1. 8 March 2016 CORPORATE GOVERNANCE IN THE HEALTH SECTOR In association with

2. Corporate Governance Challenges in the Health Sector Anthony Staines Chair of Health Systems, DCU Seanad Candidate Trinity Panel

3. Does this look familiar?

4. Corporate governance A governor was originally a steersman, or a ship’s pilot (κυβερνήτης). This is not a bad metaphor, except that modern governance includes both steering and setting the direction. It is a core function of the board of any organisation. This is true regardless of board composition (executives, non-executives…)

5. Corporate Governance to ensure through a system of information and accountability that a proper standard of safety and care is provided to all patients Sounds easy enough Is it?

6. Challenges ?

7. Numerous! Budgets Staffing Organisation Capital ?

8. How do you set priorities for your organisation ?

9. Priorities Some are very obvious  Finance  Human resources  Facilities Some are less so

10. How do you set priorities for your organisation? Private companies have one clear priority, which is survival Their central role is to create value for stakeholders In the usual circumstances this value appears in the balance sheet Health care organisations have more complex priorities

11. How do you set priorities for your organisation Many health care organisations are state owned Almost all are highly regulated  The ‘ethical’ drug companies show some of the limits of this regulation though. Mistakes make news

12. What can go wrong? ?

13. People die, unnecessarily People are damaged, more or less permanently Avoidable damage isn’t avoided Care falls below acceptable levels Staff are damaged

14. Media coverage The media focus on scandals, lies and deaths The media seek scapegoats You will do nicely...

15. Media Anyone been the centre of a media storm, and willing to talk about it?

16. Francis report How many of you have heard of it?

17. Francis report How many of you have read it?  Like the Lindsay and Findlay reports for the IBTS

18. Francis report Mid-Staffs hospital, a biggish DGH, got out of control Many people probably died, unnecessarily The Board knew that there were major problems These failings were neither subtle, nor technical, but included a failure to provide food, drink, and basic hygiene to many patients, a failure to investigate a range of serious incidents, and a very poor and dismissive response to complaints.

19. How would you feel? ?

20. Could it happen here? It has, already. Lea’s Cross Aras Attracta …

21. Should I worry? ?

22. Governance in the acute hospitals is in flux This is a polite way of saying ‘all over the place’ Some is good, some seems to be non-existent Much is unclear This is a recipe for disaster The buck stops with the DoH

23. What is wrong? ?

24. Rubbish IT systems Unclear responsibility No boards in many places Weak boards in others You might not know things were horribly wrong, until you read about it in the paper.

25. What to do (besides resign :-) ?

26. What to do Monitor patient experience and outcomes  Mortality conference  Monitor the culture  Complaints  Basic problems – sepsis, bedsores, never events  Record errors Be systematic

27. Is it possible? ?

28. Pretty straightforward All are feasible

29. Harder tasks Shifting the culture of Irish healthcare to a more open culture focussed on accountability and learning, rather than blaming, shaming and covering up Accountability remains important Systematically poor performance must be identified and addressed

30. Consequences? If this were done, then a board member, or a senior manager, could be reasonably sure that he or she was discharging their duty of governance adequately. If not, then I believe there would be no defence for them, should there be serious or systemic failings in care.

31. Hope this looks familiar now!