have local authority colleagues. We have the Integrated Care Board, the fire service, the Food Standards Agency. Sometimes it feels like everyone wants something slightly different, doesn’t it?

Often, it is not until a visit happens that we truly know how well our systems stand up. When things go wrong, Regulation 17 is one of the most common breaches applied. That can make good governance feel difficult to define and even harder to evidence.

Always action plan

Whether you are completing an audit, reviewing feedback, holding a meeting or carrying out supervision, you should be recording what is working well and what is not. If something could be better, it needs an action.

Action plans should clearly show what needs to improve, who is responsible and when it will be completed. Regulators are not looking for services with no issues. They are looking for services that identify issues themselves and take action.

Think of governance as a cycle:

• Audit/check completed
• Issue identified
• Action taken
• Improved outcome

As long as you can evidence improvement, you are heading in the right direction. It is also worth remembering that audits scoring 100 percent do not equal good governance. There is always something that can be strengthened to improve outcomes for people.

Ask yourself

• Can I evidence that I am checking all aspects of service delivery?
• Can I show the regulator that I am identifying issues myself?
• Can I demonstrate how I have improved practice or outcomes?
• Can I evidence feedback from people who use the service, staff and partners?
• Can I show a clear cycle of review, action and improvement?
• Am I keeping clear and consistent records of all of this?

If the answer is yes, you are far closer to good governance than you might think.