Board Director Induction Training Webinar Series - 2023 - session 1

Induction training for board directors: Health Service Board Director Induction Session 1 - Introduction to Victorian health system and clinical governance

Introduction and host welcome - Dr Jo Flynn, Facilitator and Chair of Boards Ministerial Advisory Committee

Jo Flynn - host: Good afternoon everyone and welcome to the first in our series of induction training webinars for board directors for 2023.  My name’s Jo Flynn and I chair the Boards Ministerial Advisory Committee, advising the Health Minister on appointments to health service and public hospital boards.

As we start tonight, I'd like to acknowledge the Aboriginal Torres Strait Islander peoples as the first peoples and traditional owners and custodians of the land, skies and water aways across Australia and pay respects to their elders, past, present and emerging.  

I'm currently on the land of the Gunditjmara people in South West Victoria and I pay my respects particularly to the elders and I'd like to welcome you all tonight and particularly welcome any Aboriginal Torres Strait Islander people who are with us.    

This webinar is pitched really at those who are starting their first term in the public health sector as a board director, but we know we have people with us tonight who've been directors for varying lengths of time and you're also most welcome.  

The webinar tonight has a lot of content in it and the slides are quite dense.  We know that and acknowledge that, but we'll send the slide pack out to you after the webinar and also a link to watch the webinar again if you want to. So our feeling in planning the webinar is it's better to give you plenty of information recognising that there will be a bit of overload tonight, but hopefully it's a resource that you can come back to.  

So just to run through how the webinar works tonight, we have a number of speakers. I'll just talk briefly at a very high level first about responsibilities of board directors.    

[Slide 1- On-screen text listing agenda]

Introduction

Dr Joanna Flynn, Facilitator and Chair of Boards Ministerial Advisory Committee

• Minister’s welcome
  • The Hon. Mary-Anne Thomas, Minister for Health
• Health System Overview and Department of Health Introduction
  • Ms. Louise McKinlay – Acting Deputy Secretary, Commissioning & System Improvement, Department of Health
• Clinical Governance Overview
  • Ms. Sarah Fischer, Director, Culture & Capability, Safety Branch, Safer Care Victoria
• Quality & Safety for board directors
  • Professor George Braitberg AM, Chair Quality and Safety Subcommittee, Peter Mac
• New Board Director Perspective
  • Ms Robynne Cooke, Director, Northeast Health Wangaratta Board
• Question and answer session

[End of Slide 1]

We then have a video from the Minister for Health, the Honourable Mary-Anne Thomas, who apologises that she was not able to join us tonight, then an overview of the health system and the Department of Health from Louise McKinlay, who's the acting Deputy Secretary of Commissioning and System Improvement in the Department of Health.

Then we're going to talk about clinical governance so essentially today's webinar talks about high level health system, how it works and about our clinical governance responsibilities.    

The webinars that follow look at financial and legal responsibilities, about accountability, culture of the boards and a number of other topics, and those webinar dates have been given to you in advance.

I also want to acknowledge as we start that many of you haven't actually had your first board meeting yet, or perhaps even had the chance to visit your health service and so you’re no doubt looking forward to and we hope that this will give you a bit of context to start those discussions in the right place.

So after Louise, Sarah Fischer will talk about clinical governance, the clinical governance framework in Victoria and she's representing Safer Care Victoria and then George Braitberg who's also a member of the Board Ministerial Advisory Committee, who chairs the Quality and Safety Committee at Peter Mac, will talk about the role of a board director and the role of the Quality and Safety Committee and finally, Robynne Cooke, who 12 months ago took up her appointment on the Northeast Health Board in Wangaratta.  We'll talk about what it's like being a new director, and perhaps a bit about what she wished she'd known at the beginning, that she's learnt now. 

Then we'll have about 20 minutes for interaction through questions and answers. So what I draw your attention to the fact that there's a Q&A function on your screen. I hope where you can enter questions.  

I want you to keep an eye on the questions as they come through and give the ones that you're interested in particularly a thumbs up, so we make sure that we deal with those that are of highest priority to you.  

So if we can move to my first slide, just talking about your role as a director.

[Slide 2 On-screen content: What is my role as director?]

Board directors are bound by legal and ethical responsibilities enshrined in the Health Services Act, supported by the Public Administration Act, Financial Management Act and governance guidelines. In practice, this means that directors must:

• Act with integrity and in good faith, at all times.
• Act in the interests of the health service.
• Hold themselves and each other to account.
• Attend and participate in all meetings, having pre-read all board papers.
• Look beyond the obvious and not just accept the information presented.
• Be curious and well informed - inform themselves of issues/risks impacting the provision of health services

[End of onscreen slide 2]

So board directors have a number of legal and ethical responsibilities and it's a sobering thought that it even, perhaps, though you're not aware of what those responsibilities are to a full extent now you have them already given that you've been appointed as a director.  I'm not saying that to frighten you.

There are plenty of people around who will support you as you grow your way into your full director role, but you have already assumed those legal responsibilities.  Some of the responsibilities we have, I think are very self-evident but just to remind us to act with integrity and in good faith at all times, to act in the interest of the health services. Your first responsibility to hold ourselves and each other, to account, to attend and participate in all meetings and be well prepared when we get there. But then there are some behavioural things about how we do it. 

It's really important that we're curious and well informed, that we look beyond the obvious, but also that we treat everybody in the boardroom, our board colleagues and those - the CEO  and representatives of management - who are there, respectfully and as our partners in delivering the sort of healthcare we want to be able to deliver for our communities and our patients.

As I said, there are lots of resources for you and on my next slide, we just talk a little bit about some of those, in particular two things I want to draw your attention to.

[Slide 3 Director resources]

The Directors’ Toolkit contains information about being a health service board director.

Chapters include:

• Victoria’s health service governance model
• Clinical governance
• Conducts, ethics and fiduciary duties
• Statutory duties
• Board structure and renewal
• Insightful strategy
• Risk management
• Productive meetings
• Stakeholder engagement
• CEO oversight
• Organisational culture and leadership
• Accountability and performance
• Financial governance
• Understanding data

The Victorian Public Sector Commission (VPSC) website has a range of resource specifically for directors on government boards. They also provide training and disseminate best practice in governance specific to government entities, including health service boards.

[End of slide 3]

There is a toolkit for health service board directors and there'll be a link to that in the information that you've been sent and that covers a lot of information about all of our responsibilities and it aligns with information which has been developed in the last year or so through the Victorian Public Sector Commission and their website has a terrific range of resources on it and is a good reminder to us. Not only are we responsible within our entity, but we have a responsibility across the broader Victorian health system and the Victorian public sector of which we are now all a part appointed to specific roles.

So our first presentation tonight is a video from the Minister for Health.  The Honourable Mary-Anne Thomas, a welcome video directed particularly at those who've just taken on their role.

Minister's welcome - The Hon. Mary-Anne Thomas, Minister for Health

[pre-recorded video played]

Honourable Mary-Anne Thomas: I want to begin by acknowledging the traditional custodians of the lands on which we are all meeting and pay my respects to elders past and present. I would also like to acknowledge all Aboriginal people who are attending here today.

I'm so sorry I can't be there in person to welcome you as new and reappointed health service board directors, but I want to thank you for accepting your role as directors. It's an incredibly rewarding and important role.  As directors, you are accountable to the Victorian Government and the people of Victoria for the delivery of safe and high quality healthcare.  Each health service board works with me as the Minister for Health and also the Department of Health in accordance with government policy. Your role involves overseeing the strategic direction of the health service.

You're also responsible for governing the health service by meeting the regulatory and government policy requirements and standards.  Some of these include developing statements of priorities and strategic plans for the operation of the health service and monitoring compliance with these priorities and plans. You'll play a critical role in supporting collaboration and partnerships within and across the health system to enable the delivery of health priorities.  As system leaders boards collective ability to model and foster collaboration will be a critical driver of a responsive healthcare system for all Victorians.  Your actions as a board director are also likely to involve the oversight of changes from two recent royal commissions.

