Improving hospital performance through up-to-date assurance systems

Allocate Software and the Good Governance Institute (GGI) are currently working together to produce a collaborative white paper exploring how mechanised assurance can have a positive impact on the performance of NHS organisations. This comes in a context of the reporting requirements on NHS trusts and foundation trusts being greater than ever, meaning that there is more of an onus on board members to ensure they are well-assured.

On Wednesday 22nd of November to aid the white paper Allocate and GGI hosted a round-table event in Manchester to discuss mechanised assurance and seek views from those inside the NHS on what a good system looks like, and also what challenges they are presented with in an ever changing environment with close scrutiny from regulators, media and also the impact of assurance and how it is felt by the patients.

So what is a mechanised assurance system..? This can be described as a solution to manage the processes and practice within an organisation for governance, risk and compliance. The system would aid with managing compliance with various regulators, manage internal strategy and risks, and provide a clear accountability and escalation throughout the organisation. Not only to highlight issues, but also to show areas of good practice.

Mechanised assurance needs the ability to create board reports that are ward to board, and also create a single version of the truth. This can be complex when there are many different systems in place and needs to be both simple and effective.

A good Assurance system is used and recognised by all staff in the organisation and is part of a shared vision and working practice. It will aid with the mitigation of risks and also identify gaps in performance and provide clear organisational transparency. The question should always be ‘What do you not know’.

Good clear and consistent escalation triggers are seen as key which can be managed within an assurance system, with clear accountability and management of actions and learning from incidents.

Assurance systems can also lead to positive change, transparency across the organisation can also be seen as being highly motivational if all staff share the same goals, and understand the purpose of assurance in the organisation.

Assurance should always be seen as all encompassing – it is not possible and shouldn’t be possible to split Quality from Finance and Workforce. The combination of the three is vital to the success and full assurance of the organisation. Assurance should be ‘wrapped around everything’. Workforce can be complex as now it is transient and not aligned to the organisation as it has been in the past.

During the event time was spent discussing how assurance is complicated currently, but vital in ensuring the good practice that results in quality performance and is key to good safe, effective patient care.

This complexity is even greater in changes to the landscape of the NHS and the introduction of ACOs and STPs. Organisations will need to understand and work towards a joined up assurance process – but it was felt at the event that this is difficult, and there is still too much organisational self-interest for this to happen, and that Assurance is not always deemed important enough to consider in the changes happening. But the impact of poor assurance is high.

The role of the board was discussed in some depth and there is the feeling that a good board should always be looking ‘out and upwards’ but its often the case that they are only looking ‘down and in’. Very few Board papers are projecting performance, and are more related to reviewing the current/past and it is felt that this would be beneficial potentially to create strategic goals and to provide to regulators such as NHS Improvement.

Regulators and increasing pressure and changes to how/what and where organisations are scrutinised also adds pressure to organisations and a good assurance system is vital to have in place to demonstrate high quality performance and compliance with the various regulations. Also as the organisations change and develop to include for example elements of social care, the regulators may also struggle to be able to understand their complex nature and will find it difficult to report on what an organisation is going to organically grow ‘to be’.

It is also important to be able to keep up with the constant demand for reporting of data, and to provide good quality and timely data within the organisation to the board, as well as external demand for data to be reported. At the event it was discussed that there is a constant need to ‘feed the beast’ but that there is often no feedback on what this data does, and what it answers.. How is someone dealing with this internally or also externally.

Technology is a key driver for the future and vital to be implemented, but it was discussed that this has to be at a pace to fit and that sometimes we are not always ready for it.

In summary, Assurance is key and should be a fundamental part of running any organisation and would be ideal if it could be both Standardised and Simple. Assurance should be everyone’s responsibility and managed and measured efficiently. Having good clear systems in place which are joined up and provide a clear picture of assurance across all elements of the organisation are vital.

In the next Blog, we shall be examining results of a survey completed by respondents from both the GGI and also Allocate customers to ask what their thoughts are on the themes of Assurance.

Do different systems of assurance have an impact on an NHS organisation’s performance? GGI & Allocate are asking NHS professionals with a remit for assurance and quality to contribute to the whitepaper – join the LinkedIn group to have your say, find out about future roundtables and to be the first to receive the whitepaper.