Governance and Management of Health Services in New Zealand

This report provides a comprehensive overview of clinical governance and its application within the New Zealand healthcare system. It begins with an executive summary highlighting the critical role of clinical governance in improving healthcare quality, safety, and standards, drawing parallels with the UK's experience. The introduction emphasizes the importance of leadership and management in addressing public and political concerns within healthcare. The report then delves into the core elements of governance, including its principles (safety, quality, patient-centered care), structure (DHB Boards, Chief Executives, clinical leaders), and framework. It further explores the principles and structures of clinical management, focusing on risk management, staff training, and quality assurance. The report traces the origins of clinical governance in both the UK and New Zealand, emphasizing the factors that led to its development, and concludes with a reflection on the importance of understanding clinical governance for effective healthcare delivery.

Running head: GOVERNANCE AND MANAGEMENT HEALTH 1
Governance and Management Health
Student Name
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Table of Contents
1. Executive summary.............................................................................................................................3
2. Introduction.........................................................................................................................................4
3.0 Governance......................................................................................................................................4
3.1 Principles of governance....................................................................................................................5
3.2 Structure............................................................................................................................................5
3.3 Framework.........................................................................................................................................6
4.0 Management..........................................................................................................................................6
4.1 Principle............................................................................................................................................7
4.2 Structure............................................................................................................................................7
4.3 Framework.........................................................................................................................................8
5.0 Clinical governance...............................................................................................................................8
5.1 Origin UK and New Zealand.............................................................................................................9
5.1.1 Origin of clinical governance in the UK.....................................................................................9
Origin of clinical governance in New Zealand....................................................................................9
5.1.2 Relevance.................................................................................................................................10
6.0 Potential governance issues with possible implication in clinical governance.....................................10
6.1 Governance issues identified...........................................................................................................10
6.2 Implications on clinical governance................................................................................................10
7.0 Personal reflection...............................................................................................................................11
8.0 Conclusion...........................................................................................................................................12
9.0 Reference.............................................................................................................................................12

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1. Executive summary
Clinical governance stands as the main contributing factor for healthcare improvement
witnessed in New Zealand in terms of safety, quality, and standards of health services. Failures
and challenges evident in the healthcare system in early 2000 contributed to the need for
improvement that gave birth to clinical governance. This is similar to the case of the United
Kingdom that also developed clinical governance because of failures in the National Health
Service causing the numerous deaths of patients. The structure of clinical governance is clearly
designed with DHB Boards at the apex followed by Chief Executive down to clinical leaders.
The principles of operation, on the other hand, composed of quality services, administrative
initiative, the point of contact and clinical decision making (Hufty, 2011). The management as
part of clinical management focuses on managerial aspects and DHBs leadership at all level in
the ministry of health. The management framework is focusing on good communication,
effective management, collaboration, and partnership, provision of good medical services and
risk management. The article ‘Do inquiries into health system failures lead to change in clinical
governance systems?’ presents various potential governance issues that affect clinical
governance such as poor reporting of the adverse event and lack of transparent system thereby
discrediting inquiries. The implications of these potential issues are evident in the poor clinical
governance characterized by failures and negative clinical outcomes (LaForgia & Harding,
2013). Finally, my learning and understanding of clinical governance, especially on governance
origin, structure, principles, and management, is critical for an effective understanding of the role
of clinical governance in NHS.

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2. Introduction
Clinical governance remains an important aspect of National Health Service in New
Zealand and around the world. Leadership and management of health services pose challenges
with more public and political issues causing serious concerns. Development of good structured
clinical governance is part of policies reformation of health services that improved the quality
and safety of health care services. Clinical governance, therefore, is characterized by well-
defined management and leadership. In addition, clinical governance also works to improve
partnership and involvement of stakeholders such as patients in health care services (Zwanenberg
& Harrison, 2000). Some of the key aspects of clinical governance include principles of
governance, structure, and framework of governance. Management is another issue that is key to
clinical governance setting stage for incorporation of financial aspect into the governance and the
risk associated with management. The main focus of this report is to explore the clinical
governance in New Zealand unfolding some of the key issues in governance.
3.0 Governance
Governance plays an important role in leadership and management of health care services
provided. The main aim of clinical governance is to improve quality and standards of health care
services that are coupled with better patient's outcome. This implies that clinical governance
works to improve leadership and management of various health care facilities to ensure that the
quality of services is met. Governance is based on principles, structure, and framework that work
to improve the quality of health care system in the country (Bevir, 2013).