This includes delivering reform into aged care founded on the principles of respect, care and dignity, and creating a future mental health and wellbeing system that provides holistic treatment, care and support for all Victorians. 

Thank you again for your passion and your commitment. I look forward to working with you as we continue to recover from the pandemic and build a stronger and more resilient healthcare system for all Victorians.

[End of video play]

Jo Flynn - host: After the welcome from the Minister, a couple of reminders for those who've logged in a little bit later about the housekeeping. Firstly, there is a question and answer button on your screen, please, as we go through the webinar, write in any questions that you would like to and keep your eye on and indicate particularly questions that others have written, that would be a priority for you and we’ll deal with the questions at the end.

Our first presenter though is Louise McKinlay who’s acting Deputy Secretary in the Department of Health in her area of responsibility, is Commissioning and System Improvement and Louise will give us an overview of how the Department and health system in Victoria works. Welcome. Louise, over to you.

Health system overview and Department of Health introduction - Ms Louise McKinlay - Acting Deputy Secretary, Commissioning and System Improvement, Department of Health

Louise McKinlay: Thank you and thank you for that introduction. And I too am on Wurundjeri land of the Kulin nation and I pay my respects to elders past, preysent and emerging and all on this call. And so it's an absolute pleasure to be with you today. Welcome and welcome back  for those who are continuing their journey.  

So my job is really to give you a bit of a whistle stop tour of the health system, a bit info about the Department of Health, and I'll talk a little bit more about the division. In terms of myself, I'm currently in an interim role. My substantive is actually as a senior executive in Commissioning and System Improvement where I've been for the last couple of years.  

I'm a nurse, I've worked in health all my life. Prior to working in the department, I was one of the inaugural directors at Safer Care Victoria and prior to that worked in various executive roles and in Western Health, so I've certainly walked the floorboards as it were, and seen live from both sides, so hopefully I can share some of that insight with you as you embark on this exciting journey and important role. Next slide please.    

[Slide 4 Our Vision is that Victorians are the healthiest people in the world]

Graph 1: The overall health status of Australians is higher than the OECD average.

Graph 2: Health care system performance- 10 Countries:in order of highest to lowest performing: Norway, Netherlands, Australia, United Kingdom, Germany, New Zealand, Sweden, France, Switzerland, Canada, United States.

[End of Slide 4]

So let me start with what we're about and our vision is quite simple, that we want Victorians to be the healthiest people in the world and you heard the Minister reference that just now in terms of all Victorians and being the best we can and certainly we are very successful at that. In the main, we have one of the best healthcare systems in the world, I would argue, and you can see that by some of the graphs there in terms of where we are positioned in terms of our performance and some of our outcomes in terms of life expectancy and so forth.

And that being said to you, there's still work to do and I'll take you through some of those priorities shortly. But certainly our role is very much focused on Victorians and delivering on this vision and we do that in various ways, so be it alerting about thunderstorm asthma, notifying of communicable diseases, safeguarding drinking water, supporting the running of healthcare facilities and being at the forefront of medical and mental health treatment or research.

So, it's really all about how we partner with communities and with other agencies to make sure we deliver on this vision. And what I would say is your work is certainly fuelled by passion to serve the community and create public value and it is in a time of unprecedented challenges and change, both in the state at an individual level, but also globally. We're facing things such as climate change, challenges around equity and access and complexity that perhaps we've not experienced before. That being said, we have been a bit of a victim of our own success. I would share that a third of the state's budget actually is spent on health. Now clearly, that's an immense achievement, but equally it's something that we need to think about in terms of sustainability.   

So we have amazing resources, collective wisdom, technology and emerging technology than we've had ever before and it's our job to harness that and build on the passion of our people and we hope to share with you very soon our strategic plan, but I can give you a little insight around how we're going to deliver on our vision.  Next slide please.    

So let me tell you a little bit about this system and forgive me because some of you will know this, but certainly we're based on a system of public administration reliant on many public entities delivering a range of services and functions essential to the delivery of healthcare to our communities.    

[Slide 5: Overview of Victoria’s public health system]

Image: Pyramid structure: Top to bottom order of group and responsibilities: Government- Minister, Department of Health -Secretary, Health Services – Health Service Board CEO and Executive, Population – Patients, consumers, carers and the community.

Boards and directors are appointed by the Minister. Boards and directors are accountable to the Minister.

[End of Slide 5]

These entities are overseen by a board of directors who operate independently of the state to however, remain accountable to the Minister, as you have heard. And I guess what this means using language of private sector, the Minister is your key stakeholder.

You're accountable to the Minister for the healthcare to your communities.  Directors are appointed by the Governor in Council on the recommendation of the Minister and Cabinet for Directors of Public Health Services as well. So, a health service board’s individual directors have formal duties, responsibilities to the Minister and the Secretary of the Department of Health, who is my boss. Next slide.

So if you think about roles and responsibilities I’ve just tried to set out on this slide at a high level, I guess the points of difference, so the department is responsible for developing and delivering policies, programs and services that support and strengthen the health and well being of all Victorians and we take that in a very broad sense.

So thinking about health and wellbeing in terms of ill health, good health, the social and economic context in which people live and thinking about vulnerable communities instance of and experience of vulnerability.  And truly, we try and place people at the heart of our policy making, service design and delivery.

From your perspective, the board is responsible for setting the vision, strategy, direction of the organisation that you serve, in line with the departmental and government policy directions and priorities. You set and shape the organisational culture oversight to the services and resource managers of the organisation to determine the risk management and oversee the management and control of risk within that appetite and monitor performance especially of that of your CEO's performance management.

So, we're a key stakeholder that will provide frameworks and give feedback and guidance to support you in delivering the strategic priorities of government, but equally ensuring the success of your organisation.  

And so, it's really important to understand how the chairperson, the board as a whole, individual directors and the CEO interact with the department and other key stakeholders and no doubt more of that to come. Next slide please.    

Victoria is a bit of a unique beast, dare I say it. We have a devolved governance here, so we actually have 81 publicly funded services and we've just given you the profile of those there on the screen and under the Health Services Act, Victorian Health services are broadly categorised as either public hospitals or public health services.

So broadly speaking, public health services are more complex in terms of what they provide and their budget and assets. Relative to public hospitals, all health services have their own board of directors that are responsible for governance of their organisation and that board must ensure that the service is delivering safe and quality care and is compliant with the requirement of the enabling acts, there will obviously be more about in later sessions around the specific acts and legislation that you need to be mindful of.  

And then via the chairperson and the board ensures that the departments are aware and advised in a timely manner about any significant board decisions and informed of any issues of public concerns or risks that may affect the health service and or are important for government to be aware of. Next slide please.

[Slide 6: Roles – Department of Health and Health Boards]

Role of the Department:

• Setting policy and strategy 
• Oversight of healthcare system
• Commissioning healthcare
• Facilitating capital funding 
• Monitor health services’ performance
• Monitoring quality and safety 
• Monitoring and ensuring delivery of policy and strategic priorities 

Role of boards:

• Set strategic directions and goals 
• Set the tone and culture of the organisation
• Foster partnerships and collaborations
• Oversight of the health service
• Prioritise resource allocation
• Determine risk appetite and oversee risk management
• Enable and monitor CEO performance

[Slide 7: Roles- Health Services in Victoria]

• 56 Public Hospitals
  • Ten sub-regional health services
  • Eight local hospitals
  • Thirty small rural health services
  • Seven multi purpose services
  • Two early parenting centres
• 19 Public Health Services
  • Six regional public health services (e.g. Bendigo Health, Albury Wodonga Health)
  • Eight major metropolitan services (e.g. Eastern Health, Austin Health)
  • Five state specialist services (e.g. the Royal Children’s Hospital, the Royal Eye and Ear Hospital)
• 6 other major entities
  • Ambulance Victoria
  • Victorian Institute of Forensic Mental Health (Forensicare)
  • Health Purchasing Victoria (HealthShare Victoria)
  • Three denominational hospitals (e.g. St Vincent’s Hospital)

[End of Slide 7]

[Slide 8: About the Department of Health]

Then turn to the department, so in the scheme of things, we're a relatively new department given that we were newly formed a couple of years ago, but the people within the department are a range of old and new and so those of you who've been around a bit will know many of us. Let's go to our org structure please. For this currently, how we're organised, you can see there.

