1 Leadership for Improving Quaity and Safety Leadership for Improving Quaity and Safety Board eadership is a critica ingredient to achieving better, safer care and governing boards can choose to be either active eaders or passive overseers in the process (Bader et a., 2006) 12
The Board of a heathcare provider has a roe in setting out the vision and goas for improving quaity and safety. Board members, eaders, managers and cinicians can seek out and use a opportunities to visiby dispay their commitment to buiding a cuture of quaity and safety by activey demonstrating the vaues of the service, reguary istening to service users and staff, seeking assurance of safety and evidence of the quaity of services. Board Roes and Responsibiities The Code of Practice for the Governance of State Bodies (Department of Pubic Expenditure and Reform, 2016) provides a framework for the appication of best practice in corporate governance by both commercia and non-commercia state bodies. In Ireand, the Pubic Appointments Service is responsibe for the recruitment of members to state boards. It has outined as part of the recruitment for Hospita Group Boards the chairperson s roe in the deveopment and impementation of effective corporate and cinica governance structures, aong with oversight of the quaity and safety of systems of care in pace for service users (Pubic Appointments Service, 2017a). In order to be an effective contributor on a board it is recommended that members: Bring independent and objective scrutiny to the oversight of the organisation; Be prepared to be chaenging, when necessary, whie being supportive to the deivery of strategy and objectives; Be equipped to offer considered advice on the basis of sound judgement and experience; Be prepared to make a time commitment to their work commensurate with the roe; Constructivey supports and chaenges the Chief Executive as to the demonstrabe effectiveness of the quaity, safety and timeiness of the services deivered; Constructivey supports and chaenges the Chief Executive in the oversight of risk management; Provide advice in reation to strategic direction, effective roe of the board in coectivey eading for quaity. Leadership for Improving Quaity and Safety The board comprises across its membership, the necessary skis, competencies and experience to enabe it to deiver on the strategic and visionary change management agenda and oversee the provision of high quaity safe service user care. The appointment process for members of the Hospita Groups seeks to ensure demonstrabe expertise in cinica, business, socia, ega, medica academic, nursing and patient advocacy (Pubic Appointments Service, 2017b). Competencies in cinica governance, quaity assurance and patient safety are sought to ensure the correct board ski mix and competencies. Recent studies revea a significant and positive association between a higher percentage of cinicians on boards (both as non-executive and executive members) and the quaity ratings of heathcare provided, especiay where doctors are concerned. This positive infuence is aso confirmed in reation to ower morbidity rates (Sidorov, 2016; Veronesi et a., 2013). A further study demonstrates that executive nurse / midwife directors, who are members of boards, can provide invauabe advice and support to the board around matters of quaity and safety (Jones et a., 2016; Masta, et a., 2007; Matche, et a., 2010). Board effectiveness for improving quaity and safety reies on the ways in which board members use their knowedge and the information they receive in overseeing the provider s pans for improving quaity (Ninnger, 2011). In order for quaity and safety of care to be a priority for the board it is schedued in a dedicated section of the board agenda to ensure that appropriate attention is given. In many cases, a dedicated board quaity and safety committee can be estabished to review reports of quaity of care in greater detai. The roes of the board and the chief executive shoud be cear around addressing quaity concerns and questions. Tabe 1 outines the roe of the board chair, the chief executive and non-executive and executive members of the board. 13
Chief Executive Officer and Executive Responsibiities Whie this guidance seeks to increase board members understanding of best practice in improving quaity and safety, it is the responsibiity of the Chief Executive Officer (CEO) to impement the board s poicies in reation to quaity and safety and for ensuring quaity and safety within the organisation. By providing timey accurate and precise information to the board the CEO ensures the board can carry out their function with regard to governance for quaity and safety and to aow it fufi the safety objectives and functions set out in this guidance document. It is the CEO s responsibiity to ensure the board has sufficient information on risk identification, assessment and contro strategies and ensures effective systems, procedures and practices are in pace in order to evauate the effectiveness of its operations. The CEO encourages board competencies and commitment regarding quaity and safety, whie providing a transparent ine of sight between the board and the rest of the organisation. An engaged board pays a key roe in organisationa cuture and safety. Deveoping and engaging the board is one of the key eadership domains that require CEO focus and dedication to deveop and sustain a cuture of safety (American Coege of Heathcare Executives and the Nationa Patient Safety Foundation s Lucian Leape Institute, 2017). 14
