Aidan Horan Director Consultancy Training Development Directorate IPA

Aidan Horan Director, Consultancy, Training & Development Directorate, IPA

HMI Annual Conference Contribution of Effective Governance Aidan Horan Institute of Public Administration 3 rd October 2011 © IPA 2011

IPA Governance Forum © IPA 2011

n o i l l i B. 3 £ 1 ? s th a e D t n e i t a 0 0 £ 8 n lio l i M P © IPA 2011

© IPA 2011

Accounts of the Public Services 2010 Vote Management Report of the Comptroller and Auditor General Volume 2 Presented to Dáil Éireann pursuant to Section 3 (11) of the Comptroller and Auditor General (Amendment), Act 1993 September 2011 © IPA 2011

E C N A N R E V O G C I M O C E N O © IPA 2011

© IPA 2011

Governance Questions Are these rules/ statutes governing the operation of FIFA? Did each football association have an opportunity to vote ? Was the election nomination process in accordance with FIFA rules? Was the counting of votes conducted properly? Has the reputation of FIFA been damaged? © IPA 2011

Key Message Good Stewardship Good Management & Performance Good Governance Good Public / Stakeholder Engagement Good Outcomes © IPA 2011

Governance The processes, structures and procedures in place to ensure that persons and organisations charged with responsibilities by government, shareholders or members carry out those responsibilities to the highest standards © IPA 2011

Corporate Governance This is the system by which organisations direct and control their functions in order to achieve organisational objectives, manage their business processes, meet required standards of accountability, integrity and propriety and relate to their external stakeholders © IPA 2011

Clinical Governance is ‘a framework through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. ’ (Scally and Donaldson 1998) © IPA 2011

Integrated governance can be described as ‘Systems, processes and behaviours by which health service organisations lead, direct and control their functions in order to achieve organisational objectives, safety and quality of service and in which they relate to patients and carers, the wider community and partner organisations. ’ (Dept of Health, UK 2006) © IPA 2011

Hard Law / Soft Law HARD LAW – legally binding obligations, a rule or system of rules, having binding force and effect SOFT LAW – not formally binding but nonetheless exercises significant influence on behaviour, could conceive of it as quasi legislation, as having some moral authority Which of the above do you consider applies to © IPA 2011 governance in the health service?

Governance Codes HSE CODE OECD CODE UK CODE STATE BODY CODE GOOD GOVERNANC E STANDARD IFAC REPORT © IPA 2011

Good Governance Standard 1 Organisation’s purpose and on outcomes 2 Performing effectively in clearly defined functions and roles 6 3 Promoting values… behaviour Core Principles 4 Informed, transparent decisions and managing risk 5 Capacity and capability of the governing body 6 Engaging stakeholders and making accountability real © IPA 2011

International Federation of Accountants (2009) Evaluating and improving governance in organisations © IPA 2011

International Federation of Accountants (2009) Evaluating and improving governance in organisations Selected key principles for good corporate governance Good governance should appropriately balance the interests of stakeholders The performance and conformance dimensions of governance are both important to optimize stakeholder value Good governance should be fully integrated into the organisation The governing body should establish a set of fundamental values by which the organisation operates. All those participating in governance should embrace these fundamental values © IPA 2011

The Commission recommends that governance arrangements across the system should enable a connected and integrated approach at local, regional and national levels that ensures that good governance is in place and that learning occurs and is disseminated effectively. © IPA 2011

The Commission agreed that the vision or framework around which the Irish health system should be based is as follows: Knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes © IPA 2011

The values underpinning this framework include openness, patient centredness, learning, effectiveness and efficiency, good governance, leadership, evidence-based practice, accountability and patient/family involvement © IPA 2011

Risk Management, Accountability, Audit (1) The Board should approve the Risk Management Framework and monitor its effectiveness © IPA 2011

AS/NZS 4360: 2004 © IPA 2011

Risk Appetite is defined as the amount of risk the organisation is prepared to accept or retain in the pursuit of its core priority objectives. What is the Risk Appetite within your organisation and does this have implications for governance? © IPA 2011

It is important to acknowledge that despite our best efforts, medicine will never be a risk free enterprise. What we must do in our efforts to make the system as safe as possible for patients and staff is to ensure that we have the right checks and balances in place © IPA 2011

Question From your perspective, what are the most significant risks facing the healthcare system and how can or are these risks being managed? © IPA 2011

Characteristics of Networks Clusters of autonomous organisations collaborating, engaged and working together Co-ordinating projects and initiatives Based on implicit or open ended agreements Agreements and obligations exist between organisations but are not legally binding © IPA 2011

Some Evolving Governance Challenges 1 Demonstrating values through behaviour/actions/ example 2 Risk Management, accountability and assurance systems 3 Communicating performance achievements 4 Managing the reputational risk 5 Building and restoring trust and confidence 6 Effective shared governance/network governance systems © IPA 2011

Role of the following in the governance agenda: Rules Compel you or force you Principle Guide you or motivate you Hard Law Legally binding Soft Law Exercises influence Values Behaviour, Standards Morality Concerns with good and bad © IPA 2011

Leadership, Accountability, Management Information Management Education, Training & Development Patient & Public Involvement Effective Governance Staff Management & Welfare Risk Management Clinical & Research Effectiveness © IPA 2011

“We live in an imperfect world: as human beings we all make mistakes and no system is perfect. However, all of us working in the delivery of healthcare owe it to our patients and to ourselves to do all that we can to minimise errors and maximise quality. The best way to do this is to accept and describe honestly where and how mistakes and failures have occurred in order to learn and to improve. A blame-free reporting and management culture is in the best interests of patients and those delivering services. ” © IPA 2011

HMI Annual Conference Contribution of Effective Governance Thank You Aidan Horan Institute of Public Administration www. governance. ie 3 rd October 2011 © IPA 2011