Governance and sustainability

HealthOne NSW service partners need to address both corporate and clinical governance to ensure the safe, proper and strategic conduct of the service.

Corporate governance has been defined as "the system by which organisations are directed and managed. It provides the structure through which the objectives of the organisation are set and the means by which attaining those objectives and monitoring performance are determined" (Flannigan & Power 2008).

Why does corporate governance matter in health care? According to Flannigan & Power (p8), corporate governance deals with:

• Legislative frameworks for health care systems
• Legal requirements under stature and common law
• Strategic planning and policy making
• Proper financial management
• Organisational structures
• Frameworks for corporate and clinical governance
• Human resources or people management frameworks
• Values and code of conduct
• Delegation and accountability arrangements
• Community engagement policies and practices

Contemporary health care is seeing more public policies being delivered through an array of networks and partnerships involving the public, private and NGO sectors (CSIP 2006). This is true of HealthOne NSW which mixes public and private interests and cultures, resources, operational standards and professional standards.

Corporate governance was the subject of a presentation by Roger West from Westwood Spice and group discussion  at the 2008 Statewide HealthOne NSW workshop.

In HealthOne NSW services governance arrangements can, and are likely to, vary and evolve over time.

Clinical governance is closely related. Clinical governance integrates clinical decision-making in a management and organisational frameworkand requires clinicians and administrators to take joint responsibility for the quality of clinical care delivered by the organisation (NSW Health Clinical Governance Directions Statement 2005).

Sustainability has been described as a dynamic construct related to enduring and withstanding without giving way or failing (Sibthorpe, Glasgow & Wells 2005a). Many definitions of sustainability also incorporate the notion of using and managing a resource over a period of time in a way so that it is not depleted or damaged.

There are many dimensions to sustainability. In a general sense they can be grouped into 6 domains:

• Political - taking into account local, state and national political contexts
• Institutional - relationships between and within institutions
• Financial - availability of general funds, specific funds and incentives
• Economic - affected by interactions between funding models and models of care, staff time and workload issues
• Client - dependent on expectations, experience and out of pocket costs for patient
• Workforce - staffing profile, skills and staff motivation
  Source: Sibthorpe, Glasgow & Wells 2005b

These domains were discussed at the 2008 Statewide HealthOne NSW Workshop in the session on sustainability.

Evaluation of the integrated primary health care centres in South Australia showed that sustainability relied on information and communication technology strategies to support integrated multidisciplinary team care, increased access to research and professional development for staff and retention of skilled health professionals (Taylor, Blue & Misan 2001). A significant factor in retaining skilled staff was a multidisciplinary team approach where there were shared patients, trust and respect among the health professionals and significant time spent together.

Braithwaite J. & Travaglia J.F. (2008), An Overview of Clinical Governance Policies, Practices and Initiatives, Australian Health Review, Vol. 32 No. 1, pp10-22.

Care Services Improvement Partnership (2006), We Have to Stop Meeting Like This: The Governance of Inter-agency Partnerships.

Flannigan A.C. & Power P. (2008), Health Care Governance: Introduction, Australian Health Review, Vol. 32 No. 1, pp 7-9.

Jackson C.L, Nicholson C, Doust J, O’Donnell J. & Cheung L. (2006), Integration, Coordination and Multidisciplinary Care in Australia: Growth Via Optimal Governance Arrangements.

NSW Health Clinical Governance Directions Statement 2005.

Sibthorpe, B.M., Glasglow, N.J. & and Wells, R. W. (2005a). Questioning the sustainability of primary health care innovation. MJA, 183(10), S52-S53. (Link to article)

Sibthorpe, B.M., Glasgow, N.J. & and Wells, R. W. (2005b). Emergent themes in the sustainability of primary health care innovation. MJA, 183(10), S77-S80. (Link to article)

Taylor, Blue & Misan (2001). Approach to sustainable primary health care service delivery for rural and remote South Australia.  Australian Journal of Rural Health, 9, 304–310. (Link to article)