Indications of Poor Governance at Mid Staffordshire NHS Foundation Trust - Case Study Example

What indicates poor governance at Mid Staffordshire NHS Foundation Trust? The most important elements of good governance include accountability, transparency/openness and recognizing stakeholders/shareholders right. Other aspects of good governance are efficiency, integrity, stewardship, leadership, an emphasis on performance as well as compliance, and stakeholder participation or inclusiveness. All these aspects of good governance are missing at Mid Staffordshire NHS Foundation Trust. For instance, there is no transparency/openness, accountability and also the stakeholders are not recognized. There is lack of accountability and transparency/openness by the leadership and board of directors and this demonstrates poor governance. This is depicted by the board not performing regular reviews which might have assisted in indentifying the root cause of the organization's problems. The board and the leadership seem not to be bothered and responsive to the problems the organisation is experiencing and this indicates lack of accountability because they are not accountable at all. Good governance includes transparency, openness, integrity and accountability among the organizational management and the board as well. For instance, the neither the management nor the board provided any information to the HCC during investigations. This indicates lack of transparency, openness and lack of accountability as well. There is lack of integrity where the management was not honest in addressing issues that the organisation faced and they do not adhering to the required professional and set standards. The board and the leadership do not recognize the stakeholders and also there is no stakeholder participation or inclusiveness. This is depicted by the fact that at Mid Staffordshire, stakeholders were not engaged or involved in decision-making. Failure to involve and engage all important stakeholders such as healthcare providers, patients and the public at large by the management indicates poor governance. This is because stakeholders have a right to be consulted and to be informed on matters of the organization as well as to be allowed to participate in decision making. Good corporate governance policy focuses on ensuring that the conditions for the organization consider the interests of different stakeholders. The stakeholders need to be given the best experiences by the organization through an organization’s optimal performance. Therefore good corporate governance aims at increasing the value of stakeholders, protecting their interests together with those of the shareholders and offering a high level of corporate leadership. What are some of signs that indicate poor leadership at Mid Staffordshire NHS Foundation Trust? Some of the indications of poor leadership include: the leadership failed to learn from the warning signs and come up with corrective strategies; No measures were established to gauge the organizational performance and try to identify the cause for organizational poor performance; There is a lack of clear and consistent communication from leadership to the staff; Patient’s complaints were not addressed; The leadership never responded to the constant flow of information signaling cause for concern; and Lack of supportive culture and shared values at Mid Staff. There were clear warnings that all was not well at Staff Mid such as the loss of start rating where the Commission for Health improvement re-rated the Trust from 3 to zero stars and where several reviews indicated that there were major shortcomings in the organisation in terms of its ability to deliver safe services and management capability was questioned. Despite these warnings, the organizational leadership did not take any step to try and rectify the issues. Good leadership involves establishing measures to assess organizational performance to catch errors and correcting the errors any time they are identified. In spite of warning signs showing that all was not well, the leadership at Mid Staff Trust did not take any adequate measures to gauge errors or correct them. Good leadership is proactive whenever warning signs are detected. Searching out the organisation deficiencies and assessing its processes to identify deficiencies and them implement improvement measures before errors arise is an important aspect for the organizational leadership. Additionally, good leadership listens to its employees but in this case in spite of staff nurse’s report in 2007 making serious allegations regarding leadership, the organisation leadership did not resolve these issues. The management did not also listen to the patients’ concerns and complaints. This also indicates poor communication since staff members were not able to communicate their concerns to the management. Good leaders encourage their employees to freely speak their mind and air their opinions as this promotes collaborative culture in the organisation. There were several indications that showed that change was required at Mid Staff but the organizational leadership did not implement the required transformations. Organizational change requires good leadership. In this case, leadership at Mid Staff should have created the required new systems and institutionalized the new approaches. Leaders by virtue of their influence within organisations can be able to bring the required transformations in organisation. Leaders play a big role in change process and for there to be a successful change; the leadership should initiate changes whenever necessary and put in the required change efforts. What shows the link between poor governance and poor performance at Mid Staffordshire NHS Foundation Trust? The poor performance of Mid Staffordshire NHS Foundation Trust is indicated by the trust delivering poor services to the patients and even drop of the star rating from 3 to zero. The poor performance shows poor corporate governance. This is because corporate governance entails making sure that an organisation complies with legal obligations and protects the shareholders against fraud and organizational failure. The board should be able to control and direct the organisation by putting the appropriate governance mechanisms in place. In this case, the board and the management did not ensure that organisation complied with the legal obligations for example where the staff members and the entire organisation never adhered to the required legal professional standards. Additionally, the Trust failed and hence the poor governance contributed to the organizational failure. If there was good governance at the Mid Staffordshire, this would have prevented the likelihood if poor performance witnessed in the Trust. This would have been achieved by the board and management ensuring that there is legal compliance, constant financial analysis and control, as well as ensuring the accountability requirements are fulfilled. The board also did not play a strategic role. This is indicated by the board and the management failing to plan for the future, not responding to the required changes and concerns and also failed to nurture and establish key relationships. For instance, if the board and the management had responded to the concerns and implemented the required changes this would have improved the working relationships and thus improved the way patients were handled and treated and the way the organisation was run and eventually improved the organizational performance. The board should not just monitor and protect but should also enable and enhance in order to ensure there is good organizational governance and hence excellent organisation performance. Which governance arrangements can assist Mid Staffordshire NHS Foundation Trust to achieve its objectives of reforming the Trust to bring it back to its feet and provide high quality services? Some of the governance arrangements that can assist the Trust in achieving its objectives include ensuring there are clear and explicit roles and responsibilities of the board, the management and all healthcare professionals at large; make sure there are appropriate and operative protocols and codes of ethics and behavior; ensure good governance mechanism such as strategies on risk management, human resources, stakeholders relations and ethical code are in place; it should be ensured that the board spends most of time addressing strategic matters of the Trust; ensure that the skills of all board members are complementary and skills of every new appointment are audited to ensure the board members have the required skills to govern the Trust; ensure that the independent directors are actively involved in the affairs of the Trust and that they are well acquainted with the organizational affairs; and finally there should be arrangements to ensure that there is inclusive decision-making process where all appropriate stakeholders are involved and that the board and the management regularly evaluate themselves and the performance of individual directors is assessed and the appropriate actions taken. Make recommendations of what should be done to ensure there is appropriate leadership and good governance at Mid Staffordshire NHS Foundation Trust? The board of directors should consist of both dependent and independent directors but majority should be independent directors to ensure independence when making decisions and exercising judgments. All stakeholders should be involved in decision making and this even includes the patients whose views and opinions should be taken into account and addressed. The government should stop exercising absolute control of Mid Staff and leave control and supervision to the board of directors. Communication process should be improved as this will increase engagement and collaboration in the organisation The board of directors should be selected by shareholders and not the secretary of the state to ensure independence when delivering their duties. The leadership needs an overhaul to ensure the new leadership steers the organisation to the right direction. The culture at Mid Staff needs to change and a collaborative culture and that of openness should be adopted. The leadership has the responsibility of setting out the desired culture by acting as role models. The leadership at Mid Staff should adopt collective decision making style in order to be able to share problems with group of staff members and together try to reach a consensus regarding the problem and the solutions. Had the leadership tried to address the problems that the staff members such as nurses raised, the issues at Mid Staff would have been tackled. A code of ethics, standards and conduct for leaders, board of directors and generally for the healthcare staff should be developed and be consistent with the common culture Read More