We read with interest the article on effective governance between partner organisations, write Richard Dale and Sheila Peskett
It confirms our own experience that explicit governance arrangements between organisations are essential in the patient pathway, to enhance quality of care and minimise safety risks.
Clinical pathways may include sub-pathways with discrete clinical processes that can be delivered by more than one service or organisation. The direction of a patient from one section of the pathway to another requires clarity about the governance arrangements at the organisation boundaries within the total pathway.
This is particularly relevant when only part of the patient's care is delivered by an independent sector treatment centre. Whether this is provided by employed or seconded clinicians, fracturing the clinical pathway adds complexity, increases risk and brings its own governance issues. The boundaries for consideration are not only between provider organisations, but include the relationship between commissioners and providers where shared understanding of governance responsibilities is necessary.
We also believe that intra-organisational governance should be addressed. This is especially so with organisations that have commissioner and provider functions, where there is a potential conflict of interest. Transparency of business transaction and governance arrangements are essential.
We worked with Michael Deighan and John Bullivant of the NHS Clinical Governance Support Team to devise an integrated governance framework. We have used this as a guide for our involvement with the independent sector, to ensure that providers have appropriate arrangements to safeguard quality of patient care.
Richard Dale, medical director, Department of Health commercial directorate, and Sheila Peskett, senior fellow, Centre for Health Planning and Management, Keele University