The term is used with great flexibility; this is an advantage, but also a source of some difficulty at the operational level. Depending on the context and the overriding objective sought, good governance has been said at various times to encompass: full respect of human rights, the rule of law, effective participation, multi-actor partnerships, political pluralism, transparent and accountable processes and institutions, an efficient and effective public sector, legitimacy, access to knowledge, information and education, political empowerment of people, equity, sustainability, and attitudes and values that foster responsibility, solidarity and tolerance.
However, there is a significant degree of consensus that good governance relates to political and institutional processes and outcomes that are deemed necessary to achieve the goals of development. It has been said that good governance is the process whereby public institutions conduct public affairs, manage public resources and guarantee the realization of human rights in a manner essentially free of abuse and corruption, and with due regard for the rule of law.
The true test of "good" governance is the degree to which it delivers on the promise of human rights: civil, cultural, economic, political and social rights. The key question is: are the institutions of governance effectively guaranteeing the right to health, adequate housing, sufficient food, quality education, fair justice and personal security? The concept of good governance has been clarified by the work of the former Commission on Human Rights. By linking good governance to sustainable human development, emphasizing principles such as accountability, participation and the enjoyment of human rights, and rejecting prescriptive approaches to development assistance, the resolution stands as an implicit endorsement of the rights-based approach to development.
Good governance and human rights are mutually reinforcing. Human rights principles provide a set of values to guide the work of governments and other political and social actors. They also provide a set of performance standards against which these actors can be held accountable. Moreover, human rights principles inform the content of good governance efforts: they may inform the development of legislative frameworks, policies, programmes, budgetary allocations and other measures.
On the other hand, without good governance, human rights cannot be respected and protected in a sustainable manner. The implementation of human rights relies on a conducive and enabling environment. This includes appropriate legal frameworks and institutions as well as political, managerial and administrative processes responsible for responding to the rights and needs of the population.
The links between good governance and human rights can be organized around four areas:. When led by human rights values, good governance reforms of democratic institutionscreate avenues for the public to participate in policymaking either throughformal institutions or informal consultations.
They also establish mechanisms forthe inclusion of multiple social groups in decision-making processes, especiallylocally. Finally, they may encourage civil society and local communities to formulateand express their positions on issues of importance to them. Reform initiatives may include mechanisms of accountability and transparency, culturally sensitive policy tools to ensure that services are accessible and acceptable to all, and paths for public participation in decision-making.
When it comes to the rule of law, human rights-sensitive good governance initiatives reform legislation and assist institutions ranging from penal systems to courts and parliaments to better implement that legislation. Good governance initiatives may include advocacy for legal reform, public awareness-raising on the national and international legal framework, and capacity-building or reform of institutions. In fighting corruption, good governance efforts rely on principles such as accountability, transparency and participation to shape anti-corruption measures.
The interconnection between good governance, human rights and sustainable development has been made directly or indirectly by the international community in a number of declarations and other global conference documents. In the Millennium Declaration, world leaders affirmed their commitment to promote democracy and strengthen the rule of law as well as to respect internationally recognized human rights and fundamental freedoms, including the right to development. The concept of good governance in the main international human rights instruments.
This communication should flow upwards and downwards through the organization, from the boardroom to the cubicle. Recruit the right mix of people multidisciplinary representation to serve on the Leadership Team.
Doornbos, M. It can also help the organization identify additional opportunities for continuous quality improvement. Ask the software vendor about how audits can occur in the system. Kisumu in Kenya is a typical example of a secondary city. Once the project is complete, continue to monitor and evaluate the project to ensure that critical success factors are achieved and a safe, effective and efficient environment is created. Asking these types of questions will get department members to open up about their workflows and business processes.