[Slide 9: Organisational structure]

We have the Secretary. There are a number of divisions and Deputy Secretaries who report into the Secretary and we have a couple of administrative agencies as well that provide specific services and I'll take you through those.  

So Aboriginal health obviously centred on Aboriginal self-determination, this division coordinates and advises on policy and strategic reforms across government to improve the health of Aboriginal Victorians.

At my division, Commissioning and System Improvement, I like to think of as a bit of an engine room of the department and we're actively stewarding the health and community care system, we have a role to play not only with health services, but also community health services, aged and community care and ambulance services, and our functions are quite broad.  

I kind of call it a bit of a cradle to the grave portfolio because it literally is. It's everything from IVF to end of life care, looking at policy and program design, implementation, performance monitoring and looking at performance improvement and very much leading the way in terms of engagement with the sector and a role around corporate advice and reporting. But I'll tell you a bit more about that shortly.

Our mental health and wellbeing branch, are leading the way off the back of the Commission and leading the mental health reforms for Victoria, which is an ambitious agenda of reforms that are certainly necessary, and they provide stewardship of the mental health and alcohol and other drug services sector.

Our public health division works to advance public health, improving population health and wellbeing outcomes and lead the response to emerging health threats and broader population emergencies.

Health infrastructure, no surprise, focuses on policy and strategy for infrastructure planning delivery and oversight of infrastructure in Victoria and across health, mental health and aged care.

Safer Care who you'll hear from very soon and works very closely with us, other government agencies and with your organisations to drive quality and safety and improvements. So working with clinicians and consumers to help services deliver better, safer healthcare to all Victorians.  

The Victorian Agency for Health Information actually is now sort of nested within the department but essentially is the sort of data and reporting agency for the department, but does report on both public and private services and a range of metrics in relation to health and wellbeing, quality and safety performance metrics really just to increase transparency and accountability and inform community and consumers and clinicians, but more importantly yourselves so there's a range of reports that they produce and that will certainly assist you in your roles on your boards.

Sorry, I just knocked my keyboard then and nearly knocked my mic off. The other roles that hopefully are pretty self explanatory but that's sort of the headliners and happy to answer any questions if you've got them as we go through. I'll let me give you a little snapshot of our strategic plan. Next slide please.

So here is our strategic plan for 23-27 and we're about to release this to the sector and it's certainly a requirement of us to government in terms of the resource management framework that we comply with that we published a strategic plan by August of each year.

This year we've taken a different tact, where we're by, we've gone with a four-year horizon and then we sort of have an annual plan that we work to as that horizon unfolds. So this sets out our priorities for the next four years and you can see there the seven strategic directions with the key deliverables core principles and enabling actions and we've developed this with extensive consultation both within and without. 

So for some of you who may have been at the health service summit in March and we certainly consulted deeply with participants in there and beyond and this will obviously be reported in our annual report and no doubt we'll take you a bit deeper in that as time goes by.  But let me sort of talk you through our guiding principles that underpin this.    So next slide please.    

So I think they're pretty self explanatory, very much driven by value. We do need to be prudent in our use of resources and ensure that we're spending wisely to deliver great health outcomes, very much centred around lived experience and making sure we do listen and respond to feedback from consumers that we partner with consumers families, carers and communities and clinicians and professionals such as yourselves and very focused on equity. So that we have a culturally safe and equitable health system and grounded in self-determination. Next slide please.    

But this just takes you into our strategic directions, so keeping people healthy and safe and communities. So basically that's about reducing harm. Early intervention and prevention, improving health literacy, providing care close to home, so how do we develop an integrated system and pathways investing enablers to deliver on that, support better management, chronic disease and so on.  

I don't want to take our eye off the future, so making sure we continue to improve and innovate and drive better outcomes, very focused on Aboriginal health and wellbeing and elevating the Aboriginal voice through legislation. Of new focus for us has been very much around moving from competition to collaboration.

You've heard we've got 81 health services who rightly so have been focused on their own determination and we want to find a system way to get better planning and design that will actually build on those partnerships and deliver better outcomes and integrated services and a key part of that is how do we have a stronger and much more sustainable health workforce certainly won't be lost on you.

I'm sure of some of the demands of recent years, but also the criticality of supporting our health workforce to be sustainable and fit for purpose into the future. And this is all in service of having a safe and sustainable health and wellbeing and care system. So being prudent about you know what we're spending making sure we're delivering care that matters when it matters in the right time.  And next slide please.

[Slide 10: Strategic Plan 2023-2027]

[Slide 11:Our guiding principles]

[Slide 12: Strategic Directions]

[Slide 13: Priority Outcomes Framework]

So I won't necessarily read through this. You'll get the deck, but this is very much connected to the delivery of the strategic plan. This is our outcomes framework and really shifting our way of thinking. I'm I might go to the next slide because I'm nearly at time.  

So I'll just very briefly touch on Commissioning System Improvement. That's the world that I play in. I'll jump straight to the next slide please.       

[Slide 14: Commissioning and System Improvement (organisation structure)]

[Slide 15: Role of Department and Role of Commissioning and System Improvement (CSI) ]

So we play a role, as I said, in setting the policy and strategy, oversight, commissioning, we often operationalise the capital funding that you realise that a health service level and working partnership with Safer Care around monitoring quality and safety and delivery of priorities. And you can see there how, CSI plays into that. So I think the I'm back to you now, Jo. So sorry to whiz through that at the end, but I'll go through the next bit no doubt through you.    

Jo Flynn - host:  Thanks. Louise.  So that was a whistle stop tour through the department of Health and its various roles and functions and importantly pointing to the new strategic plan for the department, which will be released in the not too distant future.

Just a couple of reminders, please feel free to put questions in the question and answer and I can see that we've got a couple already and we'll get to the questions at the end. And also, a reminder to people that the slides and a link to the video of the webinar will be circulated after the webinar.

So it'll give you time to come back to things that you may not have quite had time to look at closely or consider, as they went past.

So our next presentation is from Sarah Fischer, who's the Director of Culture and Capability at Safer Care Victoria and Sarah going to introduce the topic of clinical governance for health service board directors and then George Braitberg, who chairs the Quality and Safety Committee at Peter MacCallum, will talk about what it's like being on a quality and safety committee. Sarah.

Clinical governance overview - Ms Sarah Fischer, Director - Culture and Capability, Safety Branch, Safer Care Victoria

Sarah Fischer: Thank you. I was just waiting for my cue. Thanks very much, George. Hello, everybody. My name is Sarah Fischer. I'm the Director of Culture and Capability at Safer Care Victoria.    

A little bit about me, I'm an organisational psychologist by trade. I'm new to Victoria. Don't let the accent fool you.  I'm not new to Australia. I'm from the US originally but I moved to Australia in 2007 and my most recent appointment before it coming to Safer Care was at the Clinical Excellence Commission.

I was the lead organisational psychologist in the aptly named Capability and Culture team and it is an absolute pleasure to be working for the Victorian health community now.  

Clinical governance in terms of advisory, support and capability building and also ensuring the integrity of the Victorian clinical governance framework sits within my team and so I'm here kind of representing several different functions that are here to support board directors in this role. Glenn.

[Slide 16: Safe Care Victoria]

Just to share a little bit about Safer Care Victoria, our current aim and purpose although we are about to launch a revised version which I'm sure will come to you in your new roles, but at present it's to improve healthcare across Victoria so it is safer more effective in person centred which is aligned with the Victorian clinical governance framework.

