Hospital Strategic Objective: Systems Perspective in Governance – A 3-Year Design and Development Plan

Hospital Strategic Objective: Systems Perspective in Governance

A 3-Year Design and Development Plan

 

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

October 29, 2012; October 31, 2012; November 1, 2012

 

Introduction:

 

ROJoson: I believe having a systems perspective in governance is one of the steadfast strategic objectives all hospitals should have to achieve performance excellence.

 

Systems perspective is one of the core values and concepts of Baldrige Health Care Criteria for Performance Excellence.

 

 

Concept of Systems Perspective in Governance

 

There is a systems perspective approach in the governance system.

 

What is a governance system?

            What is a system?

A system refers to the organized policies and procedures with resources in doing thing (in this contex – governance)

            What is governance?

Governance refers to the action taken by a leader or manager or a team of leaders and managers in ensuring that the objectives of the hospital or project are accomplished.

 

Governance  (Baldrige)

The term “governance” refers to the system of management and controls exercised in the stewardship of your organization. It includes the responsibilities of your organization’s owners/ shareholders, board of directors, and senior leaders (administrative/ operational and health care). Corporate or organizational charters, bylaws, and policies document the rights and responsibilities of each of the parties and describe how your organization will be directed and controlled to ensure (1) accountability to shareholders and other stakeholders, (2) transparency of operations, and (3) fair treatment of all stakeholders. Governance processes may include the approval of strategic direction, the monitoring and evaluation of senior leaders’ performance, the establishment of executive compensation and benefits, succession planning, financial auditing, risk management, disclosure, and shareholder reporting. Ensuring effective governance is important to stakeholders’ and the larger society’s trust and to organizational effectiveness.

Governance (ACI)

Governance is the process of controlling the use of assets and resources to accomplish the organization’s mission or purpose. Governance function is the set of processes customs, policies, regulations and institutions affecting the way a health care organization is directed, administered or controlled.

Governance (JCI)

Governance refers to the individual(s), group, or agency that has ultimate authority and responsibility for establishing policy, maintaining quality of care, and providing for organization management and planning. Other names for this group include “board,” “board of trustees,” “board of governors,” “board of commissioners,” and “governing body.”

 

What is a systems perspective approach?

 

            What is a system?

A system refers to a “whole” thing, organization, or project, consisting of parts interacting, coordinating and collaborating with each other to make the “whole” thing moves or functions as one unified entity.   The parts may be people or non-people, like processes or tasks (subsystems).

 

                        System (ISO)

                        System refers to a set of interrelated or interacting elements.

            What is a systems perspective?

A systems perspective refers to an action characterized by simultaneously looking at both the parts and the “whole” thing to ensure that all the parts and the “whole” thing move or function as one unified entity.

Systems Perspective (Baldrige)

The Baldrige Health Care Criteria provide a systems perspective for managing your organization and its key processes to achieve results—and to strive for performance excellence. The seven Baldrige Criteria categories, the core values and concepts, and the scoring guidelines form the building blocks and the integrating mechanism for the system. However, successful management of overall performance requires organization-specific synthesis, alignment, and integration. Synthesis means looking at your organization as a whole and builds on key organizational attributes, including your core competencies, strategic objectives, action plans, and work systems. Alignment means using the key linkages among requirements given in the Baldrige Criteria categories to ensure consistency of plans, processes, measures, and actions. Integration builds on alignment, so that the individual components of your performance management system operate in a fully interconnected manner and deliver anticipated results.

A systems perspective includes your senior leaders’ focus on strategic directions and on your patients and stakeholders. It means that your senior leaders monitor, respond to, and manage performance based on your results. A systems perspective also includes using your measures, indicators, core competencies, and organizational knowledge to build your key strategies. It means linking these strategies with your work systems and key processes and aligning your resources to improve your overall performance and your focus on patients and stakeholders.

Thus, a systems perspective means managing your whole organization, as well as its components, to achieve success.

 

What is a systems perspective approach in governance?

 

The governance system or the governing body or people uses a systems perspective approach in ensuring that the objective of the hospital or project are accomplished.

 

(Based my definition) The governance system or the governing body or people looks simultaneously at both the parts and the “whole” thing to ensure that all the parts and the “whole” thing move or function as one unified entity.

(Based on the concept of Baldrige) The governance system or the governing body manages the whole organization as well as its components, with the individual components of management system operating in a fully interconnected manner, to achieve performance excellence.

