Organisational Governance

Background

Organisational governance refers to the systems, processes, behaviours and cultures within an organisation, such as an NHS hospital, that ensure it is effectively managed. In the NHS, “governance” covers various domains, including clinical governance, financial management, and corporate governance. Most recent strategic policy advice moves towards a model of integrated governance, emphasising the inter-dependency of these components.

In the NHS, the governance agenda was driven by a number of inquiries into failings of clinical care (Bristol, Alder Hey and others). More recently, policies intended to devolve responsibilities and increase autonomy to local organisations (e.g. Foundation Trusts) have given particular importance to governance issues within the NHS.

The programme

The Organisational governance programme is currently focusing on a number of projects investigating how a particular London NHS Foundation Trust can improve its governance processes in relation to:

• Control of Healthcare Associated Infections (HAI)
• Reducing medication errors
• A third project is looking at how patients and the public can be involved in improving safety and quality

This programme takes the approach that in order to understand the organisation’s governance it is necessary to understand the organisation’s context. An NHS Trust’s culture and sub-cultures, the community it serves, its staff, and key events in its history, can all have a significant impact on how it operates. Additional factors, including national policy, the media, and relevant organisations (e.g. professional bodies, pressure groups, etc) are also identified as significant to the way in which an organisation is governed, in order to ensure safe, high quality care.

The aim of each project is to develop and test interventions to improve governance arrangements. In order to develop the intervention(s), each project will review the relevant literature from both within and outside the health sector in order to learn which issues need to be taken into consideration and whether there is evidence for any particular interventions. In parallel, each project will map out relevant governance arrangements in terms of trust structures and processes; and the contexts in which they exist.

This will be achieved through analysis of relevant documents and interviews with key staff. By using a range of qualitative, ethnographic methods, we hope to gain a clearer understanding of what factors play a significant role in guiding an NHS trust’s governance; and how a trust’s governance interacts with the safety and quality of service it provides.

The mapping processes and literature reviews will inform the development and implementation of interventions in the three domains detailed above. By working in close partnership with our stakeholders, and sharing our learning as the work progresses, we intend that our interventions will strengthen service provision and safeguard the safety of patients.