Clive Lewis passed away in May 2023. NHS Providers extends its condolences to Clive's family, friends and colleagues.
Good corporate governance is an essential quality of any successful organisation, and in the NHS this needs to be particularly streamlined. For patients to receive optimum care in the potential journey from GP diagnosis to hospital admission to safe discharge, competence at every level depends on strategic cohesion of the relevant stakeholders at every stage of the process. That’s why the importance of incorporating trust and encouraging collaboration between different parties has never been so important to ensure safe, joined-up care in an efficient manner.
The NHS is incredibly complex. For example, when a patient is discharged from hospital, departments may need to seamlessly connect with colleagues in the community sector to source appropriate ongoing care. We often hear of frustration, delays, missed appointments or at worst, patients getting lost in the system. Instead of this, we need more collaboration so that the various sectors can establish partnerships that function under pressure. This has never been more crucial than at a time when the health service is facing unprecedented operational pressures – trusts are now working through significant care backlogs as well as ongoing COVID-19 demand, and facing pressures on the urgent and emergency pathway. Working partnerships are key to providing essential support to one another’s services at the appropriate times when help is needed, and crucially, must be underpinned by a foundation of trust.
Trust is vital to ensure strong relationships can be built with key stakeholders, with opportunity for it to be built and develop on a variety of occasions, including: having a willingness to admit weakness and mistakes; asking for help when needed; appreciating and tapping into one another’s skills and experience; being critical friends and looking forward to meetings and other opportunities to work together as a group. If trusts get this right, it will result in a trust dividend where change happens more quickly at lower cost. Get it wrong and progress will be sluggish.
By developing a corporate culture running parallel with a well-defined blueprint setting out the approach, the organisation is more likely to run smoothly operationally. However, this can only be achieved if the blueprint incorporates an ethical promotion of integrity and the value of diversity and inclusion. It’s also important to remember that leadership is crucial and opting for bland, one size-fits-all, box-ticking processes does not help lead to effective ways of working.
By adopting a clear, concise framework of leadership and direction, much more can be achieved. One example of a system that is establishing the right foundation blocks for good governance is Gloucestershire. Following the principle of subsidiarity, system-level programmes are being co-owned and co-led by leaders across partner member organisations. Where there are current shortfalls against national expectations these are highlighted with outline plans for further improvements articulated. System leaders have identified priorities, including:
- Accelerating plans to grow the substantive workforce and work differently
- Rapidly and consistently adopting new models of care that exploit the full potential of digital technologies
- Working in partnership to rise above pre-pandemic levels of productivity
- Using allocated additional levels of government funding to increase capacity.
This joined up approach by system partners will support core activities such as planned and emergency care, and help to embed an emollient approach to system governance.
For organisations to reap rewards such as these, the interests of the workforce must be aligned with those of key decision-makers on the board of directors. Culture as an entirety is of equal importance and an integral part of any successful and dynamic organisation. Questions need to be raised, such as how do the values of the organisation intertwine and coalesce with its processes? Is there a clear leadership strategy in producing and promoting value? Once a new directive has been created, will it drift or is there a master plan in place for its preservation? In other words, has short-term benefit been replaced by long-term gain?
To guarantee a successful administration, a mix of skills and experience is required at board level; members should feel empowered to speak up, and willing to offer suggestions for improvement in all aspects, from the promotion of diversity and inclusion to securing more positive working partnerships. Only then can improvements and progress be continuously made.
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