This interview with Steven Boyages from the Clinical Education and Training Institute NSW explores the culture of effective hospital management and identifies the common risk areas within corporate governance.

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Clinical Governance 2011:
Continually improving the quality of services and
safeguarding high standards of care
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Q&A with Steven Boyages, CEO of the Clinical Education and
Training Institute from New South Wales
www.austhealthweek.com.au/clinicalgov
Health IQ:
Maybe you can start by telling our listeners a brief background of you and your
current position in relation to clinical governance.
Steven Boyages:
Sure. Look I’m probably unique in health, it’s probably dangerous to say that, but I
am a practicing physician, I’m an endocrinologist my background and I’ve also
immersed myself in the area of health management. For 8-1/2 years I was the Chief
Executive of a very large area health service in New South Wales called Sydney
West and in the last 6 months I have moved across to a new position created post
the Garling Inquiry here in New South Wales called the Clinical Education and
Training Institute. It’s interesting that you’re talking today about clinical governance
and patient’s safety and this new institute that I now head up, I’m the foundation
Chief Executive was spawned out of a major inquiry into the death of a young
individual through a medical misadventure.
Health IQ:
That’s very interesting. Alright, now, achieving good governance goes hand-in-hand
with conducting an effective risk analysis thus what are your main risk areas
currently?
Steven Boyages:
When people use the word clinical governance, I think it’s important to understand
that that’s actually a subset of what we call good corporate governance. So, when
we run any organization whether it’s a small hospital, a small department, a large
hospital, or large regional, or area health service then we need good systems and
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2. processes in place to identify risks. It was interesting a few years back I presented
to a group of clinicians and I used the word risk and a lot of them found that word
quite foreign. So, it’s really important that clinicians understand what we actually
mean by risk. Traditionally the word risk meant – what could happen to the patient,
but we know that there are a whole host of other risks that actually indirectly may
affect the patient. In the large health service, the risk pertaining to clinical
governance are really around patient’s safety and there are lots of doubts out there
that actually highlight to us, day-in day-out what those key risks to patients are, and
we know those – they’re probably the top 10, the top 3 will include – misidentification,
allergies to known compounds, adverse drug events, information, pressure, people
have been invasive for too long. The formation of clinical sepsis and other what we
call iatrogenic the doctor-caused infections. So really what we try to do when we’re
running hospitals or through this new institute is design better systems and
processes to avoid those types of risks but at the same time particularly through the
new institute, be able to impart new knowledge and new skills and be able to
demonstrate competency of the healthcare workforce to prevent such clinical risk.
Health IQ:
Absolutely. Now, what is meant by a patient focused approach to clinical
effectiveness and is it more than just constructive feedback?
Steven Boyages:
Yeah, absolutely. I mean, look, when we say… and sometimes these words simply
roll of the tongue. So, it’s really important that we are genuine when we say a
patient sense of approach and when we’re designing services, it’s really
fundamentally important that we take into account the patient’s knowledge of such
services. How they journey through the healthcare system and design the services
around the patient rather than often what has happened around the provider, and
then sometimes even allowing the patient and/or their care to participate in the
design of those healthcare services. That not only improves the effectiveness of the
outcome of the services that we provide, but it also exist greatly with empowering the
patient and their care to improve the patient’s experience.
Health IQ:
Culture is paramount in effective running of a hospital, can you give us an example
of strategy you’ve implemented to bridge the gap and open the line of
communication between all hospital staff?
Steven Boyages:
Yeah, I mean, always competing attentions in hospital working environments and
there is almost what I term a clash of cultures. There is a managerial culture which
is designed to be able to spend the cap dollars that we have available to a particular
service or hospital in the most efficient and effective way. In other words, how do we
look after as many people as possible to the highest possible level of care with the
dollars available. On the other side, and you have the patient advocate culture, the
guardian culture which is understandable and quite appropriate to managing the
individual to the best of resources available. So there’s always potentially attention.
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3. The attention should be healthy, and what we’re always trying to do is maximize the
way the dollars are being spent, one of the best way in addressing culture is to really
understand each other’s perspective of where each group is coming from. So you
really need to engineer a strong degree of trust and respect, to be able to achieve
those goals that everyone shares which is really how do we best deliver health and
healthcare service in the best possible and safest way for the patient and the
community.
Health IQ:
Can you explore for us the need for improved clinical standards, how necessary are
they and maybe one of the some real processes that is being experienced currently.
Steven Boyages:
Yeah, what you mean by clinical standards there, I mean, there are lot of standards
out there, there are lot of guidelines out there, there’s a lot of evidence out there.
The question is – how we build systems of care, or models of care that assure all of
us that those standards are actually being delivered. Now that’s a combination of
factors that are required there and part of that is competency of the staff that we
have and how to assure that competency. Part of that is a capacity, in other words
the system needs to be able to respond appropriately. Part of that is coordination of
the services that we have available, and part of that is communication. So those four
C’s are fundamental that we align them to be able to assure patient care is
appropriate. It’s not always simply about standards being made available, it’s not
simply a knowledge issue, it’s an issue around being able to assure us of what we
know should be done is actually being implemented.
Clinical Governance 2011 forms part of the Australian Healthcare Week – a series of
events to help healthcare practitioners. You can visit
www.austhealthweek.com.au/clinicalgov for more information. Alternatively, you can
call 61 2 9229 1000 to enquire or register.
Professor Steven Boyages
Professor Steven Boyages has recently been appointed as
Chief Executive of the newly formed Clinical Education and
Training Institute (CETI). Prior to this Professor Boyages
was the Chief Executive initially for Western Sydney Area
Health Service and in the last 5 ½ years as Chief Executive
for Sydney West Area Health Service. He has professorial
appointments to the University of Sydney and the University
of Western Sydney.
Steven is a unique hybrid of clinician manager who is an
endocrinologist. He was previously the Director of Diabetes
and Endocrinology at Westmead Hospital from 1990 to 1999.
Steven previously was the foundation director of the Centre for Research and
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4. Clinical Policy in NSW Health in 1999. During that time he established the Priority
Health Programs funded to the tune of $15 million per annum; doubled the
Research Infrastructure Grants Program; established the Quality Branch of NSW
Health and was appointed as Clinical Advisor to the Director General to implement
the Government Action Plan for Health Reform
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