Governance in New Zealand Public Healthcare Services

1. Governance in New Zealand Public Healthcare Services

2. Governance is governance • Same principles – • Accountability • Probity • Transparency • Fiduciary Duty No matter what the context

3. Governance • The making of decisions in good faith • Independence of mind • With the skills, diligence and care Taken on behalf of others

4. Governance The structures of governance are – • Audit • Laws • Guidelines • Codes • Principles Which support decision-making on behalf of others

5. Governance By contextualizing governance we obfuscate decision-making We limit the opportunities to get a common understanding of governance

6. Disparities in Understanding • Management • Reduction in professional status’ • Control over practice • Power plays • Elastic and multifaceted

7. Governance appears as.. • Structure • Process • Behaviour • Carrot and Stick • Reinforcement of rules • Guidelines

8. Clinical Governance • Focus on Quality Assurance Principles of accountability, transparency and duty have limited operationalisation

9. Trust Focus on audit and compliance = Lack of trust to undertake professional roles Crisis in trust www.bbc.co.uk/radio4/reith2002/lectures

10. Paradox The trust in directors, managers and clinicians as stewards of the organisation is paradoxically opposed to the “sacred duty of trust” which clinicians accept as the fiduciary duty to make decisions in the best interests of their patients.

11. Governance in Healthcare services “Governance is the decision made on behalf of others within a given and accepted relationship of trust. Decision-making in governance in healthcare services is firstly characterised by professional maturity which enables accountability, quality and safety which assures probity, power and tension which supports transparency and balancing the duty of utility and the duty of care which compliment fiduciary duty. Secondly, governance decisions are supported by the structures of law and policy and within the context of time.”

12. Governance operationalised Professional maturity -accountability Quality and Safety -probity Power and conflict -transparency Duty of utility balanced with the duty of care -fiduciary duty

14. Professional Maturity • Education and credibility • Experience and credibility • Leadership • Skills • Metaliteracy

15. Quality and Safety • Guidelines • Rules • Audit • Professional thesis • Professional morality • Institutional memory

16. Power and tension • Symbolic and social power • Trust • Collective responsibility • Democratisation of healthcare

17. Duty of Care-balance-Duty of Utility • Economic rationality • Ideologies and philosophies • Personal and professional cultural power • Professionhood • Conflicts of Interest

18. Context Within the context of Structure and Time

19. Ideas for the future of Governance in NZ Healthcare services Implications of the framework Transparency of personal and professional experience • Code of Healthcare Services governance • Common definition of governance in healthcare services

20. Impact in Law and Process • ACE s • Balanced boards • DHB and Clinician engagement • Clinical networks • NZ Health Tribunal • Intersectoral engagement