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3.1 Principles of governance
The clinical governance in New Zealand is based on some six basic principles. These
principles include safety and quality as the goal of the clinical and administrative initiative,
decision on clinical point of contact is accepted, the review of administrative decision through
clinical is encouraged, successful initiative is the basis of building clinical governance, and in the
clinical governance, patient’s better outcome is embedded in transformative partnership. These
principles work in order to increase safety and quality of health services in New Zealand thereby
reducing risk associated with poor clinical governance and management (Savedoff, 2009).
3.2 Structure
Clinical governance in New Zealand is structured following successful transformation of
the health care and clinical governance. The clinical governance structure is headed by DHB
Boards that forms the governance structure full of partnership and management. The DHB
Boards is expected to write a report on the clinical effectiveness and the outcome of the clinical
situation. The board operation and meeting are grounded on quality and safety of clinical
governance within the country (Asie, 2011). The Chief Executive follows the board along the
governance structure and fosters clinical leadership and decision making throughout the
organization. Chief executive is assessed based on clinical outcomes, effectiveness, and clinical
governance. Thirdly, down the ladder is DHB Governance promotes the clinical governance and
clinical leadership throughout the organization. DHBs report the clinical leadership situation as
District Annual Plans giving their Statement of Intent and scorecard reports to the Ministry. The
fourth level is the clinical governance that covers patient’s journey and various services. Fifthly,
clinical leadership forms the second last level within the structure of governance and includes the
spectrum from inherent through peer-elect to clinician management appointments. DHBs

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normally report the effectiveness of clinical governance and leadership throughout the spectrum
indicating the management and their clinical activities. Finally, the DHBs and the health system
should identify the potential clinical leaders that foster and support clinical leadership at every
level (Hallgan & Donalson, 2001).
3.3 Framework
The framework of clinical governance is founded and grounded on the quality framework
of the National Health Service. The quality framework is set on three aspects and this is setting
direction, delivery of service and personal qualities. Firstly, clinical governance works under the
need for the organization to set direction through its board considering intellectual flexibility,
drive for results, political astuteness and seizing the future. Setting direction is also characterized
by giving direction in terms of the expected standards and quality of service in clinical
environments. Secondly, another aspect of the framework is based on personal qualities such as
self-belief, awareness, management and personal integrity (Baez-Camargo & Jacobs, 2011).
Personal quality gives the clinical governance a boost since it is the main aspect of management
that is fundamental for governance. Thirdly, service delivery, on the other hand, is aided by
collaborative, leading change through people, empowering others and effective strategic
influence. Good service delivers that reduces health failures is one of the central roles under
which the clinical governance is founded. In addition, the formation of clinical governance was
aided by the need for better service delivery (Braine, 2006).
4.0 Management
Clinical management is grounded in two basic elements and these are risk management
and staff management. Management mainly focuses on risk management within the clinical

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setting. In order to manage risk, the clinical management works in collaboration with clinical
officers at all level of the organization.
4.1 Principle
Clinical management is based on the principles of staff training coupled with staff
appraisal, adverse incident management, quality assurance, risk assessment, and the complainant.
Firstly, the management focus on the principle of risk management that assess various risk
aspects such as adverse incident management (LaForgia & Harding, 2013). Secondly, on staff
management, the executive works to built staff team will competency skills through training and
staff appraisal. Thirdly, quality management is another important basis of operation for the
executive management with the main aim of clinical governance being provision of quality and
safety clinical outcomes. Finally, the management operates under the principle of complainant
management that ensures that complaints are treated as feedback and with high priority for
improvement of health services (Batalden et al, 2002).
4.2 Structure
The clinical management in New Zealand is headed by the executive management
constituting executive management team. At the top of the management, the ladder is the Chief
Executive Officer (CEO) whose role is to instill leadership skills throughout the organization and
monitor all the clinical officers in the health service. Secondly, director generals that head
various departments in the health sector and play the role of coordinating activities within their
departments. Thirdly, the general managers are also part of the management in charge various
departments within DHBs. Fourthly, Chief Finance Officer is in charge of public finance within
the health sector and report on financial matters within the executive management team. Fifthly,

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Chief Information Officer is in charge information systems in the ministry of health. Finally,
Chief Legal Counsel is another officer in the executive management with legal responsibility.
Below the board, there are other clinical leaders for various clinical units and district health
departments that are also part of management (Pettersen & Lewis, 2009).
4.3 Framework
Management had operation framework that is based on quality management and safety
health service standards. The framework for management and leadership is based on good
communication, collaboration, and partnership, effective management, provision of good
medical services and risk management. Good communication is critical for the organization and
this part of the management of the various clinical officers in the health care system (Ham &
Helen, 2008). Collaboration and partnership are another clinical management strategy that that
foster collaborations and partnership at all levels of the health care system. Effective
management is another framework for the operation of the management and focuses on proper
coordination of activities to ensure better healthcare services (Siddiqi et al, 2009). Provision of
good medical services is the main role of the management as it works closely with clinical
leadership to ensure good quality health service characterized with patient’s positive outcome.
Finally, risk management is another basis of operation that guides activities of the management
with the focus on risk assessment, adverse incident management and complainant management
(Fischer & Ferlie, 2013).
5.0 Clinical governance
Clinical governance refers to the system where there is an improvement of quality service
and standards through accountability and excellence care environment. This implies that clinical

