LOS ESQUEMAS DE IMAGEN Y SU PAPEL EN LA CONSTRUCCIÓN DE

As part of the framework of corporate governance in Victoria, it is mandatory under legislation for all Boards to establish a Quality Committee as one of the sub

committee's of the Board. Chaired by one of the directors, the Quality Committee includes clinicians, administrators and academics. It is via this committee that all Board members are kept informed of the clinical governance of their health service.

Another mandatory requirement is that each health service must produce a Quality of Care Report - an independent publication from the Annual Report. Each of the health services must report its performance in relation to specific areas, such as; waiting times for emergency treatment, complaints, adverse events and mortality rates. These are measured against the Department of Human Services (DHS) Key Performance Indicators (KPIs). The health service is also required to report on the measures used to improve in these and other areas related to the quality and delivery of patient care.

It could be said that the reaggregation of the seven Victorian health care networks into twelve health care services in 2000 was in part a response to the Health Review Panel who had expressed concerns that patient care and quality may have given way to commercial viability and business imperatives. The re-emphasising of care and quality is expressed in the clinical governance reporting structure at HealthCo as shown in Figure 3.2.

Figure 3.2 Clinical Governance Reporting at HealthCo

Quality Committee

Medical & Nursing Staff Unit Manager Division/Departmental Manager Chief Medical Officer CEO HealthCo Board

The clinical governance policy at HealthCo requires all medical and nursing staff to keep up-to-date and accurate records of all treatment and medications administered to patients. These records must be accessible to Unit Managers. Any adverse event must be reported internally, firstly to the Unit Head and Divisional or Departmental Managers, who in turn must inform the Chief Medical Officer. The Chief Medical Officer assesses the event and must inform the CEO and the Board immediately. All adverse events are tabled at Quality Committee Meetings. External investigation can lead to legal proceedings and if there is evidence of clinical mismanagement that has serious consequences for the welfare of a patient then liability rests with the Board if they have failed to take appropriate action.

The Chief Medical Officer was considered the most appropriate person at HealthCo to liaise with clinicians and managers to produce a draft model of clinical governance given his professional medical experience. This draft model was first presented to

the Board in November 2001. After subsequent planning sessions and the creation of a clinical governance committee, the model was adopted in October 2002.

As has been stated throughout, the impact of economic reform and the introduction of clinical governance have not been unique to Australia, or to the specific context of Victoria. A series of major or critical incidents related to patient care, clinical and corporate governance in recent times has resulted in major, national, local, and international inquiries and investigations. They include: The Douglas Report – King Edward Memorial Hospital Western Australia (2001), The Royal Melbourne Inquiry Report (2002) and The Bristol Royal Infirmary Inquiry (2002).

Each of these major government initiated inquiries and reports highlights the need for managers to have full knowledge of, and mechanisms in place to tackle any likely operational problems. The recommendations found in each stressed the need for timely and effective reporting to all members of the Board to ensure that

management decisions are in the interest of patient access, safety and care. As previously stated, The Health Services (Governance) Act 2000, provides immunity for all of the Victorian health services directors. It reads:

A director of a board of a metropolitan health service is not personally liable for anything done or omitted to be done in good faith (Section 65Y, p.10).

Despite this immunity, directors in the public health sector now more than ever must be vigilant in their knowledge of the clinical governance mechanisms of their health service. Carver (2002:293) warned that, 'Hospitals literally hold the power of life

and death over most of us at some point in our lives'. This statement can be claimed as a truism for most Australians, who are either born, treated or die in hospital. It may be the medical treatment that we receive from clinicians that may save or lives, but it would seem that the ultimate power could be said to be held by the directors, Boards and governing bodies.

3.10 SUMMARY

This chapter presented an overview of Australia's national health care policy Medicare and its origins, along with its fundamental aims to provide equitable and low to no-cost public health coverage to all Australians. It discussed the impact of economic rationalisation and reform on the pubic sector in terms of changed governance and the evolution of the current Victorian health care system and the current governance arrangements for public health services. It argued that the changes in governance are reflective of international trends for the overlay of private business values and goals on public sector entities. That is, a push for business orientation and entrepreneurialism. It introduced the concept of clinical governance, originating from the NHS in the United Kingdom and presented the clinical

governance-reporting framework implemented at HealthCo. The chapter concluded with the argument that it is the Board of directors who are ultimately accountable for the consequences of all medical and other treatment. Their onus does not rest with their fiduciary roles, but as individuals and as a group have a corporate and personal responsibility to ‘act in good faith’.

In the Chapter 4 the methodological orientation for the study of corporate governance in the Victorian public health sector is presented.

CHAPTER 4 METHODOLOGY