GOOD GOVERNANCE PRACTICES IN A HOSPITAL

The Need Of Governance?

Demand for a continuous mode of strategic innovations that meet recent trends and assure quality of care delivery as well as sustaining businesses along with a closely followed path to stakeholder satisfaction.

Growing consumer awareness and patient demands for easy and prompt access, higher quality services and opportunities of second opinions and selection, regulatory, statutory and political influences.

Meaning of Governance

World Bank defines governance as: 'exercise of political power to manage a national affairs. 'The management faculty also places considerable emphasis on governance’.

Management gurus like Jeffrey P and Henry Mintzberg said, organisations are more than just systems for coordinating and supervising work: they are also systems for determining goals, coping with conflict and allocating costs as well as benefits.

WHO research study publications on public hospitals; it is stated that the term 'hospital governance' emphasises on a set of discrete processes and tools and its effective utilisation.

Current issues and challenges

Some of the commonly cited system failures are:I. communicationII. monitoring of policy implementation III. record keepingIV. Leadership.

A recent study states that the third most frequent cause of death in Britain after cancer and heart disease. This may be a study outcome only for the UK. In India, this kind of study outcome is not an updated declaration as yet.

Loss of trust of investors.

Current issues and challenges…..continued

Good governance is at the heart of investment decisions; a research survey analysed that 75 per cent of stakeholders are ready to pay a premium for higher good governance standards.

Investors are not willing to invest in organisations that are not build on inclusive growth models, are corrupt, prone to fraud, poorly managed and lacking sufficient protection for relevant stakeholders and lack of compliance on business and human rights agenda.

Scope of hospital good governance

The efficient use of resources Establishing the trust of investors Economic development Good governance performance Socially responsible citizenship Business excellence Regulatory Compliance Stakeholder satisfaction Risk management and sustainability Safety

Hospital good governance practices

Operates in line with fundamental principles of transparency, integrity and accountability

Provide high quality healthcare How the organisation is led and structured Organisation’s objectives are delivered economically, efficiently and

effectively Protecting interests of both the individual and the organisation. Protecting staff against any possible accusation that they acted

insufficiently. Promote stakeholder satisfaction organisation wide.

The five key elements of hospital good governance

Accountability Fairness and ethics Safety Transparency Independence

Benefits of hospital good governance practices

Facilitates the successful implementation of important strategies Leads to better accountability and transparency Prevents managers from making wrong strategic decisions.

What is the approach to Hospital Good Governance

The approach has to be simple It has to be applicable and has to be uniform yet unique for each

organisation as per the policy of the said organisation. Therefore identifying this need a Code Of Conduct (COCHO) is

developed to cater to the needs of Hospital Good Governance best suited to Indian set up.

Code of conduct

Code of conduct is a voluntary framework of guidelines outlining the responsibilities of or proper practices for an individual, party or organisation.

COCHO

COCHO is a derived set of ‘code of conduct for hospital organisations’, evolved from research data based on best practices in Hospital Governance and the industry set up.

COCHO framework is based on four sustainability pillars in terms of four Ps:

1. Principles2. People3. Planet4. Profit.

Benefits of implementing COCHO

Ensures adherence to statutory and other regulatory compliance Inculcates safety systems and practices. Inculcates a 'responsible' organisational behaviour. Establishes fair and sustainable practices recognition and thereby build

enhanced brand value. Gains trusts amongst stakeholders, funders and investors Evolves to a sustainable programme, organisation wide on a continual

improvement basis. Encourages inclusive growth models.

Examples of good governing practices

• There should be constant supply and availability of blood and other required resources

• Medicines should be approved by the hospital association• There should be constant availability of doctors• PHI should not be shared to anyone without patients permission.• Electronic machinery of hospitals should be checked and maintained

regularly• Nurses should be available 24x7• They should know the details of the patients allotted and their medicine

dosages

Continued…

• Disposal mechanism for used syringes should be Implemented• Medicines should be checked regularly for expiration date.• @4x7 power supply with adequate power backup.

Healthcare’s Information Assets: Digital, Physical and Metadata

Legal health records and other personally identifiable patient data Personal health records Aggregate patient data Claims and business operations data Registries and quality measures data Case and care management Risk and safety data Research data Reportable vital and public health data

Ways Hospitals Should can maintain good governance

Become familiar with audit protocol. Hospitals need to be familiar with the audit protocol

Update the risk analysis. A thorough risk analysis involves outlining the risk needs of the hospital, collecting data to understand the flow of personal health information across the hospital, identifying and documenting potential threats and vulnerabilities, assessing current security measures and determining the likelihood of threat occurrence.

Information should be managed as a strategic asset. information is an asset of the healthcare organization. Like other assets, information has strategic and operational value. It is no longer simply a derivative of the work process.

Continued…

Governance is integral to optimized information use and value. Information governance is the formalization of the assignment of responsibility for setting the organization’s information policy framework and ensures that its policy is to optimize, secure and leverage information as an enterprise asset.

Some examples of Governance in Hospital

• There should be constant supply and availability of blood and other required resources

• Medicines should be approved by the hospital association• There should be constant availability of doctors• There should be standard procedure for recording of PHI• PHI should be shared to anyone without patients concern• Electronic machinery of hospitals should be checked and maintained

regularly• Nurses should be available 24x7• They should know the details of the patients allotted and their medicine

dosages• CCTV’s should be present every where with security guards guarding the

access points

Some examples of Governance in Hospital

• Inventory of injections, syringes, scissors etc. should be maintained • No one should be allowed in ICU apart from hospital authorities• Fire extinguishers and emergency exit points should be present on major

corners• Proper frisking of bags and visitors should be done at entry• There should be an calling button near each patient in order to call nurses.• Water should be purified and purifiers needs to be cleaned each day.• There should be explicit signs for visitors and patients.• PHI stored on servers should be in encrypted format.

Some examples of Governance in Hospital

• Ambulance should be present with driver and other hospital staff 24x7• Doctors background check should be done thoroughly like whether degree

is fake or not, previous experience.• Service desk for hospitals needs to be available 24x7• Proper procedures needs to be followed for police cases and death as well

as birth certificates• Specialist doctors should be hired for specials cases either in hospital or

from other hospitals.• Unknown bodies should be preserved and maintained until clearance from

police.

Some examples of Governance in Hospital

• Safety procedures like new syringes for each time should be Implemented• Expired medicines should be changed regularly• Power supply should be there 24x7 & power backups should be there.• Hospitals premises should be cleaned from time to time.• Information which should not be known to patient should not be disclosed

for e.g sex of baby in womb• Operation should not done without patient or relatives concern(does not

apply for exceptional cases)• Junior doctors should be assisted by senior doctors until they are not skilled

enough.• Strict disciplinary actions needs to be present to maintain the decorum of

hospital.

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