Training on EHSTG Chapters

Chapter 1: Hospital Leadership, Management and

Governance
Outline

 Objectives
 Introduction
 Operational standards
 Implementation guidance
 Summary
 Objectives
 By the end of this session participants should

• Describe Basic Concepts of Leadership, Management and

Governance
• Identify the key leading, managing, and governing practices

• Apply Systems and Processes for Effective LMG

• Apply governance practices through focusing on hospital board

governance
 1-Introduction
 Hospital governance is essential to ensure effective,
efficient and quality services.
 The hospital governing board is a legitimate authority
mandated to provide strategic leadership.
 Hospital Management Committee(HMC) and CEO/CEDs
are tasked with executing managerial functions.
 Hospital leaders must possess a comprehensive skill set
to
 Strategically guide and manage the institution
 Intro…(2)
 In alignment with the HSDIP, hospitals develop and implement their
own strategic, long-term, medium-term, and operational plans.
 Hospitals face challenges in effectively exercising their governance
responsibilities;
 Deficiencies in leadership and managerial skills
 Unclear delineation of roles and responsibilities between the board and
management committee
 Lack of vision and focus
 Insufficient accountability and functionality
 Delays in decision-making
 Inadequate resource mobilization and utilization and
 Suboptimal implementation capability
 2-Operational standards
1. The hospital has a functional Governing Board
mandated to provide strategic leadership
2. The hospital has a functional management committee
that runs the overall function of the hospital.
3. The hospital increases resource generation and
improves efficiency
4. The hospital establishes accountability mechanisms
5. The hospital has mechanisms and practices to
continuously improve the quality of healthcare
 Operational standards…2
6. The hospital accords adequate attention for
implementation of projects, Programs, reforms and
initiatives .
7. The hospital has a regular capacity building program for
governing board members and senior managers (HIL-
PH)
8. The hospital board provides guidance and promotes
good ethical practice .
9. The hospital has created a link between the hospital its
catchment health centers.
 3- Implementation guidance
Practices of Leadership, Management and Governance
 Leadership Practices
– Scanning
– Focusing
– Align and mobilizing
– Inspiring
 3-Implementation…
Managerial practice:-
 Managers must pay close attention to providing high quality of
service to satisfy customers.
 The following practices need to be considered:

 Planning

 Organizing

 Implementing

 monitoring
 3-Implementation…
 Governance practice
1. Cultivate Accountability
 Enhance personal accountability
 Enhance internal corporate accountability
 Enhance external corporate accountability of the hospital
 3-Implementation…
2. Engage Stakeholders .

a) Engage Community: Need to work closely with these

communities
 Engage with staff:-Staff feel engaged when they have
involvement in decision-making.
 Engage with senior clinicians:-can improve engagement
with doctors and clinicians in many ways
 3-Implementation…
3. Setting a Shared Direction
 It leads to a shared action plan with measurable goals
and set accountabilities for achieving the vision.
4. Steward Resources
• Good stewards protect and wisely use their sources
entrusted to them to serve people, as if these resources
were their own.
 Systems and Processes for Effective LMG
 Healthcare Kaizen:-set of principles and of quality defects.
specific practices for continuous improvement. • Decreasing variability in the process is vital
 Kaizen is built upon the improvement cycle to improving quality.
of PDSA • Identify and decrease non-value-added
 The following are key principles of kaizen: steps.
• Continually improve. • Every interaction is between a customer
• No idea is too small. and a supplier
• Identify report and solve individual • Empower the worker to enact change
problems. • All ideas are addressed and responded to
• Focus change on common sense, low-cost in some way.
and low-risk improvements, and not major • Decrease waste.
innovations. • Address the workplace with good
• Collect, verify and analyze data to enact housekeeping discipline
change.
• Problems in the process are a major source
 Systems and Processes for Effective LMG…

B. Scientific Method of Problem Solving

•This approach integrates leadership, goal setting, and
organizational action to achieve set objectives.
•Hospital Clinical Audit guide and tools
•HIL-PH Participant manual for Frontline and Mid-Level
Leaders
 Implementation…6
Role & responsibilities of activities of the hospital
the Governing Board
 Provide proper financial
 Determine the organization’s
oversight
mission, vision and values .
 Ensure adequate resources
 Establish corporate policies
 Oversee Implementation of
 Ensure effective organizational
health financing reforms
planning
 Oversee quality management
 Direct and supervise the overall
activities
 implementation….7
Responsibilities of the members and ensure ongoing education
Governing Board… for existing members

 Oversee the implementation of national  Review effectiveness of its own

level hospital initiatives performance

 Set strategies to balance the public  Ensure legal and ethical integrity and

private partnership maintain accountability

 Select the Chief Executive Officer  Ensure community involvement in

 Support, monitor, and assess the hospital service planning and delivery

performance of the CEO  Enhance the organization’s public

 Provide orientation for new Board standing

 Implementation…8
Membership of Governing Board
 A robust governing board engages in macro-level
management.
 It consists of members who:
 Act on behalf of the community as a whole
 Are interested and committed to serve as a board member

 Have a variety of expertise as a collective whole

 Maintain high ethical principles, integrity and competence

 Deliver results while using resources wisely

 Implementation...9
 Membership…

 Commit the time required for meetings, dialogue, etc.

