GovernWith Blog

Governance Evaluator and The Australian Centre for Healthcare Governance (ACHG) are excited to announce a new initiative for building strong governance in the health sector. 

Our newly formed partnership combines the proven approach of Governance Evaluator’s online suite of board evaluation solutions with the health sector and extensive governance consulting expertise of JoAnne Moorfoot Director of ACHG and her Team to provide VHA members with a comprehensive approach to board and director review and ongoing governance support services  The partnership builds capacity for both Governance Evaluator and ACHG to ensure all VHA members have access to a consistent and proven range of solutions for improving their governance performance and ultimately driving quality outcomes for their consumers. 

Governance Evaluator is the most straightforward and intelligent way to improve your board’s performance. The easy-to-use online system enables you to manage your governance program at your own pace whilst using a proven, systematic approach to improving governance performance.  A suite of complementary, health sector-specific solutions, enable you to design a governance program to meet your specific needs. 

Using Governance Evaluator for your annual governance and director development program ensures you build your capabilities using sector relevant evaluations, consistent trending of results and dynamic action plans which are responsive to your needs at any point in time.  Our community enables you to benchmark your performance against your peers and other governing bodies with like responsibilities. 

The ACHG approach and experience is unique, combining their working and ‘systems’ knowledge of governance and strategy in the Victorian health system to apply a practical methodology to work with organisations to diagnose systems issues, and facilitate problem solutions to develop governance system improvements. 

Together Governance Evaluator and the ACHG expertly support boards and directors on their journey of continuous improvement; building a shared, consistent understanding of good governance and empowering leaders to improve organisational efficiency, productivity, service quality and culture. 

ACHG not only provides expertise convening to support boards through their governance and director development programs, but, following on from the board evaluation ACHG can provide additional support to boards. They can provide ongoing development to build and enhance the skills of the board across a broad range of areas including Corporate and Clinical Governance, Legislative Compliance, Integrity Governance Training, Occupational Health and Safety, Strategic effectiveness for boards and Roles and Responsibility of Chairs. 

If you would like to learn more about this exciting new initiative, please contact Governance Evaluator  or the ACHG achg@healthcaregovernance.org.au

A board that listens and acts will help secure a better ageing future 

Picture yourself in bed, incapacitated and unable to communicate. Your greatest pleasure is a hot cup of coffee, but every day your coffee grows cold while you await the arrival of your carer. A board that hears the voice of the consumer can prevent this from happening. 

Identifying the problem 

Governance Evaluator’s 2018 Governance Capability Benchmark Report assessed governance capabilities across over 70 boards in the aged care, health, community and government sectors, with the Governance of Clinical Care module evaluating boards in relation to the new Aged Care Quality Standards. 

It is no surprise that genuinely partnering with consumers, in particular hearing the voice of the consumer at the boardroom table, emerged as the key governance issue among aged care and health boards. The results show that only 39 per cent of aged care boards understand how to successfully hear the voice of the consumer at the boardroom table. 

Working towards the solution: today 

Aged care boards have a crucial role in achieving a person-centred aged care industry, for it is at board level that the consumer becomes genuinely embedded within the care framework. 

In order to understand what dignity and choice really means to their consumers, boards must take steps to identify who their consumer is, what they want, and what obstacles they need to overcome to get what they want. 

Leading aged care organisations are currently implementing solutions at board level that enable the consumer experience to be respected and reflected in service delivery, for example: 

• Boards are ‘getting up and going out’; conducting ‘walkarounds’ of their facilities to get a better understanding of the issues. 
• Boards are immersing themselves in the communities they serve, and are embracing the diversity within. 
• Boards are extending methodologies for collecting consumer feedback to a series of larger focus groups consisting of people with ‘lived experience’, being consumers, their children, families and carers for a deeper understanding of their issues. They are also using their definitions of choice, vulnerability, respect, dignity, happiness and dignified dying to inform their policies procedures and behaviours. 

An important component of this is gaining an understanding of the way their consumers lived and the things they loved before they entered their aged care service, and working to respect their individuality in care planning. This is how the board can be assured that the organisation understands the importance of a simple hot cup of coffee. 

Working towards the solution: tomorrow 

The capacity of behavioural data and artificial intelligence in providing a voice for the age services consumer is expanding at an astounding rate in Australia and internationally. 

No longer the stuff of science fiction novels, artificial intelligence applications collect data to model predictable behaviours in an individual consumer as well as larger populations so that deviations from an expected behaviour can trigger appropriate responses. 