In other words, the governance body or people view the operations of the hospital, departments, and projects as a whole and holistically taking into consideration the importance of alignment, coordination, collaboration, integration of all the organizational components, parts, subsystems, and activities in attaining the identified goals and objectives.

 

When does one say there is an honest-to-goodness systems perspective approach in governance in the hospital?

 

There must be evidences to show that all the members of the top, senior, and middle management and project management are using an agreed systems perspective approach in governance across and at all levels in the hospital and there is resultant positive impact on performance excellence in the hospital and its departments and projects.

 

ROJoson: I believe having a systems perspective in governance is one of the steadfast strategic objectives all hospital should have to achieve performance excellence.

 

Systems Perspective in Governance as a Hospital Strategic Objective

Goals:

To develop a well-defined systems perspective approach in governance that will promote performance excellence for the hospital, its departments, and projects.

Key success indicators:

All the members of the top, senior, and middle management and project management are using an agreed systems perspective approach in governance across and at all levels in the hospital and there is resultant positive impact on performance excellence in the hospital and its departments and projects.

Philippine Quality Award:

Year 1: Recognition for Commitment in Quality Management

Year 2: Recognition for Proficiency in Quality Management

Year 3: Recognition for Master in Quality Management even Philippine Quality Award for Performance Excellence

Objectives:

  1. To formulate a master design and development plan on establishing and developing a systems perspective approach in governance in the hospital.
  2. To deploy the approved master design and development plan across and at all levels in the hospital.
  3. To evaluate and continually improve the master design and development plan, particularly the agreed systems perspective approach framework, to ensure sustainable achievement of performance excellence for the hospital.

Critical Success Factors:

  1. Presence of a master design and development plan (MDDP) on systems perspective approach in governance
    1. Presence of a document containing the MDDP approved by top management
    2. Presence of a systems perspective approach framework in governance for the hospital to be used across and at all levels in the hospital
    3. Presence of deployment of the approved MDPP on systems perspective approach in governance
      1. Presence of a deployment plan – leadership, managership, communication and education with needed infrastructure
      2. Evidence of effective deployment across and at all levels in the hospital
    4. 3. Presence of monitoring, evaluation, and continual improvement plan on the implementation of the MDDP on systems perspective approach in governance
      1. Presence of a monitoring, evaluation and continual improvement plan
      2. Evidence of effective implementation of the monitoring and continual improvement plan

Expected Outputs:

See Goal and Objectives

See Key Success Indicator and Critical Success Factors

Integration with the other strategic objectives particularly, full compliance with the quality and performance standards (local and international)

Expected Impact:

Performance excellence for the hospital

Improved hospital performance, practices, capabilities, and results

Evaluation:

Based on goals and objectives / key success indicator and critical success factors and expected outputs and impact

Based on PQA assessment methods:

PROCESS

Approach – master design and development plan

Deployment – across and all levels

Learning – evaluation and new learnings and innovations

Integration – integration with the other strategic objectives particularly, full compliance with the quality and performance standards (local and international)

RESULTS

Level – level of achievement (PQA)

Trend – increasing level of PQA and PhilHealth recognition over 3 years)

Comparison – best compared with other hospitals (local, regional, national, international)

Integration- integration with the other strategic objectives particularly, full compliance with the quality and performance standards (local and international)

Action Plan (Draft and Sample):

Y1 Y2 Y3 Remarks with persons-in-charge
Planning
Master Design and Development Plan November 17, 2012
Approved by Top Management November 24, 2012
Deployment
Communication December 2012
Education and reinforcement on Education  –  January to June, 2013 Reinforcement – January to June, 2014 Reinforcement – January to June, 2015
Baldrige /PQA
Balanced Scorecard
ROJ ADDF
ISO
PhilHealth Benchbook
JCI / ACI
Monitoring All year round All year round All year round
Evaluation and Continual Improvement August August August
Application for PQA
Application for PhilHealth Benchbook

Budget:  Mainly on the educational activities (to be integrated with the other strategic objectives action plans

Task Team Systems Perspective in Governance

Members:

Chairperson of the Board of Directors

President

Senior Management

 

or Executive Committee

or Management Committee

 

Situational Analysis – Baseline

 

NO master design and development plan

NO systems perspective approach framework

NO integration

NO training

 

Challenges:

Buy-in of staff

 

Strategies for Implementation

Leadership

Managership

Communication

Education

 

To be continuously refined – 12nov1

 

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