Picture these scenarios: The patient who insists on getting her cancer care or knee surgery at your health system. The physician who can focus on the patient during a visit and not the EHR. The nurse who can clock out with ease—and in a contactless way—at the end of a 12-hour shift. All of this is possible because of healthcare governance.
What is healthcare governance?
Healthcare governance is defined as the C-suite working in concert with frontline clinical and operational staff to ensure that policies and procedures solve real-world problems, all while keeping a uniform and human-centered approach enterprise-wide. Such oversight is part of the full spectrum of operations, checks, and balances called healthcare governance, risk management, and compliance (GRC). At an organizational level, healthcare governance also informs the playbook that administration uses to operate the business.
The benefit of “governance done well” is successful implementation of and adherence to policies and procedures at every level and for every role—and a patient and provider experience that’s exemplary across the healthcare enterprise.
How does healthcare governance work?
Healthcare governance works by realizing the unique roles, responsibilities, and perspectives of clinical and operational staff throughout the enterprise. The goal is to ensure that systems, tools, policies, and procedures work for, and not against, patients, clinicians, and staff.
A sound healthcare governance approach is always mindful of the patient and provider experience. Take, for example, a large healthcare network with hospitals in multiple states. A person who walks into the hospital in Arkansas should have the same patient experience they’re used to at their local hospital in Louisiana. That happens when a thoughtful and dynamic healthcare governance structure is in place.
From the provider’s perspective, consider the patient who comes into the emergency department (ED) with a medical concern. The ED provider can spend more time talking with the patient and understanding his/her concern and less time dealing with a complicated EHR.
Hospital administrators & clinicians working together
The C-suite healthcare governance team typically includes the CEO and chiefs in roles including information, human resources, quality/safety/performance improvement, finance, development, and integration—among others.
But there’s another group of leaders responsible for healthcare governance. The executives responsible for guiding healthcare governance among all providers typically include:
- Chief medical officer or vice president of medical affairs
- Chief nursing officer
- Department heads
- Committee chairs (peer review, medical executive, credentialing, etc.)
These leaders have cross-functional roles. Not only are they responsible for guiding their teams to deliver patient care that adheres to regulations, accreditation standards, policies, and procedures, but increasingly, they have a seat at the table in assisting the C-Suite in guiding the hospital. Healthcare reform success, in fact, will depend on their frontline experience.
Input from nurses, doctors, and operational roles, such as billing, payroll, and scheduling is also crucial in governance discussions. Frontline staff provide valuable insight and perspectives perhaps overlooked from the administrative office. These team members contribute by helping to craft and fine-tune policies and procedures essential to organizational success.
Why is healthcare governance important?
Healthcare governance has a tangible impact on patients, clinicians, and staff. That means the administrative work behind every patient visit must be seamless to the patient and the provider. Schedules must be kept for appointments, surgical suites, and consults. This requires the workforce to be in place in the right ratio, a balancing act that grows in difficulty as an organization’s size increases. Governance includes the scheduler who needs access to software that makes it easier to get the right clinician with the right credentials in front of the patient at the right time.
A streamlined credentialing and privileging process is also key to effective healthcare governance. From the point of recruiting and onboarding a provider to enrolling them with payers and conducting credentialing and privileging, healthcare governance is responsible for the checks and balances that ensure providers are competent and qualified to serve patients. It doesn’t stop there but continues through ongoing professional performance monitoring.
Facility access also requires the oversight of the governance function. Patient safety, efficiency, and compliance are at stake. There must be policies, procedures, and tools to manage vendors, visitors, service providers, contractors, or anyone entering a facility to ensure they fully comply with policies and requirements.
On the business side, governance decides how the organization spends its capital and contracts with other entities from suppliers and contracted physician groups, as well as other organizations.
Healthcare governance has a duty to providers
Healthcare is about people. Healthcare networks’ most valuable assets are its clinicians and staff members. Ensuring that new policies and technologies help, rather than hinder providers and staff, keeps everyone focused on what’s important – enabling the delivery of safe, high-quality care in a fiscally responsible manner.
Governance should support the needs of both providers and staff and the organization’s operations.
Increasingly, that means investing in the resources necessary to help prevent burnout among providers. The unprecedented pressures they face are leading to record rates of mental health issues such as depression and suicide, substance abuse, and an exodus from the healthcare field. Healthcare governance can help create an environment where there is support—not blame or silence.
Healthcare governance leads the way
Healthcare organizations face a mountain of challenges today—satisfying patients in a consumer-centric world, complying with regulations and standards, achieving engagement and alignment with providers, and delivering efficient, high-quality, cost-effective medical care.
With standards in place across all areas under healthcare GRC—workforce management, access, compliance, quality, safety, and provider/payer management—healthcare systems ensure viable treatment for their patients and their communities.
It will be healthcare governance’s role to lead the way in leveraging data to keep pace with advances and to ensure the long-term health of the organization.