Examples of these include devices that check inconsistencies in biometric data and smart sensors that detect and report on falls, through to human pose detection applications and companion robots that identify and keep track of important objects around the residence and help the consumer remember important tasks and events. 

For an aged care service board, the collection and utilisation of this type of data, which can speak on behalf of the consumer if the consumer is unable to speak for themselves, provides assurance that their organisation is providing safe and quality care as well as providing true choice and dignity to the consumer.  This information can also be used to assure boards that their consumer needs are being heard and attended to in a proactive caring way. 

Next steps are for boards to develop more sophisticated skills around data analysis and how it can support their important oversight roles for consumers’ choices being respected, services having a culture of safety and quality, and their aged care businesses prospering. 

Originally published in LASA Fusion Magazine Spring 2019. 

A key factor for building high functioning boards that have the ability to lead successful organisations is for the board to have the right systems, processes and supports in place to empower a group of experts to become an expert group. 

An effective induction is an essential process that enables directors to be ‘on boarded’ in a timelier fashion, allowing them to contribute their expertise better at the board room table, to feel more confident about their knowledge of the organisation and its risks, and ultimately to improve their ability to govern. 

However, our research shows that boards across multiple industries consistently identify effective director induction as a critical gap in their governance processes. While effective induction is actually quite a straightforward process to achieve, many boards are missing the mark, with the result being directors who lack the understanding, expertise, engagement  and confidence required to properly govern the organisation. 

What does an effective director induction process look like? 

An effective induction process provides new directors with information about their role so that they quickly become useful, integrated and satisfied members of the board, and are able to contribute effectively. 

It is important that the induction process is relevant to each director’s skillset, and is an engaging process. This is a shared responsibility for imparting and gaining knowledge about governance requirements as well as the organisation and its top risks. 

A quality induction process should include a well thought out combination of: 

1. Knowledge about the director’s skills and experience, with corresponding supports & information: mentoring/buddying, board online systems and supports tailored for their gaps. 
2. Information about the organisation and director roles, including strategy, services provided, top risks and tolerances, directors’ roles and responsibilities, board processes, governance policies and procedures, board resources and training, as well as tours of the organisation and social events. 
3. Information about the industry/sector, including key information about the sector and its unique requirements, frameworks, legislations and legal structure 

When should the director induction process begin? 

Induction should commence in the recruitment stage, before election or appointment, to ensure that directors with the necessary strengths are appointed. The Governance Evaluator Director Development & Skills Matrix is invaluable at this stage in identifying the current skills, experience or cultural gaps on the board that will inform the recruitment process as well as explain the board’s priority areas to potential new directors. 

The induction program itself should comprise a stepped process that includes actions before, during and after the first board meeting. New directors should start by completing the Director Development & Skills Matrix and their results should inform key elements of their induction plan prior to commencement on the board.  For example, a director may be starting on the board of a healthcare organisation, but their Development & Skills Matrix results show that while they have high finance and legal skills and experience, they have low clinical governance and data analysis skills. This will therefore inform the most suitable director to be their mentor, as well as the educational resources on which they should focus. 

Their individual induction action plan would therefore include standard organisation and sector components but also include individually tailored content to help them address their specific development needs to more quickly onboard and contribute. In addition, the process enables new directors to become more aware of their strengths, so they feel more confident to contribute in that area at the board room table. 

How long should director induction take? 

Being realistic about the time it takes to become familiar with an organisation is important. An effective induction process may take up to 6 months for the initial actions and is important to be ongoing. It should also include regular check ins between the chair, mentor and the new director to ensure they feel welcome, comfortable and confident to contribute.  Good practice is to have director induction and check in as a board meeting agenda item. 

What steps contribute to an effective induction process? 

As outlined in figure 1, an effective induction process consists of often concurrent steps that seek to optimise: 

• The culture of the board – promoting a welcoming, collegiate culture that values and appreciates the new director. Achieving this culture will result in directors who are engaged, passionate and have a long tenure. 
• The contribution of the director – educating and empowering the new director in relation to the organisation, broader sector and their governance requirements, but also in relation to their own skills and areas for development. Achieving this will result in directors who quickly make a meaningful contribution to the board and continue to improve throughout their tenure. 
• Continuous improvement – ongoing evaluation and improvement of the induction process to ensure that future new directors, and the organisation, will benefit. 

Fig 1: An effective director induction process. Steps are often concurrent. Read on for more details about each step. 