And our purpose is to enable all health services deliver safe, high quality care and experiences for patients carers and staff and actually the tagline for my team culture and capability is about supporting health services to create the conditions for safe, reliable, high quality care. So we're all about leadership, we're about change leadership. So those are the I don't necessarily mean board an executive I'm talking about clinicians and clinical leaders or healthcare workers who want to make things safer or make things of greater quality in their local system. Glenn.

[Slide 17: Structure of Safe Care Victoria]

Our structure is as follows. So we've got four branches. They're not always called branches. We've got the Safety branch and my team is within Safety branch, not so super surprising given the subject matter of clinical governance.

We have the Improvement branch and their role is really about improvement programs for the system so that we can collectively improve things that matter to us all.    We have the Operations branch and they make sure Safer Care Victoria runs smoothly. And then we have the Clinical and Professional Leadership unit and that is where our chiefs all sit.

And so we've got several chief clinical roles, we've got a chief medical officer, a chief nursing midwifery officer, chief mental health nurse, chief paramedic, chief allied health officer and I think I've got everyone. We've also got some support, so a maternity advisor and a deputy chief mental health nurse as well and so they're extremely important for us in order to effectively engage with the system and it's clinical leaders.There's more I can say, but I'll leave it at there, Glenn.       

[Slide 18: Why are we here? From 2016 to 2021]

So Safer Care Victoria is actually quite a recent product, and it was I guess stood up as a result of the targeting zero review, which our Secretary who was the former Chief Executive Officer of Safer Care Victoria, was a part of and that review which I'm going to throw in the chat for you so you can access it in your own time or if Glenn and Melissa are able to email it out, that's also another option.    

So that review made recommendations on how to improve the safety and quality of care and one of those outcomes was the establishment of Safer Care Victoria.    

Another thing worth mentioning is that in 2021 the Victorian Auditors General Office completed a review of clinical governance and health services more broadly and so some of their recommendations were around setting clear clinical governance expectations, having an established culture of patient safety and understanding and responding to the quality and safety risks at board and executive levels which really gives my team a lot of rationale and motivation to do the work that we do so having the Victorian clinical governance framework working with organisations to assure that their local clinical governance framework and implementation plan is of high degree of quality.  We also do a lot of work in the team broadly around improving safety culture.

I don't have a lot of time to describe that, but if you attend our clinical governance induction which this will be provided for you at the end of the session, you can learn more about how we practically do that. And of course, understanding and responding to quality and safety risks at the board and executive levels which we do in partnership with our Department of Health colleagues either through the performance monitoring process or other means to respond to the system where need is required. Glenn.    

[Slide 19: Quote on slide]

Demystifying clinical governance is really important. Clinical governance is just corporate governance in a clinical organisation…it is important to remember your core business is delivering best care all the time…you don’t need to be a clinician to be a director - Ken Gray, Central Highlands Rural Health Board and member of SCV Applied Clinical Governance Working Group     

So  here is the quote. This just kind of really describes the what we're trying to achieve especially with our clinical governance induction program, this comes from one of our key faculty members that informed the design of something called the applied Clinical Governance Program which is a more sophisticated and stepped up skills acquisition type of development program that we offer to boards and executives.

Now that's not something that we offer standard to all like induction, it's something we offer based on need from organisations that either identify it or there has been a reason for us to come in and do and he says that “demystifying clinical governance is really important. Clinical governance is just corporate governance in a clinical organisation… it is important to remember your core business is delivering best care all of the time… you don't need to be a clinician to be a good director”.  Glenn.    

[Slide 20: Corporate governance and Clinical governance]

Corporate governance

• The system of rules, practices, processes, leadership and culture, by which an organisation is directed and monitored

Clinical governance

• The system of rules, practices, processes, leadership and culture that helps us to deliver safe healthcare

[End of Slide 20]

So it's very real statement he makes about clinical governance needing demystifying.  I don't think that I've ever worked in an org like either at the CC or here where clinical governance didn't need to be unpacked.  So sharing a little bit about it with you now about the difference between corporate and clinical, but I really recommend you coming to our clinical governance induction where we can explore this in greater depth. So corporate governance is really about the system of rules processes practices and leadership and culture.

So practices, processes, the things that we do in terms of what's mandated but leadership and culture is more that intangible thing around behavioural norms and values and that are what's being role modelled by which the organisation is generally directed and monitored and things like that fall under. corporate governance, our financial risk, human resources, legal and so forth.  

Clinical governance may be a part of corporate governance, but it is quite different, and it requires a different mindset and approach. But it's as critical, if not more critical than other, than financial governance, because and then we have a great quote in our applied clinical governance program that one of our faculty members talks about around how.

Board... I'm not gonna do it justice and so I probably shouldn't even say it, but something to the effect of “You hear about board members when there's and organisations when a harm has occurred, you don’t hear about so much when they haven't met their financial year targets, right?  So it's just something to keep in mind about what the importance of clinical governance truly is and so the clip.

So clinical governance. One phrase to describe it are the rules, practices, processes, the things that we do that have been mandated and the leadership in culture, those intangible things like our behaviours, our values, how leaders role model that helps us to deliver safe healthcare and I won't hide away from the fact that there are going to be times where your clinical governance and your corporate governance can be at odds and that's a challenge that all board directors must grapple with. Glenn

[Slide 21: Why does this matter?]

I've actually asked my team to look at to see if we can find some post COVID data to this effect because I really believe that the COVID pandemic probably has changed the landscape of this and I hope not for the worst, but it's possible so that is something I'm mindful of for other presentations, but as of 2019 prior to a global pandemic, patient harm was one of the ten leading causes of death and disability and while in hospital and this is so, it's sad to say, but it is. It's from the data, one in every patients is harmed and 50% of those incidents are indeed preventable and now this is worldwide.

We're not speaking about Australia here specifically.  15% of health spending is also on weight is wasted dealing with adverse events in terms of not necessarily focusing on the improvement, but the trying to understand and get to the root cause of what of what that's caused.  Glenn.

Motivating. I'm sure to hear to hear that.  So in order to assure that the Australian health system, and specifically the Victorian health system does not fall into the similar statistical pot of the rest of the world, what we are focused on is really helping board members to truly understand their roles and responsibilities and when you come to our other programs, we actually broaden this from just board members.  

But board members, CEO and executive and that's because those three cohorts of people have a shared clinical governance leadership responsibility.  It isn't just board members where members are ultimately accountable but it is a shared responsibility, and that group of people need to work together as solid team in order to assure good clinical governance across the organisation.

But I'm gonna speak to you specifically about board members or roles and responsibilities by virtue of why you are here.

[Slide 22: Board Member’ Roles and Responsibilities]

One of the main ones is to lead and model a supportive transparent just culture. That is, it's all    health service staff to provide high quality care and continuously improve. If you leave here from this knowing one thing, the safety culture of your organisation is so incredibly important.

Safety culture is local.  It is influenced by the way in which you lead your organisation, but you're not the only leaders that it influenced that influence. It actually goes right down to the individual ward, their team members and the team leader of that ward.

Now the team leader, that ward will model their behaviour on the leader above them and so forth and so forth, which is why we say it's critical at the very top board members, but it is pervasive. It is very local. So monitoring the safety culture of your health care organisation is going to give you one of the best predictive instruments of whether harm will occur. If you see your safety culture starting to dip that's when you know you're gonna have problems. 

You don't want to wait until it's been low for a while for when harm to occur, so that's a tip for me to you and we can talk about that more in our other programs that we run at the at Safer Care Victoria. Also, another important responsibility is to ensure that the organisation's operations and resource allocation decisions remain aligned to its purpose and strategy, which is safe, effective, and person centred care for your community.

Now that's when I said earlier, before there are going to be times where corporate governance and clinical governance are going to be at odds.

