Improvement focused governance: guidance for non-executive directors

Introduction

NHSScotland is one of the world's leading healthcare systems in respect of the implementation of quality improvement science to support delivery of the healthcare quality ambitions.

'Improvement focused governance' supports continuous improvement in the quality of service through regular review of information, the identification of actions required to maintain a strategic focus on improvement and the risks that might exist to the delivery of these strategic objectives.

Non Executive Directors want to be assured that safe and high quality care is being delivered and that the processes supporting this continually consider the actions to be taken to sustain and improve outcomes and experiences for the people served.

This booklet has been prepared to support Non-Executive Directors across NHSScotland, maximising their contribution to the strategic direction and effective stewardship of NHSScotland.

It shall be the duty of each Health Board, Special Health Board… to put and keep in place arrangements for the purpose of monitoring and improving the quality of health care which it provides to individuals.

National Health Service (Scotland) Act (1978)

There are a wide range of available guidance materials on corporate governance. Many focus on 'what' areas need to be covered - 'Governance for Healthcare Quality in Scotland' is an excellent example of such guidance. ^[1] This booklet considers how this might be achieved. The complexity and fast paced nature of the changes impacting upon health and social care organisations can also make delivery of 'good governance' challenging.

This booklet outlines a process that can be applied across different governance domains to:

• support the formulation of strategy;
• support the delivery of accountability;
• shape a culture of improvement within governance process; and
• support an improvement focus when considering information.

Board Members (including Executive Directors) need to be assured of the approaches being taken to ensure that an organisation meets all of its strategic and statutory obligations.

Quality planning, monitoring and improvement are some of the most important considerations across all of the following governance domains relating to NHSScotland:

• Clinical governance
• Financial governance
• Staff governance
• Information governance
• Educational governance
• Research governance

All of these domains are supported by further specific guidance and resources (see Annex A).

Each domain requires processes to support systematic follow-through from the point information is first considered through to the point that actions can be then be assessed against Board priorities.

Reviews of governance failures within healthcare (and within the wider public sector) have emphasised the need for a relentless focus and rigor to ensure both accountability for the delivery of high quality public services and a responsibility to create conditions that support continuous and sustainable improvements in quality.