IGAP - Integrated Governance, Assurance and Performance
Solving complexity through a governance solution that is simple and effective to deliver outcomes. With a vision to create a truly integrated oversight of governance, with a focus on 360 governance (leadership, vision, risk management, assurance, transparency, openness, honesty, objectivity and accountability) on key business areas and functions; quality and safety, people, finances and resources and regulatory compliance, an innovative governance approach was introduced at Guy's and St Thomas' NHS Trust. Integrated Governance Assurance and Performance (IGAP) was developed. The expected outcome was an ability for a holistic and 360 view, cross-fertilization of impact on key business areas and drawing context and intelligence from the data.
IGAP took the dynamic governance principles forward by creating a fusion between the work of King IV, Nancy Kline’s work on 'Time to Think' through co-creation methodology of engagement with its stakeholders and key members of the committee.
The aim of the project included:
- Removing duplication by removing redundant governance.
- Creating a golden thread that allows a truly bottom up and top down (board-to-ward and ward-to-board) oversight of key issues.
- Enabling conversations by introducing agenda items as questions, using techniques from Nancy's work.
- Using the principles of integrated reporting in a slight variation that enables cross fertilisation of ideas and impact across key business areas of quality and safety, people, operational performance and finance and resource.
During the course of this project, our own list of capital which are linked to our key business domains that we operate under. These key areas of business were identified as:
- Quality and safety – our number one priority.
- People – similar to human capital and our largest spend.
- Operational performance – like manufacturing capital.
- Finance – which included innovative ideas and transformation.
Through the means of the existing resources, a governance and oversight framework was built where all 93 services which are categorized under eight large directorates reported against defined metrics against the above headings. Though, 80% of assurance was sought from quantitative data the crucial 20% assurance was built from qualitative data such as patient feedback, stake holder engagement, staff concerns raised, working with system partners and intelligence held by our regulators.
A perfect fusion of the concepts of integrated reporting framework (IRF) from King IV, Nancy Kline's "Thinking Space" and co-production methodology enabled a tailor made effective solution that was fit for purpose. Thinking is the management skill that is practiced not too often due to the nature of the work and reacting to situations. However, thinking time well spent sharpened our thought process and allowed our senior leadership team to become visionary leaders.
Some of the early benefit realized includes:
- Effective and efficient meetings where every minute is utilized to think and consider all aspects of business in an integrated way.
- Clarified accountabilities, where solutions are owned locally by the leadership teams.
- Improved communication and transparency where all involved worked through a single version of the truth with a single filtration process that enables cross fertilisation.
- Open culture where challenge becomes second nature and conversations are focused, away from omni combatant approach towards collective team accountability.
- Risk driven business planning and running of the core activities.
- Effective and meaningful escalations, where key themes are identified and reported to the management.
- Lastly, governance structure that is purposeful and aligned to strategic vision fulfilment.
Resources:
Powerpoint: IGAP summary
Podcast: The Better Boards Podcast: Governance - Wicked Challenges in Healthcare
Document: GSTT Project of the Year nomination detailing IGAP.
Images: Guys' main entrance and A&E exterior.