This is what we're talking about. This is getting to the heart of it and so the job is hard.  I don't shy away from, but it is the job to be done and further to understand the Victorian clinical governance framework and its concepts under the five clinical governance domains which our leadership and culture, consumer partnerships, workforce, risk management, clinical practice, you can read the document but and I think I actually have a link, no I don't have it here. I will make sure that it gets sent out with the notes.  But if you come to our other programs, it will help you to understand what those phrases practically look like in terms of your leadership role. Glenn.    

[Slide 23: Australian Commission onj Safety and Quality in Health Care]

We're not the only ones that care about this. There's also the Australian Commission on Safety and Quality and Healthcare. Clinical governance is standard one, hospitals are accredited, meaning they're allowed to operate by virtue, whether they pass an assessment of all the of all, the standards, clinical governance being the first and what I would consider probably most important.  

Now that has shifted over time of how accreditation occurs and I don't have time to go through it in great depth, but that is something to become quite aware of and I can see Jo typing, so that's telling me I am behind time. Glenn, let's move on to the next bit.

[Slide 24: Most important role is to ask questions about organisational culture, e.g. ways of working, norms and behaviours]

• Does everyone understand the importance of patient safety?  
• Are we actively encouraging reporting of incidents? 
• Do we learn from patient safety incidents? 
• Are we actively implementing recommendations and taking action from safety signals? 
• Do we really have an open and fair culture? 
• Do we get the right information? 
• Are we always open when things go wrong? 

[End of Slide 24]

So we won't, I won't go through these now, but this is for you, for later. These are some really critical questions for you to ask as board members of your organisation and of your CEO. If you're asking these questions and getting the information, you know you're gonna know that you're doing your clinical governance role correctly so I suggest you read that in due course. Glenn.       

[Slide 25: Information for the board ]

1. Monitor: How safe are we?

How do we know?

• Board reports
• Benchmarks

2. Detect

• Trends
• Variation
• Astronomical

3. Respond

• What's happening in the system?
• How can we intervene to improve?

[End of Slide 25]

Some of the ways in which you can determine the safety of your organisation. We give you some ideas here around what to monitor, how, what to look for, and how to respond are other programs go through this in greater detail. Highly recommend you join, Glenn.      

[Slide 26: Essential reading]

Essential reading:

Delivering high quality healthcare- Victorian Clinical governance framework, Safer Care Victoria, June 2017. Accessed online: 15 September 2023 https://www.safercare.vic.gov.au/sites/default/files/2018-02/Safer Care Victoria Delivering highquality healthcare June (10).pdf

White paper - Framework for Effective Board Governance of Health System Quality, Institute for Healthcare Improvement, 2018. Accessed online 15 September 2023 https://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Effective-Board-Governance-Health-System-Quality.aspx

[End of Slide 26]

Here it is essential reading, so our Victorian clinical governance framework is something we don't know the link. I think it will get shared, but also the framework for effective board governance of health system quality is a worth, is a worthy read. Bear in mind though it is written for a North American audience, and we have a much different model which is highly privatised. So just read it with a grain of salt. This is a public system more so.  

OK, and the last thing I'm going to say is that please, which I said at length, so I'm not gonna say it again here, Glenn, sorry in advance to the next slide, just to say about the other programs that we have, we will be in touch, a link will be shared. Thank you so much for your time and I'm happy to answer any of your questions at the end. I will hand back to Jo.

[Slide 27: Next Steps]

Attend the SCV Board and Executive Clinical Governance Induction

• 2–3-hour virtual facilitated sessions held between August – November 2023
  • Victoria’s Clinical Governance Framework.
  • Data interpretation.
  • Case studies.
  • Your role and responsibilities.

email: culture.capability@safercare.vic.gov.au

We will contact you shortly.

[End of Slide27]

Jo Flynn - host: Thanks, Sarah and just Sarah has referred to the clinical governance training, but it's a really important part of induction to health services and there is an expectation that all directors will participate in that training and Safer Care Victoria has a responsibility to make sure that training is delivered in a way that can be accessed by everyone.  

To take what Sarah was saying down to the level of how it operates within a health service I'd like to hand over now to George Braitberg.

George is an emergency physician who's had a long history in clinical governance.  He's currently on the Boards Ministerial Advisory Committee and on the board of Peter MacCallum, where he chairs the Quality and Safety Committee. George.

Quality and safety for board directors - Professor George Braitberg AM, Chair Quality and Safety Subcommittee, Peter Mac

George Braitberg:  Thanks, Jo, and welcome everyone. I am gonna try and take a lot of what Sarah said and break it down into a sort of more practical framework for those that are going to be on the board, but particularly those that are going to be on the Quality and Safety committee of the organisation to which you are directors of and my background is an emergency physician and toxicologist and admitted medical administrator.

But I also wanna make the point too that doctors or clinicians are not necessarily experts in clinical governance, and you don't need to be adopted to chair a Quality and Safety committee. When I was an executive at another hospital, I, the chair of our Quality and Safety committee was an audit and risk person. So, it.    doesn't mean that you need to be a clinician next slide please.    

[Slide 28: The boards’ role]

The board is ultimately accountable for the clinical governance system and

the clinical care provided by the organisation.

The Board Quality Committee is a formal Committee of the Board established in accordance with section 65S of the Health Services Act 1988 (Vic) to facilitate the discharge of this duty on behalf of the Board.

[End of Slide 28]

So as we've said, the board is ultimately accountable for clinical governance systems. The Quality Committee is a formal committee of the board that's established under the Health Services Act and the role is an oversight one. It's to provide the organisation with a way they can prioritise the way they look at quality and safety, how they can embed quality and safety practices, build confidence in the organisation and its executive. Enable the organisation to increase its safety and quality of care and analyse and respond, but added oversight level not an operational level. We'll talk about that in a moment. Next slide please.    

[Slide 29 -duplicate of Slide 25]

You just saw this slide from Sarah and the only thing I wanna do is highlight what I've highlighted there which is trends. I think being able to look at how things change is a really important role of the board in its oversight role to be actually looking at trends is important and I'll talk a little bit more about that specifically, when I look at some of the, we look at some of the reports that you might see and report Quality and Safety committee. Next slide please Glenn.

So, I went back and looked at some terms of references of a number of different quality and safety so it doesn't reflect any particular organisation and I took out some of the things which I think are really important.

[Slide 30 – Quality Committee Terms of Reference – should be aspirational but achievable]

One is to set a level aspiration for the organisation and ensure that you incorporate the consumer experience in that.  It's always good to be setting standards and you wanna make sure that you're clear about what those standards are in an operational and here and now sense but also what are you aspiring for and that should be within your strategic plan as well. You need to ensure that they are effective and accountable systems to monitor and improve quality and effectiveness. You also want to make sure that you, while you're doing that, you're reducing risks you are compliant with the relevant laws, regulations, standards and codes and that you're embedding continuous improvement innovation and evaluation metrics in what you are monitoring.  

So not just about what we're doing, but how we're improving. You're ensuring that your organisation is external or accreditation ready, particularly in an era where there are short notice, accreditation inspections by the Commission and you wanna ensure that any systemic problems identified with the quality has been identified or addressed in organisational level as well. Next slide please.    

[Slide 31 – Terms of Reference (TOR)]

So essentially, as I said, the terms of reference should reflect the strategic aims of the organisation. Should always include terms of appointment, should include meeting frequency, should include evaluation process and a time in which you're going to review the terms of reference, and this is of course nothing new to anyone who's been on any committees, next slide.

[Slide 32: Membership]

And again, I've drawn this from a number of different committees that I've been involved with over time.

The chair of the committee is a board director. There's usually at least one other board director as a sitting member of the committee, the Chief Executive Officer is there or their deputy when absent, the Chief Operating Officer.  

