Is Your Healthcare Board Assurance Framework Fit For Purpose?
How to ensure your Trust's BAF is up to the job
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Change happens fast and so do risks, so how certain are you that your Trust’s BAF is actually up to the job?
The world has changed, and keeps changing. NHS and healthcare providers are continuously expected to deliver more for their money, even under unprecedented circumstances and in the midst of challenges that few could have foreseen.
What that means in real terms is that governments and the public expect Trusts to provide better joined-up services, where care is delivered seamlessly through the patient’s journey, while still achieving the best possible standards of health and well-being. Now more than ever, Trusts and their budgets are under the microscope as they scramble to keep up with the frenetic pace of change.
What this means in turn for Boards of Directors is that they need the tools to be able to deliver strategic objectives and manage risks without losing sight of maintaining care quality, outcomes and safety levels across the Trust.
The board members need to constantly ensure that they fully understand the internal and external environments within which they operate, understand critical risks to their strategic objectives, both current and potential, and have processes in place to manage and mitigate the risks and ensure the processes provide the assurance the Board needs that the Trust can achieve its key strategic objectives.
Having a rock-solid assurance framework in place is one of the best ways to give boards that confidence, whilst also ensuring that precious time and resources are spent on the right activities.
The two main requirements for Trusts to be able to evidence a robust BAF come from NHSI, and the CQC’s Well Led inspection framework. The NHSI publication Developmental reviews of leadership and governance using the well-led framework: guidance for NHS Trusts and NHS Foundation Trusts explains that the need for a BAF is part of the Key Lines of Enquiry (KLOE) no. 5, which asks “are there clear and effective processes for managing risks, issues and performance?”. The NHSI even lays out the requirement for senior leaders to be able to show that a BAF is in place and that it is assessed by the board on at least a quarterly basis.
The second requirement comes from the CQC’s Well Led domain, which obliges health providers to show that the “…leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture”. KLOE W5 asks, “Are there robust arrangements for identifying, recording and managing risks, issues and mitigating actions? Is there alignment between the recorded risks and what staff say is ‘on their worry list’?”
It is clear then that simply having a framework in place isn’t enough in itself.
There are requirements in place for it to be robust and regularly assessed by the Board. It needs to accurately reflect any risks to the initiatives laid out in the strategic plan, and if it’s to get the job done properly, a good board assurance framework should form a seamless part of your existing governance, risk management and internal control arrangements.
You need to be certain that your Trust’s board assurance framework is fit for purpose, and in order to find out whether it is, you’ll need to ask some penetrating questions. Questions like:
- Is it unwieldy or not clearly owned?
- Is it squarely centred around the Trust’s strategic objectives or is it based on ill-defined objectives or unrelated to the Trust’s performance against objectives?
- Does it link to current outcome performance and lead indicators of emerging risks?
- Does it relate projects and initiatives to strategic objectives and outcomes to triangulate the significance of specific project risks?
- Does it only look retrospectively at risks that have already come to light or is it also forward-looking?
- Does it capture the real risks to outcomes and to the processes and pathways that deliver those outcomes, or is it inconsistent or incomplete?
- Does it identify new risks regularly, and in a systematic way?
- Does it help you identify any gaps or weaknesses in your controls?
- Is it easy to read or is it excessively long and dense?
The BAF must be used dynamically to continually capture changes that come to light as a result of new information. It cannot do its job properly unless it is a ‘live’ tool that helps effective decision-making by providing evidence and supporting the decision-making process.
Furthermore, the confidence that your BAF gives the board from assurances will depend on several factors, including where the assurance comes from, how timely it is, how it is generated and how consistent it is with other assurances.
Managing all of that would not be an effective use of the Board’s time, so an effective system to automatically capture, collate manage and report the information with both oversight and exceptions, is priceless.
Often way of scrutinising assurances is to delegate the task to a sub-committee – sometimes based on their responsibility for a particular strategic objective, saving time for the board and making the most appropriate and efficient use of their expertise. Combining both automated and manual escalation processes in the system enables the span of control to be both delegated and controlled at board level.
By systematically scrutinising the assurances in this way, the board will be better able to trust them as a sound basis for decision-making and thus feel more confident about the likelihood of achieving the Trust’s strategic objectives.
At its heart, your Trust’s board assurance framework needs to deliver the right level of assurance about the right things and help you know what you actually need to know, without taking an army of administrators, risk managers, projects managers, performance managers, clinicians and senior managers to keep it live.
If it doesn’t, then it’s time to give it a firm push in the right direction…
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About the Author
As our Chief Executive and Founder, Robert has been the visionary leading InPhase to be one of the UK's leading providers of business management, governance and assurance solutions, and helping organisations align their actions and goals more easily and efficiently with InPhase's suite of integrated apps.