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Healthcare Governance

Operation and managing of a medical practice requires multiple functions coordinated towards working the same goal and that is to give satisfaction to the patients by hiring trusted and highly qualified professionals to handle different medical services with a loving touch. System influences regulatory issues such as Medicare/HIPAA compliance, coding even handling reviews and audit. They must also effectively analyze fee schedules and overhead production analysis to prevent improper budgeting. Cost accounting services is also part of this revenue enhancement. Part of the system strategic planning consultation is practicing valuation, conducting negotiations and contract review.

Organizations can harvest several benefits from appropriately practicing strategic management. Thompson (1992) noted that strategic management provides better direction to the entire organization on the vital point of  what it is we are trying to do and achieve?. The second benefit is seen financially as effective strategic management system increases productivity according to (Certo & Peter, 1988, p. 7) since it provides managers with a basis to evaluate competing budget request for investing capital and new staff. Governance is manifested by a group of individuals who have the authority and the strategic intent to make things happen. In this paper, several relevant constituencies are discussed. Components parts of an organization were composed mainly of the governing boards which are responsible for making policies or establishing direction under which the organization will operate. There are different types of governing boards in health care. The Philanthropic governing boards which service are more oriented and concerned primarily with spanning the boundary between the health care organization and the community. These boards are larger and more diverse to add on the exposure of the broadest community as possible. The appointed committee’s major duty is to prepare the plan in accordance with the hospital’s general mission, policies and corporate requirements set by the board. The board also advises the committee of what is expected of it in terms of its duties, the basic philosophy underlying its activities, any set timetable to report back to the board, and the support of its authority to make any special arrangements necessary to carry out the required tasks. And the one responsible for all the information and support the implementation of the board’s decisions is the CEO. The CEO coordinates the hospital’s resources in order to fulfill the institution’s medical care mission in the most efficient and effective way.  Then he or she tries to manage the hospital’s funds, personnel, material and equipment in a business-like manner. He or she is responsible for all the other functions such as the medical staff functions, nursing services, technical activities, and the general services activities. Successful implementation of clinical governance may also be facilitated by taking advantage of quality improvement approaches which may have a long standing role in different localities such as local audit groups. Many interviewees were seeking to develop values rather than set specific priorities and to develop an environment in which practice staff viewed active engagement with clinical governance activities .Meetings with practice clinical governance leads (invariably doctors) were common tools in opening channels of communication with practices. Some participants argued that this strategy will be undermined unless a perceived blame culture which is seen by many health practitioners to pass through the health sector that is replaced by a non-judgmental open and participative culture. Most of the senior managers in the sample were aware that many practitioners associate clinical governance with quality assurance and that it perpetuates a blame culture associated with monitoring performance rather than quality improvement. Some interviewees stated that the government’s main agenda for clinical governance was policing orientated quality assurance; this generated suspicion among health professionals. Indeed, several managers stressed that they saw their role as a “buffer” between government and practices. Most interviewees especially clinical governance leads consequently felt that the successful implementation of clinical governance depends on “getting the culture right”, with all practices becoming involved in quality improvement activities. This applies particularly to general practitioners who are also being asked to buy into a corporate philosophy alien to their independent contractor status. Few doctors were felt to be against quality improvement, but many were thought to be cautious of how it would be implemented and some were thought to be scared of the current focus on revalidation and review. While core staff composed of general practitioners, practice nurses, and practice managers which are increasingly supportive of clinical governance. Scally and Donaldson (1998) suggested that a number of factors can impact on the healthcare governance agenda. Current policies on pay transformation and role re design are creating significantly more work for staff and these pressures them by additional challenging deadlines. Some of the barriers to have successful implementation of clinical governance are lack of support from other staff or from the management, problems in funding, lack of time to address all challenging agenda, few staff to implement clinical services and continued disengagement by some staff. These barriers can be divided into structural, resource, and cultural barriers. Structural barriers include weak line management or contractual levers to influence general medical services practices, rather than personal medical services practices. Resource barriers include a perceived lack of staff, skills, or information to implement clinical governance. Doubt by practice staff of the aim of clinical governance or problems overcoming the perceived blame culture associated with quality assessment, are cultural barriers which will take longer to address.
The vision, mission and goals of an organization have a direct impact on the strategy ultimately adopted. The vision is a view of the future taking today decisions that will affect tomorrow’s issues. It is “a blueprint of a desired state, a mental image, a picture of a preferred condition that organizations work to achieve in the future” (Johnston, 1994, p. 24). To define a vision for a hospital is rather a challenge especially if its leaders are unable to see beyond today’s mission to a vision for tomorrow. According to Rathwell (1987, pp. 156-63), the strategic vision is commonly regarded to be the corporate philosophy or statement of basic principles that govern the direction in which an organization seeks to develop. The development of one commonly shared vision necessitates the collaboration of the Trustees who should all agree on a set of values, views, and principles. These accepted standards form the basis for the formation of a genuinely shared value statement. Hospital’s pro-activity necessitates the expression and revision of the vision statement on an annual basis in consideration of the environment and known trends. The mission conversely represents the harmony and articulation of the organization’s perceptive of the external opportunities, pressures and the internal strengths and weaknesses.

We must always remember that strategic management systems provide consistency of actions, and clear objectives and direction for employees thus, boosting their commitment for the sake of the sacred objective of achieving corporate synergy. Recognizing that the successful implementation of clinical governance in general practice will require cultural as well as organizational changes and the compliance if not enthusiasm of practices, system must focus on  their energies on supporting practices and by getting  involved in multi-professional and corporate clinical governance activities such as facilitative non-policing approaches. Such approaches adhere to a quiet word system of networking. Lessons learnt from the introduction of clinical guidelines also stress out the importance of constant implementation strategies and a sense of ownership by those involved.

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