3.03 (R) [INFO] Topic 1. Governance and Theory
Topic 1: What is governance and governance theory? Until recently, the term governance was used primarily in relationship to the formal governmental processes and structures of nations. The first published use of the term is generally credited to William Tyndale in his 1530 publication entitled the Practice of Prelates where he used the term in reference to the individual rule of Henry VIII: “ When the king's grace came first to the right of the crown, and unto the governance of the realm young and unexpert …”. The first use of the term governance to reference national governmental structures - as opposed to the individual rule of a monarch - is generally credited to Charles Plummer in 1885 when he added the phrase The Governance of England to the title of his edited and annotated version of the The Difference Between an Absolute and a Limited Monarchy: As it More Particularly Regards the English Constitution written by John Fortescue in 1471. The term's use remained primarily in relationship to the formal governmental processes and structures of nations until the 1990's when the term governance began to be widely and commonly applied to many different areas such as organizations, projects, the environment, and the internet. This section discusses: Definitions of Governance Challenges to Governance Governance Theory Shared Governance Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Three Quiz. Definitions of Governance There is no agreement on the precise definition of governance - especially in the current era where the term is used in so many areas. There is agreement on the general scope of governance as a concept, but not its precise definition. There is no one universally accepted definition of governance. Below are some of the many definitions which can be found: The defines governance as “the way that a city, company, etc., is controlled by the people who run it”. The online Business Dictionary defines governance as the “Establishment of policies, and continuous monitoring of their proper implementation, by the members of the governing body of an organization. It includes the mechanisms required to balance the powers of the members (with the associated accountability), and their primary duty of enhancing the prosperity and viability of the organization.” The American College of Healthcare Executives (ACHE) defines governance as “delineating responsibility, authority and accountability at all levels of the organization. Functions include the development and implementation of policies and procedures for the governance process.” Wikipedia, Governance defines governance as “the way the rules, norms and actions are structured, sustained, regulated and held accountable.” The Worldwide Governance Indicators (WGI) project of the World Bank defines governance as the “traditions and institutions by which authority in a country is exercised. This includes the process by which governments are selected, monitored and replaced; the capacity of the government to effectively formulate and implement sound policies; and the respect of citizens and the state for the institutions that govern economic and social interactions among them.” AAPC defines healthcare governance as the “general term for the overall framework through which organizations are accountable for continuously improving clinical, corporate, staff, and financial performance.”AAPC also states that there are two categories of healthcare governance: 1) clinical governance ("the systematic approach to maintaining and improving the quality and safety of patient care") and 2) corporate governance ("business performance and compliance with laws, regulations, and ethical responsibilities, so that the organization contributes positively to its stakeholders and within the community it serves. Revenue cycle/reimbursement activities fall under corporate governance, but can extend into and directly influence clinical governance through ongoing reimbursement monitoring and risk assessment activities.") Challenges to Governance Existing governance processes and structures are sometimes challenged by the "governed". The outcome of challenges to governance by the "governed" or other internal or external situations is varied. The governance structure might, for example, eliminate the challenge and continue as before or the governed entity (i.e., country, organization) may change (e.g., divide into different entities). The entity may even cease to exist. Some of the more well known instances of such situations are: Henry VIII challenged the legitimacy of the governance of the Catholic Church and the Catholic Pope over his life and marriage. The outcome was a split of the entity (Catholic Church) - Henry VIII established the Church of England with the . American Revolutionaries challenged the legitimacy of the governance of the British Empire and the British monarchy. The outcome was a split of the entity (British Empire) - the United States was formed. The Declaration of Independence (signed in 1776) states that the reason for the Revolution (the challenge to the governance of the British Empire) was because when the governed have experienced “absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.--Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government.” Many of the original foundational documents for United States governance are stored in the National Archives. Note [FUN]: The video for Topic 1 - A Room for Treasures: Cool Things at the National Archives- is a YouTube video produced by the National Archives as part of its Inside the Vaults series. The video highlights some of the interesting, little-known items in the National Archives. Issac Le Maire challenged the legitimacy of the corporate governance of the Vereenigde Oostindische Compagnie (aka: VOC, Dutch East India Company) in 1609. Le Maire was a large shareholder in the VOC and demanded that the VOC governance structure and the VOC itself be liquidated because of VOC business practices. The outcome was that the VOC overcame this challenge and continued much as before. The VOC (founded in 1602) continued operations until 1799. However, Le Maire's challenge is considered to be the first recorded event of shareholder activism challenging an organization's governance processes and structure. Vote of No Confidence which the Merriam-Webster online dictionary defines as "a formal vote by which the members of a legislature or similar deliberative body indicate that they no longer support a leader, government, etc. " Wikipedia defines the term as "a statement or vote which states that a person(s) in a position of responsibility (government, managerial, etc.) is no longer deemed fit to hold that position, perhaps because they are inadequate in some respect, are failing to carry out obligations, or are making decisions that other members feel are detrimental." Governance Theory Governance theory can be defined as an evidence-based proposed explanation - with broad application - for observations of the way in which formal and/or informal policies, rules, norms, and regulations organize and guide the direction and functions of a group of human beings. For example, governance theory addresses the outcomes expected from the implementation of various governance structures. Often the phrase governance framework is used instead of the phrase governance structure. In discussions of governance, governance theory and governance structure/framework are equally important - because people generally have very strong opinions about a preferred form of governance structure. For example, political governance structures/frameworks are often referred to as forms of government and people have very strong opinions regarding the form under which they wish to live - conditions under which they wish to be governed. Some of the different forms of government are: Democracy Military Dictatorship Monarchy Oligarchy Republic The same is true of organizational governance structures/frameworks. Some of these structures/frameworks will be discussed later in this module. Briefly discussed in this topic area is the governance structure/framework known as shared governance. Shared Governance Just as there is no agreement on the precise definition of governance, there is no agreement on the precise definition of shared governance. There is, however, general agreement on the general scope of shared governance as a concept. The concept of shared governance within an organizational governance structure/framework means that "employees" of the organization participate in the governance decision-making. This is an issue in those organizations where the "employees" - those who directly produce the organization's "products" - are highly trained professionals such as colleges/universities and healthcare organizations. Although shared governance is not used in all healthcare organizations, when it is used, it generally takes one of two forms: 1) professional employees (e.g., physicians, nurses, other health professionals with direct patient contact) participate in a clinical governance structure co-equal to the corporate governance structure; or 2) professional employees are integrated into the corporate governance structure (e.g., member of the corporate Board of Directors). The first situation is the one defined above where AAPC defines healthcare governance as being comprised of two categories: 1) clinical governance ("the systematic approach to maintaining and improving the quality and safety of patient care") and 2) corporate governance ("business performance and compliance with laws, regulations, and ethical responsibilities, so that the organization contributes positively to its stakeholders and within the community it serves. Revenue cycle/reimbursement activities fall under corporate governance, but can extend into and directly influence clinical governance through ongoing reimbursement monitoring and risk assessment activities.") This shared governance structure (sometimes called integrated governance) is the primary governance structure of the National Health Service (NHS) in England. In the NHS, corporate governance and clinical governance go hand-in-hand where clinical governance is defined as "a systematic approach to maintaining and improving the quality of patient care within the National Health Service, (NHS)." Shared governance is also found in healthcare organizations in the United States. Examples include: Lahey Hospital and Medical Center Vanderbilt University Medical Center University of Virginia Health System Stanford Health Care, ValleyCare There are many articles and reports on governance. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: Shared Governance: Hartford Hospital's Experience Evolving Hospital-Physician Relationship Demands Shared Governance, Aligned Goals Engaging Physicians in Operational Governance Power and Integrated Health Care: Shifting from Governance to Governmentality The Involvement of Medical Doctors in Hospital Governance and Implications for Quality Management: A Quick Scan in 19 and an In Depth Study in 7 OECD Countries A Primer on the Dangers of 'Shared Governance' The Evolution of Nursing Shared Governance at a Community Hospital Empowering Frontline Nurses for Shared Governance Traditional and Non-Traditional Collective Bargaining: Strategies to Improve the Patient Care Environment For First Time, Physician Practice Owners are Not the Majority 4 Best Practices for Supporting Employed Physicians' Independence Physician Engagement – A Primer for Healthcare Leaders Governance in Healthcare: Leadership for Successful Improvement Healthcare Governance Amidst Systemic Industry Change: What the Law Expects The Importance of Good Governance Governance Arrangements for Health Systems in Low-Income Countries: An Overview of Systematic Reviews Decentralised Versus Centralised Governance of Health Services Exploring the Relationship between Governance Mechanisms in Healthcare and Health Workforce Outcomes: A Systematic Review Frameworks to Assess Health Systems Governance: A Systematic Review