Tabe 1: Key Governance Strategic Roes Formuate Strategy Ensure Accountabiity Shape Cuture Chair Chief Executive Non-executive Executive Ensures board deveops vision, strategies and cear objectives Hods CEO to account for operations and strategy. Ensures board committee are propery constituted with terms of reference Reports to the owner / sharehoder Provides visibe eadership in deveoping a positive cuture for the organisation, and ensures that this is refected and modeed in their own and in the board s behaviour and decision making Leads strategy deveopment process Leads the organisation in the deivery of strategy Estabishes effective performance management arrangements and contros Acts as Accountabe Officer Provides visibe eadership in deveoping a positive cuture for the organisation, and ensures that this is refected in their own and the executive s behaviour and decision making Brings independence, externa skis and perspectives, and chaenge to strategy Hods the executive to account for strategy Offers constructive scrutiny and chaenge Participates as member of key committees Activey supports and promotes a positive cuture. Provides a safe point of access to the board for whistebowers (protected discosure) Takes ead roe in deveoping strategic proposas drawing on professiona and cinica expertise (where reevant) Leads impementation of strategy within functiona areas Activey supports and promotes a positive cuture for the organisation and refects this in their own behaviour Leadership for Improving Quaity and Safety Context Ensures a board members are we briefed on externa context Ensures a board members are we briefed on externa context Ensures reevant members of their teams are we briefed Inteigence Ensures requirements for accurate, timey and cear information to board / directors are cear to executive Ensures provision of accurate, timey and cear information to board / directors Satisfies themseves of the integrity of financia and quaity and safety inteigence Takes principa responsibiity for providing accurate, timey and cear information to the board Engagement Pays key roe as an ambassador, and in buiding strong partnerships with: Service users and pubic Cinicians and staff Key institutiona stakehoders Reguators Pays key eadership roe in effective communication and buiding strong partnerships with: Service users and pubic Cinicians and staff Key institutiona stakehoders Reguators Ensures board acts in best interests of the pubic Senior independent director is avaiabe if there are unresoved concerns Leads on engagement with specific interna or externa stakehoder groups Source: adapted from Rice et a., (2015) 15
Leadership Behaviours for Improving Quaity Pace the quaity of patient care, especiay patient safety, above a other aims. Engage, empower, and hear patients and carers at a times. Foster whoe-heartedy the growth and deveopment of a staff, incuding their abiity and support to improve the processes in which they work. Embrace transparency unequivocay and everywhere, in the service of accountabiity, trust, and the growth of knowedge. (Extract from the Nationa Advisory Group on the Safety of Patients in Engand, A Promise to Learn, a Commitment to Act, 2013) Board members as eaders have the opportunity to be more than champions for improving quaity of care; they can be active participants (HSE, 2016a). A board can ceary demonstrate their commitment to quaity and safety by coectivey eading and infuencing the overa cuture of the organisation. Maintaining a cuture that prioritises quaity and service users safety is a reasonabe expectation for highy effective boards. Boards can channe their efforts towards supporting a cuture of earning rather than driving compiance ony. Individua and coective board member behaviours can acceerate the organisation s quaity journey. The Institute for Heathcare Improvement (IHI) High-Impact Leadership Behaviours: Five Things Leaders Can Do to Promote Improvement (2013) outines how eaders can examine their own behaviours (see Figure 1 beow). Figure 1: IHI High Impact Leadership Behaviours 1 Person-Centeredness Be consistenty person-centred in word and deed 2 Front-Line Engagement Be an authentic presence at the frontine and a visibe champion of improvement 3 Reentess Focus Remain focused on the vision and strategy 4 Transparency Require transparency about resuts, progress, aims and defects 5 Boundariessness Encourage and practice systems thinking and coaboration across boundaries Source: adapted from Swensen et a., (2013) 16
Boards have an essentia roe in promoting a cuture of quaity and safety of care through their own behaviours and actions by: Setting one arge goa for quaity and safety for the organisation Making quaity and safety of care a core part of the board s meeting agenda Refecting the core vaues of the organisation in the decisions of the board Supporting the provider in becoming a earning organisation Sharing service user stories at board meetings Fostering a cuture of transparency and honest communication Encouraging and supporting the executive to identify resources for staff education on improving quaity and safety Supporting the executive in deveoping the provider s programme for improving quaity and safety. Board Considerations - Roe of Leadership in improving Quaity and Safety How does our board define quaity and safety? What are our specific targets and outcomes for improving quaity and reducing harm? Who can be part of the process to deveop those aims? Does our board demonstrate our commitment to quaity and safety by the actions we take? Leadership for Improving Quaity and Safety Does our board communicate in a transparent way? How does our board invest in the deveopment of staff as eaders for improving quaity? How does our board ring fence resources for improving quaity and safety? 17