Governance in New Zealand Public Healthcare Services

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

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

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

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

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

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

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

Trust Focus on audit and compliance = Lack of trust to undertake professional roles Crisis in trust

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.

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.”

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

Professional Maturity Education and credibility Experience and credibility Leadership Skills Metaliteracy

Quality and Safety Guidelines Rules Audit Professional thesis Professional morality Institutional memory

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

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

Context Within the context of Structure and Time

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

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