Healthcare Governance & Why it Matters

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, and not the EHR, during a visit. The nurse who can clock out with ease—and in a contactless way—at the end of a 12-hour shift treating COVID-19 patients in your hospital’s ICU. 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. In today’s competitive environment, this might mean preparing for a potential acquisition or a divestiture. 

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 many states. A person who walks into its hospital in Hope, Arkansas, or Grapevine, Texas, should have the same patient experience they’re used to at their local hospital in Pineville, Louisiana. That happens when a thoughtful and dynamic healthcare governance structure is in place.

From the provider’s perspective, consider the patient whose emergency department (ED) physician discovered a mysterious bump at the back of her knee and then referred her to a dermatologist to determine if it’s cancerous. That’s possible when the provider can focus on the patient, rather than typing at the computer—or at the end of a 12-hour shift when he’s exhausted—because the EHR screens are intuitive and not cumbersome. From the patient’s perspective, consider that she feels assured her ED physician has been vetted properly and is currently competent and qualified to treat her. 

Governance is: Admin & clinicians in sync

The C-suite healthcare governance team typically includes the hospital/healthcare system CEO and the 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 running the hospital. Healthcare reform success, in fact, will depend on their front-line experience.

Also providing input for crucial governance discussions—frontline nurses and doctors, in addition to their colleagues in operational roles such as billing, payroll, and scheduling. Including clinicians’ and staff members’ perspectives is essential today. The daily experience of these team members gives valuable insight and perspective perhaps not seen from the administrative office. These team members contribute to healthcare governance by helping to craft and fine-tune policies and procedures essential to organizational success.

Why is healthcare governance important?

Healthcare governance is important because it 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 easy to get the right clinician with the right credentials in front of the patient at the right time.

Healthcare governance must be dynamic. For example, look no further than the way hospitals responded to the COVID-19 pandemic. To follow the Centers for Disease Control and Prevention and other authorities’ recommendations, governance acumen dictated whether hospitals were able to ensure their staff were trained, equipped, and capable of:

• Preventing the spread of respiratory diseases including COVID-19 within the facility
• Quickly identifying and isolating patients and informing the correct staff and authorities
• Caring for patients with confirmed or suspected COVID-19 as part of routine operations
• Caring for COVID-19 patients while maintaining adequate care for other patients
• Monitoring and managing healthcare personnel that might be exposed to COVID-19
• Communicating effectively within and outside the facility about their COVID-19 response

A streamlined credentialing and privileging process is also key to effective healthcare governance. From the point of recruiting and onboarding a provider—through 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.  

Healthcare facility access, too, requires the oversight of the governance function. Managing external parties who access a facility—or entire health system—is a big job. 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 that they fully comply with policies and requirements. Organization whose governance abilities fall short in this area face stiff penalties and fines. 

On the business side, of course, governance decides how the organization spends its capital and contracts with myriad entities, from suppliers and contracted physician groups, to charitable organizations.

Healthcare governance delivers a memorable patient experience

During the COVID-19 pandemic, healthcare executives and clinical and operational staff have focused on doing everything they can to help patients. But COVID-19 wasn’t the only crisis they faced. In the east, the country endured what the National Oceanic and Atmospheric Administration called a “record-breaking Atlantic hurricane season,” and states such as Utah experienced unprecedented floods. Wildfires in California forced some hospitals to evacuate. Healthcare governance has a role to play to address these unforeseen events. 

For example, healthcare governance strategy can ensure that the appropriate technology assets and policies are updated on an ongoing basis. The benefit is that the healthcare system can optimize to meet the immediate need, instead of investing tremendous resources updating systems and policies that have gone stale.

The investment in healthcare governance has a powerful impact on patient loyalty. It means that the patient whose children were born in your facility—who also refers her friends and family—couldn’t imagine trusting any other provider with her knee surgery or her cancer care. 

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.

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. 

Increasingly, that care may be delivered less often inside the walls of the hospital and more often via telemedicine, using mHealth, and in specialized outpatient centers that are more easily accessible to patients. Again, 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.

Learn more about how symplr’s portfolio of GRC solutions can make your on-the-ground teams' lives easier while driving results in the areas that matter most to leadership.