Governance, Leadership and Culture

Governance, leadership and culture drive the way a facility is managed and experienced by both staff and consumers. The effects of governance and leadership trickle from the top down and affect every aspect of an organisation, ultimately determining its overall culture.

Governance

Governance, in this context, is defined as the way organisations are managed at the highest level. Governance is not only about control and management but relates to the specific systems and mechanisms that hold it to account (Cambridge Dictionary 2019; Governance Institute of Australia 2019).

Leadership

Leadership is defined as both the position or fact of being the leader and a set of characteristics that make a good leader (Cambridge Dictionary 2019). This definition makes clear that leadership is not just purely based on rank, but something that is a practised skill.

Culture

The culture of an organisation is its character and atmosphere. Culture is a combination of an organisation’s values, attitudes, traditions, beliefs, interactions and behaviours, on both a visible and intrinsic level (ERC 2019).

Governance, Leadership and Culture relates to Standard 1 of the National Safety and Quality Health Service Standards, Clinical Governance in which:

‘Leaders of a health service organisation have a responsibility to the community for continuous improvement of the safety and quality of their services, and ensuring that they are person-centred, safe and effective’.

(Australian Commission on Safety and Quality in Health Care 2017)

What Does Good Governance, Leadership and Culture Look Like?

Improving the safety and quality of healthcare for patients should be the focus of all aspects of governance, leadership and culture. Those in leadership positions are required to develop and use clinical governance systems to achieve this aim.

Broadly speaking, an organisation’s governance, leadership and culture can be measured by:

• How it carries out day-to-day responsibilities; and treats its staff, patients/residents, consumers, and the wider community.
• The extent to which it responds to new ideas; and encourages freedom in decision-making, and personal expression of staff, patients/residents, and other consumers.
• The way in which power is distributed and how freely information flows down through the organisation’s hierarchy.
• How committed staff appear to collective goals and objectives of the organisation.

(Business Dictionary 2019)

The governing body of an organisation should create a culture of safety and quality improvement in partnership with patients, carers and consumers. Priorities and strategic directions for safe and high-quality healthcare should be communicated (Australian Commission on Safety and Quality in Health Care 2017).

There is ample research to link high-quality clinical governance to health service performance and outcomes (Australian Commission on Safety and Quality in Health Care 2017; Bismark et al. 2014).

Beyond what has been mentioned in this section, the NSQHS Standards recommend that through leadership, governance and culture, organisations should:

• Ensure they meet the specific health needs of Aboriginal and Torres Strait Islander people;
• Support the organisation’s clinical governance framework;
• Define roles and responsibilities for the governing body, management, clinicians and the workforce;
• Monitor response to clinical incidents;
• Review the organisation’s progress on safety and quality on an on-going basis.

(Australian Commission on Safety and Quality in Health Care 2017)

Additional Resources

• Ausmed, 'National Safety and Quality Health Service Standards (NSQHSS) Explained': https://www.ausmed.com.au/cpd/articles/national-safety-and-quality-health-service-standards
• Australian Commission on Safety and Quality in Healthcare 2017, National Safety and Quality Health Service Standards, 2nd Edition: https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

References

• Australian Commission on Safety and Quality in Health Care 2017, National Safety and Quality Health Service Standards, 2nd ed. ACSQHC, Sydney (NSW), viewed 16 October 2019, https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf
• Bismark MM and Studdert DM 2014, ‘Governance of Quality of Care: a Qualitative Study of Health Service Boards in Victoria, Australia’, BMJ Qual Saf., 23(6), pp.474–82
• Business Dictionary, Organisational Culture, Business Dictionary, viewed 17 October 2019, http://www.businessdictionary.com/definition/organizational-culture.html
• Cambridge Dictionary 2019, Governance, Cambridge Dictionary (online), viewed 17 October 2019, https://dictionary.cambridge.org/dictionary/english/governance
• Cambridge Dictionary 2019, Leadership, Cambridge Dictionary (online), viewed 17 October 2019, https://dictionary.cambridge.org/dictionary/english/leadership
• ERC 2019, Workplace Culture: What it is, Why it Matters, and How to Define it, ERC, viewed 17 October 2019, https://www.yourerc.com/blog/post/workplace-culture-what-it-is-why-it-matters-how-to-define-it
• Governance Institute, What is Governance, Governance Institute, viewed 17 October 2019, https://www.governanceinstitute.com.au/resources/what-is-governance/

(Answers: a, a, d)