This document discusses governance and its central role in healthcare regulation. It provides examples from investigations conducted by the Health Information and Quality Authority (HIQA) that found issues relating to governance, such as a lack of auditing, budgeting, and follow-through on improving issues. National standards from Ireland, Australia and the Joint Commission International emphasize clear accountability, monitoring, and continuous quality improvement, with governance as a core component. The presentation argues that strong governance is needed to coordinate healthcare services and ensure high quality and safety.

1. 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)

3. What is Governance?
Line Management
Structure
Governance
Teams and
Committees
Control:, Monitoring
& Evaluation
Roles and
Responsibilities
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4. 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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5. 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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Governance: Central to Regulation
National Quality
Standards for
Residential Care
Settings for Older
People in Ireland
Safer Better
Healthcare
National
Standards
Prevention &
Control of HCAI
Governance
National Standards
for Residential Services
for Children and Adults
with Disabilities
HIQA
Investigations

7. 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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8. 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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9. HCAI: HIQA Findings reliant on Governance
• “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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10. HCAI: HIQA Findings relating to 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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11. 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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12. 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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13. Safer Better Healthcare: Governance
• 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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14. 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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15. Safer Better Healthcare: HIQA Findings
• 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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16. 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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17. 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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18. • 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…

19. Thank You
www.healthcareinformed.com

20. • 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