If there's an Executive Director of Quality or Chief Medical Officer or Chief Nursing Officer who have that portfolio in their own right. There may be a Director of Quality and Safety as well and Director of Allied Health or divisional directors, however, the organisation is structured, where you've got most medical senior medical and senior nursing representation. 

In the committee, as well as a consumer or a number of consumer representatives and sometimes particularly if there's a smaller public hospital, you might have an external expert appointed to provide an independent perspective. Depending on the size of your organisation, not all of these positions will be separate, they might be rolled into one or two other positions. Thank you, next slide.    

[Slide 33: What do you cover in Board Quality Committee?”]

And again, I've structured a sort of agenda for us. I'm a big advocate of hearing a patient story, whether it's by a patient, video of a patient presenting their own story, whether it's a frontline healthcare worker presenting a story of about a patient, whether it's a negative outcome that we need to learn from, whether it's a positive outcome that we can celebrate.

I think setting the tone of the meeting with the patient story is really an important thing because it brings everyone back to the tables to why we're meeting. Reflecting the quality Committee work plan, which is usually an annual plan that has been set up previously, going through the quality and safety report and here it's about KPIs and it has to be at a monitoring level from the board. It's not 200 KPIs it needs to be those KPIs which are thought to be important and relevant to the operator to the work of the board and be presented in a way in which those trends I mentioned before identified.

They can be mapped back to accreditation standards, they might be mapped back to the clinical governance framework domains that we just heard about, the leadership and culture risk management, clinical practice, consumer engagement, all of those things.

So, in some ways what you will do with your executive is you'll organise the themes or the headings under which those KPIs are going to be presented, so they're more meaningful and easier to work through.

You'll always look at adverse events, serious adverse patient safety events. You look at the high level summary, the recommendations and look at how those recommendations are being implemented, looking at trend analysis, do you have a particular problem with incidence of one type and similarly with feedback from patients, looking at complex complaints and looking at trends benchmarking with the Victorian Healthcare Survey, experience surveys or any other internal patient surveys that you send out.  

Many organisations do this now electronically such as when you're leaving a hotel, you often get a text with a couple of questions to answer.  Very, very importantly showcase improvement, innovation. Sarah said that we often only hear about things when harm has occurred and it's really the remit of the Quality and Safety Committee to showcase improvement and innovation and to celebrate success of your organisation. So always make time for the positives in my opinion. Next slide please.  

And then going back into the things you do need to look at as a clinical risk register and risk management, making sure that you are looking at those implementation records of recommendations, particularly those who have been very high level incidences looking at clinical processes.

This is an opportunity for your clinical teams to present what they've been doing and for the board to be able to recognise that, but also importantly for the clinicians to know that they've got an ear to the board and it's a really, again an interesting way to hear about what your clinicians feel and looking at benchmark reports.

So VAHI, we heard about they produced the PRISM and Monitor report and it's an opportunity to see how your organisation is benchmarked against others that you consider in your category and always consider recommendations and reports regarding workforce requirements related to quality and safety. We need to always be mindful, particularly post COVID about our workforce welfare. Next slide please.    

[Slide 34: Quality and Safety Simmary Data – Hospital A]

So here I'm just gonna finish off with some ways data can present, be presented.  These are some hospital acquired complication data.  It's good to get the indicator, it's good to get the descriptor. It's good to get a summary of the event side of the rate per 10,000, or thousand presentations, a comparison to the previous month, the comparison to the previous year and then an average rate and in a nice, I like nice graphs that show me things are either getting better or worse so, with how you do that is up to how you work with your business intelligence people and your executive.

But here you can clearly see some green and you can here some see some red and all ready brings your attention to what the reds are gonna be about. Next slide please.    

[Slide 35: Trends and targets are important – Hospital B]

Another way I look at data which I really like it’s taken for another organisation is looking at mentioned trends. I think several times but looking at a data point and here you can see that where there's a shift, you get diamonds when it's a sustained squares gets a trend and if it's moving the dial, it becomes a shift.  

So, I think, there are the shift and trend and I think there are ways in which data can be presented, so it's much more succinct and you can also see where the median target is as well as where you want to be aspirationally. Next slide please.

[Slide 36: Example from the Monitor Report – Benchmarking]

And this is taken from one of the VAHI reports and as you can see it's benchmarked against your hospital and your statewide other comparable hospitals. Next slide please.    

[Slide 37: How it works]

So I think how it works pragmatically you set up an agreed means of communication, ensuring your board, chair and CEO are informed you meet with your key reporting executive either face to face or virtual to create the work plan and mapping it back to the strategic outcomes. Your exec usually prefers a draft agenda for you which you work with, you then look at the papers to be sent around a week before the meeting.

That's an opportunity for you to question and clarify anything you don't want to ambush your executives at the meeting table. You should always have those discussions beforehand and allow the executive time to prepare the response. As I said, the board monitor sets up expectations, directs the exec when needed, but it's not micromanagement and shouldn't get involved in operational issues unless there's a real crisis. Next slide, please.

[Slide 37: Conclusions]

It's a privilege to be on board quality committee. The committee has a significant amount of interaction with clinicians, which I think is fantastic and the clinicians but again, a clinical background, they really appreciated it's about, as Sarah said, the business of safe, timely, effective person centred care. It should be used to highlight innovation and best practice and celebrate the work that teams doing.

Increasingly we'll need to have a lens on self/staff welfare as it impacts on care delivery and it is important role because you're ensuring the organisation is accreditation ready or you're making sure the executive are ensuring that your organisation is accreditation ready and I think that's my time and I thank you for your listening.

Jo Flynn - host: Thanks very much, George and our final presentation will come to in a moment is Robynne Cooke.   

Robynne is a director at Northeast Healthcare Wangaratta but she's also the Chief Operating Officer at Mercy Health and she's just done her first 12 months on health service board.

Just a couple of reminders though, we will circulate the slides, we will circulate a link to the webinar, but if you've got some more questions, please put them up in the Q&A now please rate those that you're most interested in so we can make sure that we deal with those and we'll have about 15 minutes of question and answers after Robynne’s presentation. Over to you, Robynne.    

New Board Director Perspective - Ms Robynne Cooke, Director, Northeast Health Wangaratta Board

Robynne Cooke: Thanks, Jo and I would also just like to acknowledge the traditional owners of the land on which we meet today and I'm just plugging in my laptop.  Sorry but I can go to the first slide, we can multitask.

[Slide 38: Tips and hints]

So, some tips and from my perspective knowing that I'm a nurse by background and also I work in health, and there are some advantages and disadvantages for that being on a health board.  

Prior to starting and picking up what Jo said a number of you haven't had a board meeting yet. Excuse me. There are all sorts of plans that you can access. 

There's the board strategic plan, the health services strategic plan, there's quality plans.  There's a reconciliation plan.  There's minutes and annual reports and there's obviously capital plans, bear with me.  As part of your orientation please get some time to meet the executive.  You should have some formal time to do that.

They need to get to understand your skill set, but equally you can understand and connect with the executive, including the CEO. You need to meet with other board members as well, once again connecting it may take you a few meetings to get into a rhythm.  With other board members, especially if you're the newbie on in the block and they've been there for a number of years.  You need to get, just keep a sense of your skill set against their skill set. I'm not into detail, but some of the best board meetings I've had of late have been with other board members who look at every dot point so, it's a real bit of a team effort. 

Some health services have multiple sites and you'll get a sense that those multiple sites also have different cultures and it's really good to get out and feel the health services. Consideration where you need a board buddy for a while and my advice is to get a bit of a history lesson on the last 12-18 months where there's been Safer Care Victoria reviews, whether there's been independent audit reviews and if there's some action plans and work plans in that space.    Next slide please.    

[Slide 39: Commit]

It's a real commitment to be on a board and you know you have to commit. I in my Wangaratta board, I get up there for every second board meeting and I feel that is the respect that the community deserves from me being on the board and I get to understand the community a bit more. 

But in the orientation phase you can Zoom, obviously, but face to face is really important. 