 Subscribe to the principles of accountability for themselves and

others
 Prioritize the benefits of the hospital rather than personal benefits

 Are participatory in planning, decision-making, and activities

 Declare any conflicts of interest

 Implementation …10
Appointment of Board Members
 Boards are comprised of between 5 to 7 members, or as specified in Federal
and Regional Directives.
 Due consideration to gender and professional mix,
 Community representation, and
 Professional efficiency and experience

Tenure of Board membership

 The tenure of service of Board members should be between 3-5 years, and
may serve a maximum of two terms
 Implementation…11
 Revocation of Board membership
 The Board member has no interest to continue membership

 If he/she changes residence or leaves the office s/he

represents
 If the Board member loses the faith of his/her constituency
and a request is made by the constituency to replace
him/her
 Implementation…11
Revocation of Board membership…
 The Board member has failed to fulfill the duties of
his/her membership.
i. Repeated absence from Board meetings
ii. Proven corruption
iii. Repeated failure to follow up on actions agreed by the Board
iv. Breach of confidentiality
 Implementation…12
 Roles of the Chairperson of a Governing Board
1. Understand the organization:
2. Know his/her own responsibilities and authority as Chairperson
3. Create a safe environment for decision making
4. Build a working culture
5. Cultivate future leadership
6. Communicate with the members through an effective information system
7. Maintain a productive relationship with the CEO and the appropriate
government body
 Implementation…13
Accountability
 Board members have individual and joint responsibility
for the decisions they pass.
 Governing Boards are accountable to their respective
appointing authority.
Allowance for Board members
 Board members duty compensation should be offered in
accordance with federal and regional directives.
 Procedures of Board meetings

Frequency of Board meetings

• First year of establishment the Governing Board meets
once every month
• Develop a schedule whereby the Board meets no less
than the frequency set out in Federal or Regional
Directives
• Extra-ordinary meetings may be convened should a
matter of particular importance arise.
 Procedures of Board meetings…
B) Agenda items
• Set jointly by the Board Chairperson and Hospital CEO
• All Board members should be invited to nominate
agenda items
• The agenda and any documents should be distributed to
Board members at least one week in advance of the
meeting
 Procedures of Board meetings…
Agenda items…
Standing items on each and every meeting of the Board:
1. Approval of previous meeting minutes
2. Committee reports
3. CEO’s report
4. Old business – issues unresolved from last meeting;
5. New business
6. Next steps
 Procedures of Board meetings…
Decision making
• Decisions by the Board should be made by majority vote.
• In the case of a tie the Chairperson has the deciding vote.
• Voting may only take place when a full quorum of Board
members is present.
• The criteria for a full quorum vary from Region to Region (from
50% + 1 of Board members to 2/3rd of Board members)
• The CEO is an ex officio Board member and hence has no
vote on the Governing Board
 Procedures of Board meetings…

Governing Board standing committees

• As a minimum the following standing committees should
be established:
– Executive committee
– Finance committee
– Audit committee
 Procedures of Board meetings…
Governing Board standing committees…
• Other standing committees may be established on a temporary or
permanent basis as the need arises
• When selecting members for each committee the following principles
should be followed:
• Committee members should be selected from the current Board members
• Selection should be transparent and fair, without favoritism of any kind
• The Governing Board Chairperson should be a member of all committees
• Each committee should have its own chairperson
 Implementation …14
Roles and Responsibilities of CEO
A. Governing Board development, communication and relationships

B. Planning, monitoring and evaluation of hospital operations

C. Budgeting

D. Development of hospital management committee and other

structures
E. Personnel management and development

F. Quality of care
 Implementation …15
G) Regulations compliance
H) Management of hospital buildings, campuses and physical assets
I) Public Relations
J) Professional development
K) Strengthen and improve good governance practice of the hospital
L) Leadership
 summary
• Particular Focus on Hospital Governing Board
• Basic LMG concepts and key practices
• Application of systems and processes for effective LMG,
with a particular
• Hospital LMG Operational standards
• Implementation guidance for leadership, managerial, and
governance practices,
• Emphasis is placed on the roles and responsibilities of
governing boards
• The importance of accountability, compliance with
regulations, and continuous improvement
Thank You!