Governance in New Zealand
Public Healthcare Services
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Governance is governance
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Same principles –
Accountability
Probity
Transparency
Fiduciary Duty
No matter what the context
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Governance
• The making of decisions in good faith
• Independence of mind
• With the skills, diligence and care
Taken on behalf of others
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Governance
The structures of governance are –
• Audit
• Laws
• Guidelines
• Codes
• Principles
Which support decision-making on behalf of others
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Governance
By contextualizing governance we
obfuscate decision-making
We limit the opportunities to get a
common understanding of
governance
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Disparities in Understanding
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Management
Reduction in professional status’
Control over practice
Power plays
Elastic and multifaceted
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Governance appears as..
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Structure
Process
Behaviour
Carrot and Stick
Reinforcement of rules
Guidelines
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Clinical Governance
• Focus on Quality Assurance
Principles of accountability, transparency
and duty have limited operationalisation
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Trust
Focus on audit and compliance
= Lack of trust to undertake professional
roles
Crisis in trust
www.bbc.co.uk/radio4/reith2002/lectures
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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.
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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.”
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Governance operationalised
Professional maturity
-accountability
Quality and Safety
-probity
Power and conflict
-transparency
Duty of utility balanced with the duty of care
-fiduciary duty
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Professional Maturity
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Education and credibility
Experience and credibility
Leadership
Skills
Metaliteracy
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Quality and Safety
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Guidelines
Rules
Audit
Professional thesis
Professional morality
Institutional memory
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Power and tension
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Symbolic and social power
Trust
Collective responsibility
Democratisation of healthcare
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Duty of Care-balance-Duty of Utility
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Economic rationality
Ideologies and philosophies
Personal and professional cultural power
Professionhood
Conflicts of Interest
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Context
Within the context of
Structure and Time
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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
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Impact in Law and Process
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ACE s
Balanced boards
DHB and Clinician engagement
Clinical networks
NZ Health Tribunal
Intersectoral engagement
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