Finding the sweet spot between governance and management for success
We know that governance and management must work in harmony to support consistently good care. Although boards and executives enact distinct clinical governance roles, high-performing health services exhibit consistency between board priorities and management practices.
But this is not often discussed within the clinical governance context. Some boards and executives struggle to find the harmony sweet spot, while others may not know they should be trying to find it.
This systematic review explores the relationship between management practices and care quality, and finds that hospitals with management systems focused on effective operations, monitoring, target-setting and supportive human resources consistently outperform their peers on clinical quality metrics. We might call this the ‘clinical governance and management system’ within which both boards and executives must play their role for success. The authors describe roles for boards and executives.
Boards can support effective care quality management by:
- Strengthening Oversight and Engagement: Boards must engage directly in reviewing quality performance data and participate in setting clear, measurable quality goals. Their involvement should translate into actionable directives for management.
- Prioritising Clinical (Care) Quality: Boards must make clinical (care) quality a central focus, dedicating substantial time to discussing it during meetings as a standing agenda item.
- Using Quality Metrics Effectively: Boards should actively use clinical (care) quality metrics to guide decisions, track organisational goals and assess leadership performance. Tying CEO and senior management evaluations and compensation to specific quality outcomes reinforces accountability.
Key actions for executives and managers to support quality care:
- Align Targets with Board Priorities: Managers should ensure that internal targets reflect the board’s quality priorities and national benchmarks. This alignment enhances coherence in quality improvement strategies.
- Implement Strong Management Practices: Managers align staff efforts with the organisation's quality goals and establish robust systems for monitoring progress towards the goals and clinical (care) outcomes and optimising operations to achieve them.
- Focus on Quality Monitoring and Operations: Management should emphasise continuous monitoring of clinical (care) performance.
- Foster a Culture of Accountability: Linking strategic goals with front-line execution requires a culture where striving for quality care is non-negotiable and supported.
Boards and executives should make time in planning sessions to revisit their respective roles and to review how well they are enacted – separately and together – to support quality care.
All accessed 15/02/2025: