Healthcare in the U.K. is state-funded and led by way of a political manifest. The issues of governance in the National Health Service are complicated, and it is a 'wicked challenge.' The hierarchical structure, multi-layered bureaucracy, and under-investment in the health system are coupled with crippled capital restrictions and a mountain of workforce issues.
In this podcast, Dr Sabine Dembkowski, Founder and Managing Partner of Better Boards, discusses the challenges of boards in the NHS and healthcare with Nabil Jamshed. Nabil is recognised for his outstanding governance work in the largest Trust in the National Health Service in the U.K. He is Head of Corporate Governance at Guy's and St Thomas' NHS Foundation Trust for the Integrated Specialist Medicine Clinical Group.
"A wicked problem doesn't equate to a wicked answer"
Nabil explains that health care as a service provided to customers, clients, and patients has grown significantly in complexity over the years. Governance within that is what he describes as a really wicked problem, and he thinks solving this is the biggest challenge in the health sector.
"If you don't take a holistic approach, and take everybody with you on the journey, the governance in the traditional way will fail"
Nabil explains there are many different approaches to governance, and there is still an absolute need for the mechanical aspect of governance - meeting the minimum compliance regime, standards to ensure a safe environment, producing a high-quality product, etc. However, governance also needs both a vision and strategy. He feels this is where traditional models fail because they do not emphasise the softer aspects of governance sufficiently and focus too much on compliance.
"When you have your non-executives involved versus your executives, they have two different lenses"
Nabil relates that executives tend to focus on operational delivery. In contrast, the Non-Executives focus on the assurance that everything is happening as it should happen, with no loopholes, and that this does not expose the organisation to significant risk. In his Trust, they modelled the governance structure on assurance committees and fixated on those capitals. Every committee led on one, two, or a combination of capitals, with responsibility against that.
"Any single report that comes to the board is aligned to those six capitals"
All information produced for board packs is now aligned to the six capitals, as is any single report. He is proud of the Triple-A model that has been introduced. Within each report, the three A questions are
1. What do we want the committee or the board to be Alerted to?
2. What do we want to provide the board and the committee Assurance with?
3. What Actions are we taking to address going forward?
Every single report that comes to the board covers those three elements. But he notes the real change is in the discussions held at committees in local feeder groups, which is an absolute bottom-up approach.
The three top takeaways from our conversation are:
1. Have a clear-cut, long-term strategy; stick to it regardless of changes and believe in the process it will deliver.
2. Build agility in governance and link it to your strategy and the risks you identify through that process, not getting hung up on one compliance only.
3. Complex problems do not mean a complex solution. They mean a simple solution. But that simple solution doesn't mean the complexities are avoided - you understand and address them and build your governance to simplify those complexities.
Healthcare in the U.K. is state-funded and led by way of a political manifest. The issues of governance in the National Health Service are complicated, and it is a 'wicked challenge.' The hierarchical structure, multi-layered bureaucracy, and under-investment in the health system are coupled with crippled capital restrictions and a mountain of workforce issues.
In this podcast, Dr Sabine Dembkowski, Founder and Managing Partner of Better Boards, discusses the challenges of boards in the NHS and healthcare with Nabil Jamshed. Nabil is recognised for his outstanding governance work in the largest Trust in the National Health Service in the U.K. He is Head of Corporate Governance at Guy's and St Thomas' NHS Foundation Trust for the Integrated Specialist Medicine Clinical Group.
"A wicked problem doesn't equate to a wicked answer"
Nabil explains that health care as a service provided to customers, clients, and patients has grown significantly in complexity over the years. Governance within that is what he describes as a really wicked problem, and he thinks solving this is the biggest challenge in the health sector.
"If you don't take a holistic approach, and take everybody with you on the journey, the governance in the traditional way will fail"
Nabil explains there are many different approaches to governance, and there is still an absolute need for the mechanical aspect of governance - meeting the minimum compliance regime, standards to ensure a safe environment, producing a high-quality product, etc. However, governance also needs both a vision and strategy. He feels this is where traditional models fail because they do not emphasise the softer aspects of governance sufficiently and focus too much on compliance.
"When you have your non-executives involved versus your executives, they have two different lenses"
Nabil relates that executives tend to focus on operational delivery. In contrast, the Non-Executives focus on the assurance that everything is happening as it should happen, with no loopholes, and that this does not expose the organisation to significant risk. In his Trust, they modelled the governance structure on assurance committees and fixated on those capitals. Every committee led on one, two, or a combination of capitals, with responsibility against that.
"Any single report that comes to the board is aligned to those six capitals"
All information produced for board packs is now aligned to the six capitals, as is any single report. He is proud of the Triple-A model that has been introduced. Within each report, the three A questions are
1. What do we want the committee or the board to be Alerted to?
2. What do we want to provide the board and the committee Assurance with?
3. What Actions are we taking to address going forward?
Every single report that comes to the board covers those three elements. But he notes the real change is in the discussions held at committees in local feeder groups, which is an absolute bottom-up approach.
The three top takeaways from our conversation are:
1. Have a clear-cut, long-term strategy; stick to it regardless of changes and believe in the process it will deliver.
2. Build agility in governance and link it to your strategy and the risks you identify through that process, not getting hung up on one compliance only.
3. Complex problems do not mean a complex solution. They mean a simple solution. But that simple solution doesn't mean the complexities are avoided - you understand and address them and build your governance to simplify those complexities.