Improvement focused governance: guidance for non-executive directors

Improvement Focused Governance

Governance processes are sometimes considered to be incompatible with quality improvement models and approaches. Processes such as risk management, compliance reporting, scrutiny and inspection are also often thought to be at odds with quality improvement.

Non Executive Directors need to know what to ask, know when and how to contribute positively to dialogue, and when to challenge. Further discussion about where a Board might need to ensure further action, new actions or a change in the way support or resources are being allocated. For example, the booklet in this series entitled "Safety Checklist: Questions Everyone Should Ask About Safety" outlines the ways in which various elements of the Scottish Patient Safety Programme might influence Board dialogue or the way in which learning from adverse event reviews might then inform actions to improve systems and processes.

An improvement focused governance discussion would focus on challenge and scrutiny in a way that was informed by models of quality improvement ( i.e. taking account of systems issues, the nature of the variation in data considered or psychological processes influencing staff responses).

It would also focus on understanding trends in data and would not be content with reassurance through infrequent measurement that is then aggregated and presented in a 'Red', 'Amber' and 'Green' ( RAG) report for example. ^[2]

Improvement focused governance is better served by measurement processes that encourage action when the data signal concerns or successes - rather than requiring effort or actions in responding to inherent variation or noise in the data being considered.