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Meeta Ruparel
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Growing consumer awareness and patient demands for easy and prompt access, higher quality services and opportunities of second opinions and selection, regulatory, statutory and political influences; all demand for a continuous mode of strategic innovations that meet these demands, trends and assure quality of care delivery as well as sustain businesses along with a closely followed path to stakeholder satisfaction. Hospitals can achieve these goals by implementation of good governance practices.
The meaning of the term ‘governance’ as reported has a broad range; centres of the World Bank defines governance as: ‘exercise of political power to manage a national affairs. ‘The management faculty also places considerable emphasis on governance. Management gurus like Jeffrey P and Henry Mintzberg said, organisations are more than just systems for coordinating and supervising work: they are also systems for determining goals, coping with conflict and allocating costs as well as benefits.
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Consensus oriented
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Accountable
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Participatory
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Good governance
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Transparent
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Follows the law
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Responsive
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Effective and efficient
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Equitable and inclusive
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So also, Sir Adrian Cadbury said, good corporate governance is concerned with holding the balance between individual and communal goals and economic and social goals; to create and sustain businesses legally and ethically. And at the same time ensure a high level of satisfaction to all its stakeholders.”
In one of the WHO research study publications on public hospitals; it is stated that the term ‘hospital governance’ emphasises on a set of discrete processes and tools and its effective utilisation. It highlights that the act of governance reflects a variety of organisational elements and/or stakeholders, at national (macro), organisation wide (meso) and operational management system (micro) levels. Each of these three levels interacts with each other forming complex patterns and thereby defining unique/individual ‘Hospital governance structure’ specific to that organisation. Each level has its own distinct characteristics and its respective team of decision makers.”
| More about ISDC
Integrated Social Development Consultancy (ISDC) is a not-for-profit firm, which works extensively in the field of developmental issues, social compliance/audit, code of conduct assessments and audits, CSR audits, business and human rights agenda and Sustainability. ISDC has beset as a pioneer in India for the concept of Hospital Good Governance and the COCHO framework. ISDC in consultation with eminent panelists from fair trade practitioners, CSR experts and healthcare management professionals have evolved with the COCHO framework and compliance criteria for assessments. ISDC has skilled professionals, CSR and Code Of Conduct assessors who religiously work towards the betterment and development of good governance, CSR and sustainability practices. |
Current issues and challenges
- Some of the commonly cited system failures are communication, monitoring of policy implementation, record keeping, training, leadership, etc. Some recent representative examples are listed below.
- UK’s The Sunday Times (1999) said: “blunders by doctors kill 40,000 a year”…. “Medical error is the third most frequent cause of death in Britain after cancer and heart disease. This may be a study outcome only for the UK, but the status quo isn’t so good/acceptable worldwide either. In India, this kind of study outcome is not an updated declaration as yet.
- Responsibility for the effectiveness of systems rests unambiguously at the board room agendas.
- Compliance failures and statutory regulations and initiatives have placed good governance systems and cannot be surpassed anymore.
- Globalisation leads to increasing cross-border investment opportunities but it can result in a lopsided development if there is a lack of knowledge about the regulatory framework of international standards and expectation of foreign investors.
- Loss of trust of investors.
- Good governance is at the heart of investment decisions; a research survey analysed that 75 per cent of stakeholders are ready to pay a premium for higher good governance standards
- Investors are not willing to invest in countries/companies/organisations that are not build on inclusive growth models, are corrupt, prone to fraud, poorly managed and lacking sufficient protection for relevant stakeholders and lack of compliance on business and human rights agenda.
Understanding of the term ‘hospital governance’ is somewhat complicated and equally critical. Hospital decision makers and policy makers traditionally tend to view key elements of hospital performance through the related but narrower perception of ‘hospital management’ and ‘patient volumes’. In true sense the term governance in general is related to directing policy (e.g. accountability, stewardship, etc.) and so it tends to be difficult to be able to transit in form of operational actions for better performance.
The aim is to align as nearly as possible the interests of all stakeholders, individuals, corporations and society at large.
The scope of hospital good governance is to promote:
- The efficient use of resources
- Establishing the trust of investors
- Economic development
- Good governance performance
- Socially responsible citizenship
- Business excellence
- Regulatory Compliance
- Stakeholder satisfaction
- Risk management and sustainability
- Safety
Hospital good governance practice is:
- Operates in line with fundamental principles of transparency, integrity and accountability
- Provide high quality healthcare
- How the organisation is led and structured
- Organisation’s objectives are delivered economically, efficiently and effectively
- Protecting interests of both the individual and the organisation.
