Principles for good governance | Tara meets Sophie Edwards
Sophie Edwards works for NHS England and NHS Improvement as an Adviser on the Time For Care Programme. Sophie’s job involves coaching health organisations and people within them to make change and improvement happen.
As part of a new collaboration with Source 4 Networks, I spoke to Sophie about how good governance can make your network a success. Our conversation really helped focus the mind on what good governance looks like. Get all the tips below, or listen to the full interview.
Good governance… helps you make decisions
Governance can sound dry, but it allows you to make decisions, manage finances and, ultimately, it can be the difference between success and failure. “As a network, you've got resources,” Sophie told me. “And you've got to negotiate your priorities and make decisions together.”
Good governance… starts early
Governance isn’t always the first thing people want think about, but it matters. “If you leave it too late,” Sophie said, “the conflicts and the natural tensions arise and you haven't got a mechanism for working through those conflicts and coming to decisions.”
Good governance… is structured
Your governance structure should be dictated by what network’s purpose and how it is resourced. “You need to think about who the network reports to,” Sophie explained. “If you've got decision-making committees, terms of reference are going to be useful so that the board knows what they're responsible for, who is mandating them, who they report back to, and how they relate to the constituencies they represent. For a less formal network, you might look at something like a charter of expectations.”
Good governance… relies on trust
If the relationships aren’t strong, governance can become a barrier rather than an enabler. I’ve been in networks where it’s taken months and months and still the Is aren’t dotted and the Ts aren’t crossed. In my experience, governance and trust go hand-in-hand. “I think they're like an infinity symbol,” Sophie agreed. “You need to trust that the governance procedures are strong enough to make fair decisions. You've got to have those relationships in place to be able to negotiate the tensions that will arise.” Likewise, you need to build trust among stakeholders outside your network. “If people can see how decisions are made, it feels fair,” Sophie said, “even if the decision is something that you wouldn't choose for yourself. A good steering group might be making sure that a short summary of the decisions is shared.”
Good governance… is based on real-life
The idea of governance can be daunting, so it can help to think about the real-life situations. “It can be really helpful to do a bit of scenario planning,” Sophie suggested. “Think about a project and ask… On what's the basis do we take decisions? It might be that everybody has to gain something. It might be that nobody has to lose out as a result of this project happening. It gives everybody a voice in setting the ground rules.”
Good governance… involves the right people
I once worked with a Training Hub that spans four CCGs. The governance was tricky, but now it works really well. That was down to a fantastic leader, with the influence and relationships to make it work. It works well when there are a few people of influence to shape the discussion and get people working together. If you’re part of a network that spans large organisations, don’t forget your in-house governance people. I have been involved in networks where, when those people see the documents in black and white for the first time, it raises lots of questions and anxiety about what’s they’re signing up to financially or otherwise, and it comes to a stop. “Get some sensible advice from people who work in governance,” Sophie agreed. “They can help you think through some of the risks that you might have to manage as a network.”
Good governance… evolves
It’s no good, according to Sophie, to let your governance structures gather dust. “It doesn't sound interesting and dynamic to look at your governance,” she said, “but it’s arguably one of the most important parts of running a network. There can be signs when you're not making good decisions. For example, are you constantly going back on decisions? That tends to suggest governance isn't working. Stopping and reviewing your governance on a regular basis is good.”
Good governance… listens to those who say no
Sophie and I agreed that most networks are formed out of enthusiasm to make things better. However, you will encounter obstacles and you have to listen to the naysayers. If someone says you have to go back to start because you didn't tick this box, learn from it. It's easy to for the defences go up, but there is risk, reputation, finance, quality, safety and patient expectation to consider. Sophie agreed that you need to embrace the naysayers. “That person has got really useful insights,” she said. “Listen to their concerns and give them a space to advise you. People who live and breathe governance are really good at it.”
Tara Humphrey is the founder of THC Primary Care, a leading healthcare consultancy specialising in workforce transformation and the only consultancy to have worked with 11 Training Hubs across South London, Kent, Surrey and Sussex.
Tara and her team also work with GP federations supporting the implementation of clinical services.
Tara has over 20 years of project management and business development experience across the private and public sector and has an MBA in Leadership and Management in Healthcare, is published in the London Journal of Primary Care and is the author of over 150 blogs articles. She presents her own podcast: The Business of Healthcare With Tara Humphrey.