Leadership, culture and governance

Does the culture of your organisation have effective leadership and high performance?

When focussing your activities to improve access to care, the change you are making will require effective culture and  good leadership to be successful.

There is significant evidence highlighting the importance of collective leadership in health care organisations.  This means that change must be influenced in a bottom-up way (by clinicians and service managers) and not just through the top-down application of formal authority.  In the health system, professionals play key leadership roles, both informally and where they are appointed to formal positions. You must involve large numbers of leaders from clinical backgrounds at different levels for sustainable change.

Features of the culture of high performing organisations include:

  • having clear shared values and objectives
  • being realistic
  • having a desire to learn from mistakes
  • having clear lines of accountability but integrated teamwork
  • devoting attention to the quality of their leadership, their processes and to their strategy
  • having an action oriented culture
  • making decisions based on data
  • being transparent about performance  

Is your executive sponsoring your project and driving the change?

Strong and committed executive leadership is essential throughout your change process in order to achieve Whole of Health Program objectives.
Executive leadership should focus initially on communicating the “why?”
  • WHY the Whole of Health Program (WoHP) is important to improving the quality of patient care across NSW
  • WHY overcrowded emergency departments and delays to care for patients are not safe or effective. Extended stays in ED lead to adverse event, longer lengths of stay and poorer outcome in mortality
  • WHY the organisation must value the time of patients, their families and staff by using measurement of patient experience and workplace culture to guide efforts.
Visible leadership from your senior executives in partnership with key clinician leaders establishes a clear message of the importance of the program to the organisation.

Ask yourself:
  • Is the WoHP an agenda item at all organisational meetings, with regular review of data and outcomes?
  • Are health service executives visible in clinical areas, seeking to better understand issues from clinicians and patients?
  • Have the WoHP performance trajectories been shared across the organisation?
  • Are governance structures and processes aligned with desired clinician engagement?

Local Health District / Specialty Health Network governing boards

The actions of local boards affect patient outcomes and system performance. High performance in quality and efficiency is more likely to be achieved where boards:
Also, boards explicitly hold the chief executive accountable for performance against quality and safety goals. This enables boards to make an enormous difference to the quality of patient care. Communication about the Whole of Health Program must include your local board. 
 

Education and training

HETI Leadership Program
The Health Education and Training Institute (HETI) Leadership program of work has four main streams that will build individual and organisational Leadership skill and capacity.
 

Tools and resources

Michael West: developing cultures of high-quality care
VIDEO – The King’s Fund hosts this lecture on leadership in the NHS.  Michael West, Professor of Organisational Psychology at Lancaster University Management School, looks at how leaders can develop a culture of high-quality care and patient safety in their organisations.
 
This factsheet provides key points about governance, the relationship between governance and clinical practice, strategic goal setting, stakeholders and risk management.
 
This report from The King’s Fund in the UK emphasises the role of the nurse executive in ensuring that boards are as fully engaged with the clinical quality agenda as they are with financial performance.
 
A Hospital-Wide Strategy for Fixing Emergency-Department Overcrowding
An article by Brandon Carrus, Stephen Corbett, and Deepak Khandelwal that shows a sustained reduction of emergency-department wait times requires not only an end-to-end transformation of multiple hospital processes but also a change in hospital culture, stronger staff skills, better performance management, and visible leadership.
 
Getting Started Kit: Governance Leadership
As part of their 5 Million Lives Campaign, the Institute for Healthcare Improvement recommends "Six Things All Boards Should Do" to improve quality and reduce harm in their hospitals.
 
Institute for Healthcare Improvement(IHI): How-to-Guide: Governance Leadership (Get Boards on Board)
Current as at: Wednesday 13 June 2018
Contact page owner: Whole of Health