Key enabler - corporate governance

The presenter's comment "don't let governance arrangements get in the way of what you want to do" resonated with workshop participants.

Developing the local clinical models was seen as fundamental to informing the financial modelling and governance arrangements. Some HealthOne NSW partners had initially started with developing their governance arrangements, before moving to business modelling, but found that these were dependent on, and informed by, the model of care. Without a clear understanding of and agreement about the model of care, partners were not certain about their respective roles and responsibilities and risk exposure.

Workshop participants also agreed that allowing governance arrangements to evolve over time, instead of entering into inflexible arrangements in the early stages, was important. The HealthOne NSW service concept is new for most people and there was a level of comfort in knowing that arrangements could be developed and tested.

At HealthOne Rouse Hill for example, corporate governance arrangements have started with a simple agreement where the AHS and the local Division of General Practice are equal partners, but will eventually evolve to a company limited by guarantee. The HealthOne Rouse Hill partners have agreed that the company board will have representation from the AHS and the Division, as well as other members including community representatives.

The session facilitator recommended that developing HealthOne NSW services draft a constitution (using a simple template) and then test its suitability when the service becomes operational. The constitution can then be revised to reflect the shared understanding of the business.

Many sites reiterated the critical importance of defining roles and responsibilities and redesigning systems and processes to support the new way of working. After the clinical model has been developed, business modelling should be the next step to ensure the model is sustainable (see the session on sustainability for further exploration of this issue). A marketing plan should finally be developed in the knowledge that clinical and business matters have been satisfactorily addressed.

It was agreed that, to date, the success in service development can be attributed to the trust that has been built between the partners and with stakeholders. Successful engagement strategies included:

• Getting quick wins
• Hearing each others problems and challenges and engaging in honest and frank communication
• Getting staff from partnering organisations to work together on joint projects
• Using independently facilitated sessions to work through sticky issues

Key messages

• The formal governance arrangement will reflect what evolves as partners and stakeholders work together to develop the model of care and build trust.
• Therefore, start with the model of care and build trust by actively engaging with partners and stakeholders and communicating frankly and honestly.