Hospital governance 

What is governance?

The Audit Commission (2002) defined governance within the NHS as: “The systems and processes by which health bodies lead, direct and control their functions, in order to achieve organisational objectives and by which they relate to their partners and wider community.” Put more simply, it can be defined as ‘the way in which an organisation is managed at the highest level, and the systems for doing this’.

How is this done?

First of all, by following a set of principles. The six underlying principles of hospital governance are:

  • Accountability
  • Transparency and openness
  • Integrity
  • Stewardship
  • Efficiency
  • Leadership

Secondly, by isolating the processes and activities that need to be in place to follow these principles. In hospitals, the main components of clinical governance are:

  • Risk management.
  • Clinical audit.
  • Education, training and continuing professional development.
  • Evidence-based care and effectiveness.
  • Patient and carer experience and involvement.
  • Staffing and staff management.

Who governs?

Milton Keynes University Hospital has two governing bodies: the Board of Directors and the Council of Governors. The Board of Directors and the hospital’s executive management team are responsible for exercising all aspects of governance, while the role of the Council of Governors, which includes publicly elected members, is to make the hospital publicly accountable for the services it provides.

The hospital’s Board is led by the Trust Chair and consists of executive and non-executive directors.  Non-executive directors (NEDs) ensure the Board acts in the best interests of patients and the public. Acting as critical friends, they hold the Board to account by challenging its decisions and outcomes.  They also help the Board to formulate strategies, by bringing independent external perspectives.

The Council of Governors holds non-executive directors to account for the performance of the Board and represents the interests of the hospital’s Trust members and the public.

How is governance organised?

Milton Keynes University Hospital NHS Foundation Trust is divided into the five divisions of Medicine, Surgery, Women & Children, Core Clinical and Corporate. Clinical Service Units (CSUs) sit within the four clinical divisions and encompass specialties such as General Surgery, Acute Medicine, Diagnostics and Screening, while all non-clinical departments such as finance, workforce and operations functions sit within the corporate division.

Each clinical division and CSU is led by a team of three, consisting of a clinical director, a lead nurse or allied health professional, and an operational lead. Each team is collectively held accountable for its area, escalating issues and concerns up through the governance structure to the executive directors.