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A robust governance framework and implementation directly impacts an organization’s success from a corporate standpoint and is imperative for ensuring safe, high-quality patient care. By definition, governance is the overall framework through which organizations are accountable for continually improving their clinical, corporate, staff, and financial performance. A strong governance framework lays the foundation for making decisions, resource allocation, and prioritization.

When looking at building a governance framework, it is vital first to understand that it will not happen on its own. It needs to be a well thought out, structured process that you build alongside the correct stakeholders and team members. It is also important to associate the priority you’re driving your governance teams forward on with your strategic organizational principles. During the process of establishing and implementing this framework, you also need to promote progressive forward movement through cycles of surveying, planning, implementation, and evaluation. This continuous evaluation will help tell you how you are doing and encourage continuous improvement.

So how do you get this process of creating a successful governance framework started? We have compiled four principles that any organization should review when building a new or optimizing a current governance framework.

Principle 1: Engage the right stakeholders 

  • Make the call to action: This should be in the form of the CEO or someone similar, articulating the vision statement and widely communicating it. You want to ensure that they are stating the destination of where the organization is headed so that everyone in the organization is moving towards that point and all activities are focused on that end goal.
  • Form the Leadership Team: Once the call to action is established, you need to create a leadership team to support it. This process will include strategically selecting a group of multi-disciplinary members to drive your initiatives. It is important to have someone who is a visionary on that team along with early adopters, willing to jump in and follow that visionary, working to articular the vision and move it forward. Another individual you want on this team is someone who is in charge of the scarce resources because you will be using their resources to drive this team.

Principle 2: Establish a shared understanding of objectives

  • Prioritize Focus Areas: As part of this second principle, you will need to identify the high-level opportunities for outcome improvement. Using data and looking at the organization, you want to find the low hanging fruit. What objectives are you not doing well that there is a wide variety of variance that we could save a lot of money on and improve care? You want the highest value proposition identified and want to provide a focused effort to achieve improvement in these areas. You also need to align what you are deciding on with the strategic objectives of your organization.
  • Assess organizational capabilities and readiness: While you are prioritizing this focus and governance structure, you also need to look at your organization and ask, “is it ready?”. Are you able to make the necessary changes to achieve this high-value proposition? This step includes conducting an assessment of your organization, processes, methodology, infrastructure, skill, and culture to correctly identify if you actually can move forward and achieve that goal.

Principle 3: Align incentives and rules of engagement

  • Adopt a consistent improvement methodology: At the end of this framework creation process, you want to have a structure in place that you can reproduce and continue to use as you are looking at future priorities and changes. You want to empower people while also instilling accountability to achieve these new priorities and giving them ways to escalate areas when they cannot follow through. You also want to promote consistent execution. All of this is built into your governance structure, committee structure, and the charters you create for these committees.
  • Align Incentives: From a financial standpoint, it is critical to align your incentives. Everyone’s compensation needs to align with the same vision, goals, and accountability of the governance framework. i.e. it should be part of the CEO’s bonus, and any other members on the team.
  • Look for potential competing priorities: All goals should be aligned together to ensure no conflict of interest. For example, you don’t want revenue team members to be aligned to goal A and the clinical team members aligned to goal B, and those two goals conflicting. They should both align with whatever the highest priority is for the organization. This alignment will ensure that you are all working towards the same goal. That is not saying that there won’t be conflict, but if you all have the same goal, it will make it easier to come together and determine what works best for the organization as a whole.

Principle 4: Disciplined Prioritization

  • Strategically Prioritize Opportunities: You have looked at that high-value proposition, and now you will look to leadership to mobilize around this area. You’re looking at your frontline stakeholders and using them to help shape and understand this goal’s shared vision and objectives. You have brought this down to the committee level and have these front-line workers who are manning these committees to take this out to their co-workers and champion it.
  • Allocate Resources: It is essential to look at the allocation of resources so as not to overburden these resources. Resource management is a widespread challenge for many organizations. Co-workers can only manage so much, and you have to be careful not to overwork or burn them out. You have to be strategic when making these decisions to ensure it works for all involved.
  • Establish Prioritized Teams: As you are making these decisions and populating these teams for your governance structure, you need to ensure you have those innovators and early adopters as well as resisters on these teams. The resisters will help make you better because they will force you to think more about what you are implementing and challenge you, leading to an improvement of the final solution.
  • Implement Processes to Operationalize & Sustain Improvement: This cannot be looked at as a project; it is a process. The process must be continually improved and be the framework around how you work through anything you evaluate and any future improvements. Inevitably, you will have people who try to side step the governance structure or think they are above it. Still, the more you can bring it back to the process you have put in place, the better off you will be, and the more people will understand that this is how things move forward within your organization. From there, you measure success. Ask yourself, have we been successful? Look at all of the things you have done and communicate your success regularly so that people understand what you have accomplished.

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