Análisis, Resolución y Cierre de Incidentes

In framing its recommendations on governance for hospital groups, the Strategic Board has taken cognisance of the recommendations of the May 2012 Health Information & Quality Authority (HIQA) Report of the investigation into the quality, safety and governance of the care provided by the Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital (AMNCH) for patients who require acute admission (HIQA, 2012) particularly recommendations 3 to 29 which are applicable to hospital group boards.

The four main functions of a board are:

1. strategic planning 2. policymaking

3. supervision and challenge of executive management, and 4. accountability to stakeholders.

1.8 Recommendations for the Governance of the Transitional Hospital Groups

i

Each hospital group will be established on an administrative basis. These arrangements are transitional and will need to be formally evaluated in light of the emerging UHI model before the establishment of independent hospital trusts.

ii

Hospital groups can utilise an Academic Healthcare Centre (AHC) model to provide overarching governance structures for the relationship between hospitals within a group and their relationship to their primary academic partner. Within the AHC model, any proposed over-arching board must meet the criteria outlined in the recommendations below for interim group boards.

iii

There is a legitimate concern that emphasis on the Academic Healthcare Centre agenda may not fully recognise the urgent need for the reorganisation of acute hospital service provision. Therefore, hospital groups must demonstrate a capacity to respond effectively to national imperatives on service reorganisation within and between groups.

iv Each hospital group will establish an interim group board to which the management team reports. Ideally, this board should have a minimum of six and maximum of nine members.

v

In a hospital group where there are pre-existing voluntary boards with statutory authority, it is critical that these boards fully support the decisions of the interim group board during the transition phase. Common membership should be considered as a way of

securing this support.

vi The primary function of the interim group board is to oversee the delivery of high quality, safe patient care to meet the needs of the population it is appointed to serve.

vii

Pending the enactment of legislation establishing independent hospital trusts, the interim group board will provide regular reports through the CEO/Chair, to the Director General of the HSE/Director of Acute Hospitals or the equivalent in any successor to the HSE.

viii The Chair of the interim group board will be appointed by the Minister.

ix The Chair will nominate the interim group board membership for ministerial appointment.

x The role of the Chair and CEO will not be combined.

xi

The interim group board will comprise the necessary skills, competencies and experience which will enable them to make a contribution to the performance of the hospital group.

Membership must ensure demonstrable expertise including but not limited to at least the following domains: Clinical; Business; Social; Legal; Medical Academic; Patient Advocacy.

(HIQA, 2012)

xii

Each hospital group will agree an annual business plan / memorandum of understanding (MoU) with the Director General of the HSE/Director of Acute Hospitals or the equivalent in any successor to the HSE. The business plan / MoU will outline the national strategies to be incorporated in delivering on its commitments and specify within clearly defined budget and employment ceilings which services will be funded, and where those services will be provided within the hospital group. It will state the performance and outcome targets to be met within a defined timeframe and what nationally agreed measures will be used in order to monitor performance.

xiii

The interim group board will develop a Quality Improvement Framework to monitor the delivery of high-quality, safe patient care at all levels and on all sites across the group.

Hospital groups will be required to comply with clearly articulated national performance requirements in relation to issues such as quality, access, and financial management.

xiv Governance training will be offered to members of the interim group board early in the first term of their appointment.

xv

Board members must exercise their responsibilities in a professional and independent manner. Individual members, when carrying out their duties, must not act as representatives for different constituencies.

xvi

The Interim group board must proceed towards full implementation of the governance recommendations in the HIQA Tallaght Hospital Investigation Report (HIQA, 2012) and other recommendations as contained in but not limited to the Ethics in Public Office Act (1995).

xvii Evaluation of board performance should be the responsibility of the Chair of the board and carried out according to evolving best practice.

xviii The CEO and Executive Management Team of the hospital group will attend board meetings, but will not be members of the group board.

xix

Hospital groups will adhere to the terms of Business Plan/MoU (for the group) or contracts for the provision of services set out for them by the HSE or its successors as a component of the national service plan agreed with the Minister. These Business plans/MoUs and/or contracts must give maximum flexibility to the hospital group whilst ensuring all necessary synergy and linkages required for the overall national health plan to be implemented.

xx

The HSE or its successor will ensure the accountability of hospital groups by auditing service delivery against the Business Plan/MoU and/or other contracts or modifications thereto under the existing legal framework. Such auditing by the HSE or its successor will be done in a way that maintains the group’s flexibility and independence in deciding the most effective means of delivery.

xxi The interim group board will appoint sub-committees to oversee specific functions, as outlined in the HIQA Tallaght Hospital Investigation Report. (HIQA, 2012)

xxii

Where a hospital group has one or more pre-existing hospital boards, the hospitals in the group must work, through voluntary delegation of powers and common membership, to reach a position where the interim group board is the effective decision-making body for all hospitals in the group.