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How does Integrated governance lead to successful Health systems?

By Rola Hammoud; MD, MHA, FACHE/ President, ACHE-MENA

Healthcare systems are complex adaptive systems where diverse stakeholders interact together to administer patient care. This complexity leads to an increased rate of communication errors thus affecting patient safety. During the past twenty years, many actions have been implemented to improve patient care and outcomes to meet customers’ expectations. This has been driven by an impressive move of patient safety committees, national and international organizations, regulators and of accreditation bodies to raise the standards of care and lead to safer healthcare environments. 

Healthcare in the Middle East is delivered by multidisciplinary clinical teams working in public and private organizations. To support the delivery of high-quality care in a safe environment, hospitals develop their Clinical Governance in a systematic approach based on national guidelines and international standards. They base this governance on the establishment of safe systems, the implementation of lean management processes and the monitoring of patients’ outcomes. However, this type of governance is not enough in our modern healthcare institutions. Clinical governance shal l be complemented by risk management, financial governance and resources governance which sit all together under the umbrella of “corporate governance”.

Corporate governance is key in the new era of healthcare management. It is important in all systems whether private or public, whether startups or huge teaching hospitals. It is a set of rules, policies and practices that dictate how the board of directors function to oversee the management of organizations and it is based on the principles of accountability, fairness, transparency & responsibility. This concept has evolved during the last 30 years after many incidences of significant losses and closure of organizations because of poor governance.

A well-structured governance leads to improved organizational and financial performance in a culture of trust, ethics, fairness and accountability creating a reputation of respect to the community, and stakeholders while maintaining diversity, gender equity, ethical procurement which are all attractive elements to the confidence of investors and to the retention of exceptional talents. The responsibility is collective and aims at acting in the best interest of the organization and not for a single shareholder.

New business models are based on a corporate code and a corporate purpose of adding value to customers, investing in the workforce, adopting ethical practices, supporting communities, respecting diversity, and inclusion, being innovative and generating a long-term value to shareholders. 

Building a proper corporate governance is the responsibility of governing bodies who shall not be concerned in the institution’s daily operation, per se, but in giving the overall direction, controlling the executive actions, and maintaining compliance with legal and regulatory requirements. It is a “Nose in, fingers out” concept.

Governing bodies’ structure, constitution and policy framework are set as per the law of the land and follow evidence-based best practices, taking into consideration the code of ethics, the scale, the complexity, and the maturity of the organization as well as the community, the geographical spread, and the country’s regulations.

A Hospital’s governing board shall have a strategic focus, and support the mission, vision, and values of the system. They set policy, delegate responsibility, oversee executives’ decisions, and ensure appropriate risk management policies and accountability processes are in place throughout the hospital. They ensure the healthcare organization is heading in the right direction.

The strategy formulated by the board is communicated clearly to the workforce through the Chief executive officer whose performance is regularly evaluated by the board to ensure the hospital is properly managed and meets the desired standards.

The constitution of the board is critical. Diversity, equity, and inclusion, when taken into consideration, support a meaningful decision-making process. Board members, executive directors, and non-executive ones are chosen in a fair representative way while taking into consideration many factors such as age, gender, race, ethnicity, culture, function, and sector. Their role is not restricted to the impartial adequate review of reports and the request for clarifications to help in the collective decision making. Board members are accountable for the outcomes and performance of the organization. They are responsible for communicating with, and being accountable to, internal and external stakeholders.

Governing boards are run with the help of a few committees constituted by board members such as governance committee, financial committee, audit committee, risk management committee and succession planning committee. The delegation of tasks to those committees will free up the board for major issues such as strategy and major financial and organizational decisions.

While delivering a high-quality care and maintaining the safety of patients falls under clinical governance, business performance, ethics and compliance falls under corporate governance which is a necessary governance in our new world because healthcare organizations are accountable to their surrounding community and stakeholders.

Governance in healthcare is evolving to integrate both clinical and corporate governance in an effective way. Healthcare providers need to be educated on the importance of this interconnection and the impact of effective communication and mutual respect on the organization’s sustainability. Clinical leaders are becoming more aware of the importance of their administrative (financial, investment, resources, IT..) and governance duties and the role those play in supporting patient care, processes, and procedures.

Most hospitals in the Middle East are privately owned and family business organizations. In some institutions, we notice few governance responsibilities are distributed to people across the organization, such as support in risk management activities, performance monitoring and auditing… etc.., In such cases, it is still the governing board’s ultimate responsibility to ensure that the overall governance system is implemented effectively. 

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