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The Need Of Governance?

Demand for a continuous mode of strategic innovations that meet

recent trends and assure quality of care delivery as well as sustaining
businesses along with a closely followed path to stakeholder

Growing consumer awareness and patient demands for easy and

prompt access, higher quality services and opportunities of second
opinions and selection, regulatory, statutory and political influences.

Meaning of Governance

World Bank defines governance as: 'exercise of political power to

manage a national affairs. 'The management faculty also places
considerable emphasis on governance.

Management gurus like Jeffrey P and Henry Mintzberg said,

organisations are more than just systems for coordinating and
supervising work: they are also systems for determining goals, coping
with conflict and allocating costs as well as benefits.

WHO research study publications on public hospitals; it is stated that

the term 'hospital governance' emphasises on a set of discrete
processes and tools and its effective utilisation.

Current issues and challenges

Some of the commonly cited system failures are:




monitoring of policy implementation


record keeping



A recent study states that the third most frequent cause of death in
Britain after cancer and heart disease. This may be a study outcome only
for the UK. In India, this kind of study outcome is not an updated
declaration as yet.

Loss of trust of investors.

Current issues and


Good governance is at the heart of investment decisions; a research

survey analysed that 75 per cent of stakeholders are ready to pay a
premium for higher good governance standards.

Investors are not willing to invest in organisations that are not build on
inclusive growth models, are corrupt, prone to fraud, poorly managed
and lacking sufficient protection for relevant stakeholders and lack of
compliance on business and human rights agenda.

Scope of hospital good


The efficient use of resources

Establishing the trust of investors

Economic development

Good governance performance

Socially responsible citizenship

Business excellence

Regulatory Compliance

Stakeholder satisfaction

Risk management and sustainability


Hospital good governance


Operates in line with fundamental principles of transparency, integrity and


Provide high quality healthcare

How the organisation is led and structured

Organisations objectives are delivered economically, efficiently and


Protecting interests of both the individual and the organisation.

Protecting staff against any possible accusation that they acted


Promote stakeholder satisfaction organisation wide.

The five key elements of hospital

good governance


Fairness and ethics




Benefits of hospital good

governance practices

Facilitates the successful implementation of important strategies

Leads to better accountability and transparency

Prevents managers from making wrong strategic decisions.

What is the approach to Hospital

Good Governance

The approach has to be simple

It has to be applicable and has to be uniform yet unique for each

organisation as per the policy of the said organisation.

Therefore identifying this need a Code Of Conduct (COCHO) is

developed to cater to the needs of Hospital Good Governance best
suited to Indian set up.

Code of conduct

Code of conduct is a voluntary framework of guidelines outlining the

responsibilities of or proper practices for an individual, party or


COCHO is a derived set of code of conduct for hospital organisations,

evolved from research data based on best practices in Hospital
Governance and the industry set up.

COCHO framework is based on four sustainability pillars in terms of

four Ps:








Benefits of implementing COCHO

Ensures adherence to statutory and other regulatory compliance

Inculcates safety systems and practices.

Inculcates a 'responsible' organisational behaviour.

Establishes fair and sustainable practices recognition and thereby build

enhanced brand value.

Gains trusts amongst stakeholders, funders and investors

Evolves to a sustainable programme, organisation wide on a continual

improvement basis.

Encourages inclusive growth models.

Examples of good governing


There should be constant supply and availability of blood and other required

Medicines should be approved by the hospital association

There should be constant availability of doctors

PHI should not be shared to anyone without patients permission.

Electronic machinery of hospitals should be checked and maintained


Nurses should be available 24x7

They should know the details of the patients allotted and their medicine


Disposal mechanism for used syringes should be Implemented

Medicines should be checked regularly for expiration date.

@4x7 power supply with adequate power backup.

Healthcares Information Assets:

Digital, Physical and Metadata

Legal health records and other personally identifiable patient data

Personal health records

Aggregate patient data

Claims and business operations data

Registries and quality measures data

Case and care management

Risk and safety data

Research data

Reportable vital and public health data

Ways Hospitals Should can

maintain good governance

Become familiar with audit protocol. Hospitals need to be familiar with

the audit protocol

Update the risk analysis. A thorough risk analysis involves outlining the
risk needs of the hospital, collecting data to understand the flow of
personal health information across the hospital, identifying and
documenting potential threats and vulnerabilities, assessing current
security measures and determining the likelihood of threat occurrence.

Information should be managed as a strategic asset. information is

an asset of the healthcare organization. Like other assets, information has
strategic and operational value. It is no longer simply a derivative of the
work process.


Governance is integral to optimized information use and value.

Information governance is the formalization of the assignment of
responsibility for setting the organizations information policy
framework and ensures that its policy is to optimize, secure and
leverage information as an enterprise asset.

Some examples of Governance in

There should be constant supply and availability of blood and other required
Medicines should be approved by the hospital association
There should be constant availability of doctors
There should be standard procedure for recording of PHI
PHI should be shared to anyone without patients concern
Electronic machinery of hospitals should be checked and maintained
Nurses should be available 24x7
They should know the details of the patients allotted and their medicine
CCTVs should be present every where with security guards guarding the
access points

Some examples of Governance in

Inventory of injections, syringes, scissors etc. should be maintained
No one should be allowed in ICU apart from hospital authorities
Fire extinguishers and emergency exit points should be present on major
Proper frisking of bags and visitors should be done at entry
There should be an calling button near each patient in order to call nurses.
Water should be purified and purifiers needs to be cleaned each day.
There should be explicit signs for visitors and patients.
PHI stored on servers should be in encrypted format.

Some examples of Governance in

Ambulance should be present with driver and other hospital staff 24x7
Doctors background check should be done thoroughly like whether degree
is fake or not, previous experience.
Service desk for hospitals needs to be available 24x7
Proper procedures needs to be followed for police cases and death as well
as birth certificates
Specialist doctors should be hired for specials cases either in hospital or
from other hospitals.
Unknown bodies should be preserved and maintained until clearance from

Some examples of Governance in


Safety procedures like new syringes for each time should be Implemented
Expired medicines should be changed regularly
Power supply should be there 24x7 & power backups should be there.
Hospitals premises should be cleaned from time to time.
Information which should not be known to patient should not be disclosed
for e.g sex of baby in womb
Operation should not done without patient or relatives concern(does not
apply for exceptional cases)
Junior doctors should be assisted by senior doctors until they are not skilled
Strict disciplinary actions needs to be present to maintain the decorum of