- Protecting staff against any possible accusation that they acted insufficiently.
- Promote stakeholder satisfaction organisation wide.
The five key elements of hospital good governance are:
- Accountability
- Fairness and ethics
- Safety
- Transparency
- Independence
Benefits of hospital good governance practices
- Facilitates the successful implementation of important strategies
- Leads to better accountability and transparency
- Prevents managers from making wrong strategic decisions.
| FAQs and More |
| What is the approach to Hospital Good Governance?
One needs to accept that all businesses in India have a good mix of traditional ties as well as the technically advance conduct, therefore often the International standards though very technically sound sometimes become difficult to understand and implement for the executors at the hospital level. The approach has to be simple; it has to be applicable and has to be uniform yet unique for each organisation as per the policy of the said organisation. Therefore identifying this need a Code Of Conduct (COCHO) is developed to cater to the needs of Hospital Good Governance best suited to Indian set up. What is code of conduct? A code of conduct is a voluntary framework of guidelines outlining the responsibilities of or proper practices for an individual, party or organisation. (Including ethical codes, industry compliance and best trade practices) What is COCHO? COCHO is a derived set of ‘code of conduct for hospital organisations’, specially evolved from research data based on best practices in Hospital Governance and the industry set up. COCHO framework is based on four sustainability pillars in terms of four Ps: Principles, People, Planet and Profit. Why COCHO? We may have ‘good’ hospital systems in private and corporate institutes and many of our government hospitals also follow quality and patient safety protocols, but there are discrepancies observed; Let us talk of some examples here…
One is forced to question that are these hospitals in questioned not certified for different standards under ISO/accreditation for quality, health and safety, environment etc. If the answer is yes then these protocols needs to be revisited and reviewed. On further introspection one realises that the standards compliance help to meet the wall requirements of numerous certifications for the business model and maybe it is not sufficient. So understanding the root cause of the problem, it evolved that the issue is to develop a spirit of compliance rather than a certificate. After informal discussions with industry takers it was felt that there needs to be voluntary involvement and passion to improve the industry at all segments and all level. Hence the COCHO framework was developed to enhance the industry to have the flexibility of customised approach and to be able to accept that there are certain areas of improvement on a voluntary, responsible and accountable participation to make it more sustainable. How is it different from business ethics? Business ethics aims at imbibing a culture of responsible business conduct within an organisation; Hospital Good Governance supplements the legal and ethics framework with a holistic approach (inclusive of organisational leadership, social accountability, sustainability, professional ethics and business conduct for good management practices). A hospital generally conducts health awareness programmes and free medical camps; is this CSR? Often it is argued that healthcare is a charitable cause and hospital is an organisation registered as trust, society or 25 C company and are already having the philanthropic agenda. And they extend their work with community outreach programme. Which is true to a good extend but is it all that one should aim at? Therefore one needs to evaluate who is the beneficiary? How do you define the community for healthcare service provider and who are my internal and external stakeholders? And last but not least what is the impact made? The spirit should be adopted from the basic healthcare rules of prevention is better than cure. Hence, the healthcare service providers now need to evaluate their professional functioning to contribute to social responsibility and sustainability agenda in terms of four Ps: principles, people, planet and profit. How is this different from national accreditation standards? The COCHO guidelines are not standards these are frameworks customised to suit the uniqueness of each organisation policy and functioning. What are the benefits of implementing COCHO?
Building a case to implement COCHO. The purpose of COCHO is to enhance the healthcare organisation/healthcare providers to serve patients and the society in a more efficient, ethical and effective manner. Hospital Good Governance also plays an important role in maintaining industry integrity and managing the risk of resources, fraud combating against management misconduct and corruption. I foresee that soon there will be enforcements on hospitals from international clientele to comply with fair practices and good governance code of conduct, which will possibly be a supply chain check for medical tourism to ensure stakeholder satisfaction on a global sustainable platform. Is COCHO framework available for all and how can a hospital initiate the COCHO process? Yes, COCHO framework is available for all Indian organisations interested to participate and implement within their organisation. The first step to initiate COCHO process is to send an expression of interest. On receipt of the expression of interest, an appropriate road map is rolled out with an orientation of COCHO with the applying organisations management, followed with the assessment programme. AUM MEDITEC in association with ISDC provide consultancy and services to help deploy hospital good governance best practices and COCHO compliance. For more details contact: meeta@meditecindia.com |