Getting started for your board 

As you can see, an effective director induction process is based on understanding the new director’s skills and experience, and working within a health board culture with a commitment to contribution and continuous improvement. The benefits of achieving this from the outset are significant, in terms of director satisfaction, tenure and contribution right from their first board meeting, as well as the effective governance of the organisation. 

The Governance Evaluator Director Development Program is the perfect place to begin, as it supports boards to achieve the key characteristics of effective governance, ensuring a consistent and high functioning level of the right skills, experience, and behaviours across all directors. 

Our expert conveners support boards to optimise their induction process, and guide directors to build and maintain their Individual Director Development Plans. 

Steps to an effective director induction process in further detail 

Culture 

• Welcome*: As soon as possible after the board has confirmed/been notified of the appointment of a new director, the chair sends a welcome and congratulations letter, inclusive of requirements for commencing the induction process prior to participating in the first board meeting. 
• Appointment*: The new director signs all relevant contracts, statements and disclosures. 
• Introductions*: The chair introduces the new director to existing directors (and senior staff, if appropriate) as soon as possible after their appointment and seeks to involve the director socially in board activities. 

Contribution 

• Development & Skills Matrix*: The new director completes a Director Development & Skills Matrix to identify areas of high strength/expertise and areas where development may be required. 
• Individual Director Development Plan*: The chair assists the new director in building a tailored development plan to guide their education, training and development priorities throughout their tenure on the board. 
• Chair briefing*: The chair takes the new director through the minutes of recent meetings, and briefs them on the issues the board is dealing with at the moment, or will be looking at in the future. The chair also draws the new director’s attention to the roles and responsibilities of the board in general, and the roles and responsibilities they will be expected to undertake as an individual, and discusses any concerns they may have. 
• Mentoring*: Based on the results of the Development & Skills Matrix, the chair nominates a more senior member of the board with differing skills and experience to the new director to act as mentor to the new director. The mentor supports the new director in a variety of mutually agreed and scheduled ways, such as taking the new director through board papers, sitting next to the new director in board meetings and regularly checking in by phone or face to face, accompanying the new director on a walk around the organisation. The chair is kept informed throughout the mentoring process. 
• Background reading*: The new director is provided with a copy of the organisation’s relevant governance manuals by the chair and/or board support person, which will serve as an initial introduction to the group as well as an ongoing reference. It should include:  
  • relevant organisational documents such as the mission statement, organisational purpose & strategic plan, constitution/rules 
  • financial information, including current year-to-date budget, financial position and funding model and the most recent annual report 
  • services provided by the organisation, their top risks and assurances, and the risk reporting strategy to the board 
  • introduction to the organisation’s operational and committee structure 
  • information about the organisation’s social media, newsletter and other communication methods for the new director to subscribe to and/or follow 
  • information about IT systems and networks used by the board for intra-board communication, with necessary logins 
  • basic biographical and contact information about board members, and staff (if appropriate) 
  • basic meeting schedule and board annual calendar 
  • roles and responsibilities of the board and its directors 
• Organisation tour: The chair invites the new director to take a tour of the organisation’s facilities and introduce them to staff, volunteers, members and the beneficiaries of the organisation. The chair and/or board support person also shows the new director where the board meets, and all other general housekeeping requirements, to ensure the new director feels comfortable. 

Continuous Improvement 

• Induction review: The chair and/or board support person surveys the new director regarding the induction process to identify any potential areas for improvement 
• Regular Check-ins: The chair and/or mentor meets with the new director each month for the first 6 months of their tenure to monitor their Individual Director Development Plan, address any issues and ensure they feel engaged and confident to contribute. 

*These steps should take place prior to attending the first board meeting. 

Make a booking below to chat with our a governance expert and see how we can help you. 

While board self-assessment is recognised by organisations including ASX, DHHS and AICD as an accessible, flexible and sound contributor for understanding and improving a board’s performance, the issue of subjectivity within a self-assessment is a long-standing point of discussion and debate. 

How realistic are boards at self-assessing their own performance? 

While the issue of subjectivity within a self-assessment is a real consideration, there are methods a board can employ to reduce the influence of subjectivity from the outputs of a board self-assessment. 

As illustrated below, the most important action a board can take to counter any subjectivity is to ensure the self-assessment is not the sole source of information, but rather is one of several key elements in the evaluation process. 