George highlighted something about the papers, you need to commit to reading, reading the papers.  George used the word ambush, not in the Wangaratta board but in a previous board in New South Wales it was a bit bumpy.  I had a bumpy board meeting where I felt that I wasn't quite prepared and I didn't go through the process of asking those questions and I asked them at the board meeting and I do feel the executive at the time was slightly ambushed. So being a little bit mindful of that.  

In health, we talk a language that is not out there.  We talk in acronyms, so you actually need to get the board to or the board secretary to give you a health dictionary. So, we talk about NWAU we talk about HITH/RHIF and all sorts of things TACP things that you actually need to understand because they will be in the board papers.

So please if you don't understand those acronyms, put your hand up. Board document system so, Wangaratta we use Convene so you may get used to a different system and that's really good for asking questions throughout when you get to first get the board papers and then those questions can be published, publicised to all the other board members. So there are some good tools out there to help with that.    

I think being active is really important too not just there to warm the seat.  Annual general meetings. Getting out going to care first rounds, which is where the board walks through the organisation and the one that I've been on at Wangaratta, have been really enlightening and the staff actually liked to see board members. 

There will be in camera sessions and that's where the majority of the executive step out and I think you really do need to understand the risk and risk appetite of the board and you know there will be risk sessions that you will be involved in. Next slide. Thank you.    

[Slide 40: Your Development]

Your development.  I have a professional coach. For that board meeting few years back which was a bit bumpy, I reached out to another board member just to step me through some of the learnings for me.  

Education sessions like this are really important and they should be ongoing and I noticed that there are probably a few board members who have come back into this for a refresh. You have to be a bit like a bit of a sponge. You have been recruited for your skill set to complement other board members and the executive.  So, in the beginning it is absorbing and touching and feeling that safety culture as well.

Formal governance courses are great and I don't think you should ever lose sight of why you were there and that's all around safe care and improving the patient experience and sometimes we tend to get, lose sight of that and George reinforced patient story at the beginning of the board meetings, keeps us grounded as board directors. Next slide. Thanks.

[Slide 41: Pitfalls to avoid]

Some pitfalls you are not the CEO or any member of the executive, and it has been a challenge for me, I must say, because I know all things about health.  

I run organisations so my swim line is very much in that strategic space although in other organisations I've worked in the board have Linked in and George mentioned when there's a crisis, but you know gotta keep everybody in their swim lane. 

I think you need to understand the roles, the board chair is really important. That is the gateway to the CEO and it does get confusing when multiple board members then go to the CEO directly and not at Wangaratta but in another board I was in, I think the CEO was on speed dial for the all the other board members and it just creates a little bit of confusion and it does challenge that governance.   

Need to check in and so, I if I've got a question for the CEO about something, then I will obviously check in with the board chair as that link and that's really important. So understanding those roles is really critical. 

If you end up on a board subcommittee, not everybody can chair a meeting, so you know I think that's really important and sometimes you may have to coach other board members on how to chair a meeting and have those structures.  

Silence does not equal agreement. So, you have to be active, and if you don't agree with a recommendation then you obviously need to talk it through because it will be minuted that all board members agreed with a recommendation. 

And I have my Wangaratta board all separate to my Mercy board and that's so I don't have the two worlds colliding. So, I actually have a separate diary. I have a separate file.

Everything's different just so I can keep the work world not colliding with the board world.  Some people can manage multiple things in their diary, it's just not how my brain works. So I've kept everything as separate as I can. Next slide. Thanks.

[Slide 42: Sub committees]

The subcommittees are really important.  I'm on three at Wangaratta.    

You can't be on all there is a nomination process that probably will occur in July and/or August.  Once again, you can go through the board chair or the board chair will ask you what committees you would prefer to be on.  The heavy lifting does happen in the board subcommittees. It is where you know that very in depth discussions do occur and then it is the role of the board subcommittee chair to then take that feedback to the board meeting, talk to the papers talk to the summary however it is set up in the board. 

You can be an observer for other board subcommittees, everyone seems to like to be on the Finance Committee.  But, you can be an observer, but once again you need to get some support from the board chair and in the beginning you may want to go into some of the subcommittees just to get a sense of what some of the discussion is about.  You can't be on all of them and what comes back to the board, then we'll be that consistent documentation agendas and minutes. 

If you feel like at the board committee that you are not getting the information from the board subcommittees then that may be a bit of a red flag and once again you know seek some advice from the board chair. Next slide. Thanks.

[Slide 43: Feedback]

Feedback’s really important, I check in with the board chair. I've had a formal meeting with the board chair and just about how I was going, obviously you need to be involved in the evaluation of the board and the board subcommittees.  

Now things can go wrong and some of the things that you need to be aware of is around governance and policies not being followed, quality and safety agenda as George highlighted.  

There's red flags written all over that, finance, yes and my advice also is look at detail at procurement and also leases, in either the audit and risk papers or the board finance or the board subcommittee in finance and do your due diligence and you'll have a good time. Thanks, Jo, back to you. Thanks everybody.

Jo Flynn - host: Oops. One of us had to start with us on mute. Thanks very much, Robynne.  We've got quite    a few questions. I'm just gonna run through a couple of them quickly to start and then I'll pass some of them onto my colleagues.

So, just for a bit more background I'm on the, currently, as I said, I chair the Boards Ministerial Advisory Committee, but I'm on the board of Ambulance Victoria, I chaired the board of Eastern Health for ten years. I've been on the board of Forensicare.

So just the last question that the most recent question that's there is. If you have queries on the board papers prior to the meeting, is it preferable to table them with the chair or the executive?

It's really important in your board that you have an agreement about how those things work, normally speaking you would direct your questions through the chair, but some boards have a process where you would direct them to the board secretary, CC to the chair, but as Robynne was saying, there needs to be some discipline around that otherwise we're creating a lot of work for the executive team, so first port of call really is through the chair. 

There was a question about directors and officers insurance which or are we insured for our roles, which Glenn put answer up.  So, our entities hold insurance with the Victorian Managed Insurance, whatever the A stands for association anyway.  That covers all actions taken by board directors and other responsible officers in the organisation providing those actions were undertaken in good faith so that reminds us of the need, as I said at the beginning, to act with integrity and in the interests of our organisations. 

But we will cover legal responsibilities more fully in the second webinar in this series and the third question that I wanted to just come to was in relation to the board's responsibilities in occupational health and safety.

So, George put up a comment there about the important role of the Quality and Safety Committee and ensuring that we have oversight at that level of occupational violence and aggression. But most health services also have a people and culture committee. They have, we have as entities as employers, enormous responsibilities for making sure that we have created, maintain a safe workplace for our employees and as well as that, we need to be concerned about their health and wellbeing and you certainly can't deliver a good health service if you don't have staff who are supported and safe at work and have the resources they need to do their jobs.

Now I'm gonna come to you, George, with two questions about Quality and Safety Committees.

One is about needing registered clinician on the committee and one is about the role of the community and engaging with the community and having community reps on the Quality and Safety Committee.

George Braitberg: Thanks Jo. To the first, as I said, and I did make the point specifically because I am a clinician that I don't think you need to have the chair of the Quality Committee being a clinician.  But I do think that it's usual practice.

If you have a registered clinician on the board that they are in the subcommittee, the Quality and Safety subcommittee, not necessarily the chair, but are a member of that committee.  In as much as sometimes being a clinician helps with the language that Robynne spoke about and also to just help with follow up any of the concerns might be raised through any of the incidents that are being reviewed.  

So, I think it does help and also interpretation of some of the KPIs.  In terms of a community member and there's often some consumer confusion about consumer and community members.  

If it's a community member, it's that person is there because they're representing the community that the hospital and the board serves and I think it is important that input is there and similarly, if it's a consumer rep, it's important that I think someone who has been at the end of treatment provided by that organisation has a way in which they can feed into the way the organisation manages its quality and safety agenda.  