GOVERNANCE AND MANAGEMENT HEALTH 9
governance work to restore the quality of services and standards clinical care for patients and the
health in general.
5.1 Origin UK and New Zealand
5.1.1 Origin of clinical governance in the UK
The origin of clinical governance especially in the UK can be traced back to the early
1990s following the failure of National Health Service. Beginning 2001, there were many
inquiries that probe several deaths within the country. Deaths in various hospitals raise many
political and public concern on the potential harms associated with failures in National Health
Service (Scally & Donaldson, 1998). Furthermore, different cases of deaths prompted the need
for changes and management improvement within health service. Several reports of challenges
and problems in the health service led to move by Labour ministry to minimize risk in health
service leading to various reviews in health care management and leadership. The overall result
of reforms was clinical governance that agitated for improved health care and incorporation of
financial assessment into the health service (Braine, 2006).
Origin of clinical governance in New Zealand
The origin of the clinical governance in New Zealand date back in 2009 following the
finding from national assessment project that sort to transform the healthcare and clinical
governance. The transformation of the clinical governance follows various leadership and
management challenges that are witnessed within the health care of New Zealand. At the time of
formation, clinical governance had the aim of partnership coupled with multidisciplinary training
of clinicians in partnership and involvement of various stakeholders in healthcare services. A key
milestone in the development of clinical governance policies was the development of fully

GOVERNANCE AND MANAGEMENT HEALTH 10
structure board and the entire structure of clinical governance in New Zealand (Fischer, 2012).
Clinical governance was necessary to streamline the health care operation eliminating possible
issues associated with inefficiencies.
5.1.2 Relevance
The origin of governance, especially in the UK and New Zealand, play a significant role
in the transformation of health care, clinical governance, and leadership. It is worth noting that
the origin of clinical governance in New Zealand and the UK has significance in the
transformation of the health care system these two countries. The origin of governance has
relevance in the current clinical governance since the failures and challenges that were witnessed
in the health care led to the creation of governance. In addition, the clinical governance for New
Zealand has several similarities to that of UK (Empter & Janning, 2009). Clinical governance
emerges because of some problems that were witnessed in health care and these were negative
clinical outcomes. Moreover, clinical governance has direct influence on patient’s clinical
outcome since it improves quality, standards and safety of health care systems.
6.0 Potential governance issues with possible implication in clinical
governance
The clinical governance article entitles “Do inquiries into health system failures lead to
change in clinical governance systems?” reveal some potential governance issues.
6.1 Governance issues identified
Some of the governance issues identified include inadequate negative event reporting
systems, the lack of transparent systems for staff and clients to report concerns on the quality of
patient care, and an ineffective medical credentialing and performance review system.

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6.2 Implications on clinical governance
The implications of the potential issues presented within the article indicate that the there
are many questions that are raised on the credibility of the inquiries that aim to improve health
care with many questioning the involvement of the clients in health care or safety improvement.
The clinicians training especially on interaction with clients and improved communication skills
are wanting based on the issues presented from the article (Eeckloo & Delesie, 2007). Training
creates awareness among the staff on the governance issues and the importance of governance to
clinical staffs. Firstly, lack of negative issues reporting systems in the health care system leads to
increasing negative patient’s outcomes accompanied by lack of accountability in the health
system. Secondly, transparency is associated with accountability without which problems recur.
Another issue of ineffective medical credentialing in the health care as identified in the article
leads to poor clinical services as medical practitioners lack credibility. Finally, performance
review system is normally a driver for improvement and lack of performance review reduces any
capability of change. Interaction with patients, therefore, is jeopardized as stakeholders
involvement lacks. The fundamental question that therefore remains is the role that inquiries play
in bringing changes in health care system failures (Corporate Leadership Council, 2005).
7.0 Personal reflection
I have learned the importance of clinical governance in improving quality of health care
services. Leaning origin of clinical governance especially in New Zealand is significant in my
understanding of the role played by clinical governance in management and leadership of the
health care system. As clinical officer, learning the structure, framework and principles of
clinical governance play a significance role appreciating health service management and the
importance every level of governance structure starting from DHB board down to clinical

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leaders. My knowledge on potential issues that affect or influence clinical governance has
enriched my understanding of factors that determine efficiencies of health care service. Indeed
the clinical governance has initiated several quality improvements that have better clinical
outcomes. How potential issues lead to inquiries of challenges affecting NHS is essential in the
identification of areas of improvements (Brinckerhoff & Bossert, 2008). For instance, one area in
my clinical practice that has been improved is transparency and accountability being key pillars
of clinical outcomes. The structure of clinical governance makes it clear on the accountability or
transparency required when attending to patients. The main aspect of clinical governance that has
potential usefulness in preventing negative patient’s outcomes remain as training of clinicians on
structure of governance and event reporting.
8.0 Conclusion
In conclusion, clinical governance has played a revolutionary role in improving health
care services. The inception of clinical governance is indeed connected to the need to improve
the healthcare system with the capability of reducing health care failure and negative clinical
outcomes. This makes it clear that the basis of operation of clinical governance lies in the
provision of safety, quality, and good standard healthcare services. The structure of governance
is comprehensive enough to enable efficiencies in operation and reporting at every level of the
Ministry of Health. Potential governance issues affect and influence efficiencies in the service
delivery especially in health care improvement. My understanding of clinical governance and
management is pivotal in appreciating governance as a tool to reshape and improve quality of
health care service through leadership.