These elements should include: 

• A self-assessment questionnaire that asks about aspects of good governance that require supporting evidence rather than simply seeking perceptions. For example, a question may ask about the presence (or otherwise) of a policy or procedure, and the regularity of updates. This requires a more objective response than asking about how the respondent feels about the board’s performance in relation to the same policy or procedure. 
• Leadership and communication from the chair so that the board are assured about the confidentiality of their responses and the subsequent ways in which their responses will be used. For example, for professional development.  
• Ensuring a whole board discussion of the self-assessment findings takes place, which triangulates responses between members, and between group behaviours and responses.  
• Periodically bringing an objective aspect to the evaluation by engaging an external independent convener to facilitate the group discussion, or to enrich the entire evaluation and capability building process by undertaking desktop reviews, director interviews, and by facilitating and building group and director action plans.  
• Benchmarking the results of the board evaluation to those of other boards in similar industries and environments. Confidential benchmarking against the cohort average as well as the best performing boards in the cohort will stimulate further conversation about the board’s self-assessment findings.  
• Historical trending of results, so that themes that may have emerged in initial evaluations can be tracked in subsequent years.

How do boards translate the results of the evaluation into improvements? 

As well as the often-legislated requirement to ensure delivery of safe and quality services via a culture of continuous review & development, it is crucial for the morale and drive of the board members that the time they invest in undertaking a robust evaluation is rewarded via assurance that the evaluation will result in more effective governance of their organisation. 

The first step to achieving this is for the evaluation process to be comprised of multiple elements (as described above). 

Secondly, while the evaluation process is a vital snapshot in time, equally important are the discussions and actions that follow the evaluation. There are a variety of methods to translate the results of the evaluation to inform the group discussion: 

1. In an independent convener led process, the convener analyses the outputs of the self-assessments, confidential interviews, desktop review, peer review and committees review and presents them to the board as a recommendations report for review and discussion.  
2. In a chair led process, the chair analyses the outputs of the self-assessment and confidential interviews and presents them to their board either as a recommendations report or a facilitated discussion. 

Thirdly, with the priority areas identified, the board action plan must be built to convert the priorities to actions and then ultimately to results. The board action plan must include SMART (Specific, Measurable, Attainable, Realistic and Timely) actions set against each priority area that are assigned to a responsible person, and be tracked against deadlines. Regular review of the board action plan is vital to ensure that it remains current and actions are followed through across the remainder of the year. 

Individual action plans must be built in concert with the board action plan, which are developed and used by members to resource and address any individual gaps in knowledge, experience or skills uncovered during the evaluation process. The importance of gathering and acting on this information is also recognised by ASIC in their most recent Governance Principles. 

Next, the beginning of each new year provides an opportunity to challenge, and confirm or reset, the board’s current priorities by comparing performance to the average and best performers in their industry cohort via a board review of their Governance Capability Benchmark Report. 

Finally, annual re-evaluation is a vital component of continuous improvement, as it highlights areas of development and new areas of focus for the next capability building cycle. 

The very act of evaluating, discussing, choosing actions and being accountable for their implementation, then measuring both internally and externally, sets the culture of quality and continuous review and development from the top. As the Royal Commissions and prudential enquiries have determined, this type of culture is essential to effective governance and quality delivery of service. 

Despite accreditation processes being embedded in health systems across more than 70 countries around the world, the actual value of accreditation to health care organisations is not well understood; and more work is needed to determine its value and how to measure it. 

What is the value of accreditation? 

Accreditation is often viewed as a costly, time-consuming bureaucratic burden that adds little value in terms of patient care. Yet accreditation has also been found to be positively associated with high-quality care, high patient satisfaction and good outcomes. This means that accreditation processes could be used to develop and support a culture of safety and quality among health workers. Particularly when staff are aware of its purpose and are involved in the accreditation process. 

Measuring value in health care 

Our latest health policy evidence brief from the Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association, assesses the value of accreditation to health service organisations against the health care quadruple aims of: 

• Improving the patient experience of care (including quality and satisfaction) 
• Improving the health of populations 
• Reducing the per capita cost of health care
• Meaning in work 

Findings from the brief advocate for a research-based approach to developing a common narrative on what constitutes value, so that value relating to interventions such as accreditation can be more appropriately assessed. 

Where do we go from here? 

A 2018 review by the Australian Commission on Safety and Quality in Health Care (ACSQHC) has resulted in revisions to the assessment process, the assessment team, use of data, regulatory oversight, communication of assessment outcomes, and resources and support for health services. 

The changes will be phased in from January 2019, and it will be interesting to see a formal evaluation of the results further down the track.