Five new publications have been co-produced with RSM
Board Assurance: A toolkit for healthcare sector organisation Assurance goes to the heart of the work of any NHS board of directors. The provision of healthcare involves risk and being assured is a major factor in successfully controlling risk. Assurance is the bedrock of evidence that gives confidence that risk is being controlled effectively, or conversely, highlights that certain controls are ineffective or there are gaps that need to be addressed.
Good Practice at meetings An overview of the guiding principles that need to be adhered to achieve the best outcomes from time spent in meetings. This guide covers best practice in terms of meeting logistics, agenda setting, papers, chairing and post meeting actions. There is a direct correlation between effectiveness of a board and the personnel and personalities sat around the table but there are elements of process and guiding principles that need to be adhered to if boards are to secure the best outcomes from the time spent in meetings. Paying attention to the meeting logistics facilitates the smooth running of the meeting as do agendas that mirror the annual work plan and reflect the terms of reference of the committee. Each agenda item/paper should be suitably précised to ensure that board members are clear as to the context and purpose of the paper, the key issues/risks arising from the content and what is expected from the board in terms of decisions. An effective chair will steer a clear path through the noise of meetings, summarising agenda items effectively and ensuring clear outcomes are captured and followed up. The use of post meeting wash up sessions help to ensure an effective flow between committees providing regulators with evidence of Board to ward line of sight.
Good Practice: Quality Impact Assessments The need for a formal process of ‘quality impact assessments (QIA) over cost improvement plans’ has been in place for some time and a focus on cost containment and improving efficiency (without due regard for the impact on service provision) is seen as one of the key drivers for poor care experienced by patients. This guide covers best practice in developing a process for identifying and developing CIPs with full clinical engagement as well as providing guidance for non executive directors on their role in approving and monitoring their implementation. Cost reductions are increasingly more challenging to identify and the need for a formal quality impact assessment process is essential in a system as complex and interdependent as the NHS. However, the quality impact assessment can often be seen as the last step before implementation of a cost reduction and better outcomes can be achieved by an overall comprehensive CIP process that incorporates significant bottom up clinical engagement, a series of gateway reviews and one where the board is demonstrably actively engaged and signed up to the process. In measuring the impact of implementation of the scheme it is important that the metrics chosen are meaningful and relevant. Good practice suggests that invariably it is necessary to identify a few scheme specific metrics rather than rely on the more generic overall KPIs that are part of the monthly performance report.
Improving QGAF scores The Quality Governance Assurance Framework (QGAF) has four key elements; strategy and planning, capabilities and culture, processes and structure and measurement. Taken together they ensure that a trust has in place systems and processes to facilitate ward to board connectivity, the necessary culture and skills to promote quality and an overview of performance that ensures good practice is recognised and shared and problems are addressed in a timely manner. This guide explores some of the key issues trusts face in lowering their scores and achieving best practice.
Much of the QGAF approach and principles remain firmly embedded in the recently issued Well Led Framework which in effect replaces the separate QGAF and Board Governance Framework and therefore the disciplines of self-awareness, realism and continual improvement remain. There is a need to achieve closer parity of scoring between the trust self assessment, the external review team and the Monitor assessment team, in order that the trust can move into a phase of continual improvement but there is a tendency for optimism bias in most self-assessments and the perception is that trust boards do not always factor in the external environment and are therefore not fully in tune with the political sensitivities related to QGAF scoring. Pivotal to the narrowing of the variance between the internal self-assessment scores and those of the external reviewer/NHS Improvement is the level of ownership and exposure that the board and/or quality committee adopts. In an effort to support providers to improve their QGAF scores and reduce the overall assessment failure rate, NHS Providers have set out some practical improvement examples from providers that have been instrumental in improving QGAF ratings under the headings of people, focus and systems, process and structure.
Ward to Board Assurance The consensus of those working in the NHS recognises the importance of ‘getting out of the boardroom’ or ‘bringing the ward into the boardroom’. However, the complexity of trust boards fully understanding what is happening in each and every ward/department within their organisation is not without its challenges. This guide explores the various issue to be overcome in developing an effective ward to board assurance flow and suggests solutions to overcome the most common problems. Despite the difficulties of developing an effective ward to board assurance flow it is vital that board members make better connections within their organisations to enable them to triangulate the messages contained in board papers with observations and interactions with patients, staff and stakeholders. One of the most common problems is the myriad of committees, fora and work groups that exist serving to obfuscate the flow of information between the ward and the board. Further confusion occurs where organisations fail to separate performance management and assurance with the two often being conflated via poor organisational structure design. Clarity of roles and responsibilities together with separation of operational management and assurance is instrumental in simplifying the governance framework of an organisation and this should be coupled with a consistent approach to performance management across all divisions.
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