Now that can be through a consumer advisory committee or community advisory committee.  But I think as we are maturing along the journey and if we look at the domains of the clinical governance framework as it has been up until now, consumer partnership is very much part of one of those foundational domains and I think we are moving to a state where we should be normalizing having consumers on a quality and safety committee.    

Jo Flynn - host: Thanks, George, and I have also chaired a couple of Quality and Safety committees and it's certainly a normal expectation that you would have community members on the committee how they're selected is something that varies, but it's quite common to have crossover membership with your community advisory committee.  

But it's really important that the Quality and Safety committee hear, the voice of the community in considering what's safe. 

I just want to also come to the question about Board walk throughs. Again, this is something that needs to be organised. 

So, we're not actually talking about people just turning up at the health service and having a wander around but talking about structured visits that may happen with one board member and a member of the staff or may happen with the whole board having a whole board, troop through your emergency department or some other section of the hospital is a bit intimidating, but a fairly common practice for the hospitals that have a health services that have multiple sites is to have a board meeting in it in a different site on a rotation basis and then organise some kind of a tour or interaction or a morning tea with the staff where there can be some free mixing and conversation and people can as we're saying, get a bit of a feel for what's it like on the ground.  

Coming to you, Louise, there was a question about, a little bit more about what the Commissioning and System Improvement division does and anything else that you'd like to have a comment, to make a comment on that we've discussed so far.

Louise McKinlay: Thank you, hard to cover in a short space of time because it is so big.  So broadly speaking, we've got sort of five streams.

We have our commissioning and performance stream, which is essentially the main interface with your organisations.  So there are performance teams based within regions and coordinated centrally and they organise the quarterly performance meetings, day-to-day conversations with your executives and staff around operational and performance issues, incidents, media queries so on and so forth.

So, they also have some statewide portfolios such as HealthShare Victoria and they play a big role in this and so many of them my team are on this call behind the scenes and then I have a second stream which is very much around policy and program management. So things like cancer, dental, public IVF, end of life care, child health and so on.  

So as I said, literally cradle to the grave. So that involves us either setting a policy direction and implementing it, improving policy and or funding services to deliver pieces of work such as Dental Health Services Victoria, community organisations.  

Then I have a stream that's very much around the funding policy. So sets the policy and funding guidance works on setting up statements of priorities, works with your CFOs around financial planning improvements etcetera and advises government on same as well as linking in with the Commonwealth and then we've got a couple of sort of priority programs around timely emergency care.

So looking at AV ED demand, surgery recovery and reform so looking at planned surgery and making sure we treat people on time and also think about how we reform the way we do surgery into the future.

And then we have Digital Health. So that's all things electronic, medical records, cyber security, virtual telehealth and much, much more so that's kind of it in a very quick response.  

Jo Flynn - host: Thanks Louise.  Just another comment to make about face to face versus distance versus hybrid board meetings.

Of course, practice has changed enormously over the last three years, and we've all learned that we can run pretty successful hybrid meetings or virtual meetings.

Nonetheless, there are very strong reasons why, as a as part of the governing body, the board of a health service, we need to be physically present some of the time, and there's a new policy just being endorsed or recommended by the by our committee board, BMAC in relation to what the expectation should be now it's, we're in a bit of a transition time, but increasingly I think there will be quite clear expectations that people are at board meetings face to face for some of the time.  

What that actually turns out to whether every second meetings are a virtual meeting is something that needs to be resolved, but it does need actual physical presence.

The other thing is because of the state of COVID because we now don't turn up to work any longer when we've got sniffles and coughs, often, even if you're planning to have a face-to-face meeting, you need to allow provision for some people to participate remotely. And so even in the best will in the world, people are intending to be at the meeting face to face, it turns out that that's actually not the best thing for them to do and so.  As I said, provision needs to be made for some people to be able to join remotely.  

I'm going to just check for any last comments from Robynne and Sarah, and we're gonna wind up with a couple of closing remarks in a minute, but there is a question there about opportunities to observe other board meetings.

There are actually issues, board meetings are confidential and it's not normal practice for people to sit in on board meetings of other board meeting other organisations. 

It is normal practice though within an entity for people to sit as observers, as Robynne said on other committees just to get a feel for what they do and what sort of agendas that they have.

So while observership programs are coming in more broadly in governance, they're not as yet something that's being embraced in this sector because of the confidential nature of the materials that are being considered. 

Robynne, any comment about anything that you'd like to add as you can concluding remarks over to you? 

Robynne Cooke: No, thanks Jo. I think you get out of the board role as much as you put into it.  I would, that's would be my you know you put the effort and you know it reaps the rewards. And enjoy everyone, it really is a great experience to be part of.  Thanks Jo.

Jo Flynn- host:  Thanks very much, Robynne and to you, Sarah, any final comments?

Sarah Fischer: No. Only to say that I hope to see you all again, either in one of our programs or for another positive reason in terms of an interaction with Safer Care Victoria, thank you.

Jo Flynn- host: Thanks very much. So we've come to the end of our webinar. As I said at the beginning, we recognise that there was a lot of content. We hope that that's been helpful to you and that the resources that we've indicated here are things that you will be able to follow up and you will receive those by email shortly including a link to some of the documents and we've provided just here in the slides, which you will, as I said receive a link to particular resources that are really important.  

[Slide 44: Resources for board directors]

• Victorian Public Sector Commission: The commission promotes high standards of governance, accountability and performance for Victorian public entities, including health service. Resources are available at: https://vpsc.vic.gov.au/governance/
• The Directors’ Toolkit: The toolkit provides essential information on the public health sector environment.
• The Integrity Governance Framework: The integrity governance framework and better practice assessment and reporting tool are resources to assist Victorian public health services in assessing their integrity risks. Available at: Integrity governance framework and assessment tool resources

I also want to just reassure you we're absolutely cognizant for those of you who have just started, this is your first month. You've got lots of questions. You're not on your own.  You're one of a collective on the board and you're in a system which is actually pretty well managed and run and as Louise said at the beginning, provides a really good service to the community of Victoria.  

On the whole, it's also all our wish though, that we do better than we currently do, that we provide the best service in the world and that all of our staff are happy that all of our patients get good care and that's often how it plays out. But sometimes things go wrong and we need to admit that and learn from it. So just to highlight for you the coming webinars.    

There's session on the, if we could move to the next slide on the 15th of August at the same time on organisational culture leadership and legal responsibilities and then on the 20th of September accountability, funding and risk management.

[Slide 45: Future Sessions]

• Session 2: Organisational culture, leadership and legal responsibilities
  • Tuesday 15 August 2023, 4:00 – 5:15pm
• Session 3: Accountability, funding and Risk Management
  • Wednesday 20 September 2023, 4:00 – 5:15pm

[End of Slide 45]

So some of those things that you've asked questions about beyond the sort of broad health system structure and clinical governance which is what we've intended to cover today, will be picked up in those.  

So there's also a couple of questions that have just come in about can you rely on the board secretary to send stuff out to you that you need to read absolutely, but equally all of you, I would encourage to if you haven't already, to look at the health service website for the health service you're going to, you've probably done that already, but read the current strategic plan, get to know a bit of background about who's who.  

You’re, the more you know the better placed you are, the better more context you have to interpret what's happening in front of you. And a few people said this, but I'd like to reiterate being on the board of a health service is a really challenging, interesting and stimulating thing.

You're working with a group of people from a range of disciplines different disciplines, something many of us, in whatever the our substantive professional career has been, have less chance to do. People who are there motivated to deliver the best healthcare they can for their community.

So, again, to echo what the Minister said, thank you very much for being on prepared to take on the role, I hope you find it stimulating and enjoyable and please reach out to your colleagues on the board to people on other boards, to the people in the department who's contact details you know if you want particular advice about something or support, we're really all in a system designed to help and support each other so please enjoy your evening and look forward to meeting you again in a month's time.  

Thank you.

[End transcript]