Effective executive governance depends on a balance of executive roles. By including a variety of stakeholders, leaders ensure that everyone responsible for aligning with and executing on the vision has a voice. Include stakeholders benefiting from the initiative in addition to those feeling the burden of the expense. Include owners of scarce resources too, whose buy-in is critical to success. In addition to multidisciplinary representation, consider the core competencies of the individuals who will lead—the innovators, first followers, and early adopters.
follow Do they have what it takes? The innovator needs to stand alone and take risks to present a new idea. They also must keep early processes easy to follow, so that the first follower can jump in effortlessly. The first follower also needs to be comfortable taking risk and so confident in the movement that they invite more people early adopters to join. The new idea is no longer an anomaly or risk, but a standard part of operations. This team of innovators and early adopters is the linchpin of executive governance.
The innovators are the torchbearers of key initiatives—disrupters willing to confront skeptics head on and stand behind the vision. Early adopters bravely follow the innovators, working to sustain and grow their work. Effective executive governance understands the critical roles innovators and early adopters play in permeating the vision and protecting priorities. Then prioritize those in a data-driven, strategic way to target areas for early and meaningful change where the highest value proposition exists. This way, the work is deep and effective in a few areas of greatest opportunity, rather than ineffectively in too many.
A key process analysis KPA tool such as the Health Catalyst Key Process Analysis tool can help generate insights into improvement opportunities by combining clinical and financial data to determine need, impact, and cost savings potential. The organization might be ready and able to take on some areas of change, but need more preparation in others.
Perform a self-assessment or structured interviews with a third-party improvement expert to carefully examine these areas: processes, methodologies, infrastructure, skills, and cultural factors. This audit will identify potential weaknesses and help ensure that the organization is prepared for improvement work and able to manage risk.
At the end of the day, governance is all about the allocation of scarce valuable resources. Typically, this will include analytical resources—data analysts and architects—as well as business subject matter experts whether clinical, financial, operational, or other. The improvement methodology is the framework by which leaders organize teams, assign accountability, and empower individuals in improvement work. Think of the methodology as the improvement training plan. The process of establishing and adopting a common methodology throughout the organization does, in fact, require formal training for the Leadership Team.
Whether they bring in experts to do this on site or send team members to an off-site program, the goal of this training is to build confidence in the improvement methods and develop the skills and practices to implement it. These skills and practices include effective collaboration, a shared language, common messages and principles, a plan to anticipate hurdles, and common understanding of possible team structures.
Effective executive governance aligns everyone within the organization around the same vision, goals, and accountabilities. Make outcomes improvement goals part of the compensation framework.
Look for and eliminate scenarios where individuals feel conflicted when engaging in outcomes improvement because their opportunity costs are too high. In the case of clinicians, this means making it possible, and appealing, for clinicians to participate in improvement work while not compromising patient care.
This can be done by making improvement work and goals part of job descriptions at all levels, rather than work that may appear additional or optional. Aligned incentives rewards helps manage tensions of competing demands for scarce resources and ensures systemwide shared risk and reward.
In the context of healthcare governance, polarity refers to a pair of values that we tend to see in adversarial terms— this VERSUS that —but are, in fact, interdependent and mutually valuable. For example, in improvement work, strive for quality AND low cost. These do not need to be competing priorities. Keep polarities in the organization balanced by identifying the ones that could impede improvement and then developing a plan to foster their coexistence. In a previous step, they have already identified the high-level opportunities of focus for the organization.
Now that these are selected and leadership is mobilized around those areas, it is time to operationalize the vision by prioritizing desired, measurable outcomes within those strategic areas. This will require some deeper analysis to identify specific areas of opportunity. This becomes a fantastic leverage point for engaging front-line stakeholders in shaping and understanding the shared objective. In turn, they will identify passionate individuals for leading the charge of outcomes improvement—they become the most valuable leaders.
The owners of resources those who make allocation decisions throughout the institution need a consistent rubric for making resource allocation decisions clinical care versus process improvement, for example. To help make the investment successful, leaders need to manage investment allocation across properties. For example, if the organization is committed to data-driven quality improvement , then it might be short on analytics resources systems, tools, staff, etc.
If I am a director in one of these areas, then I need to know how to process and prioritize requests for my scarce resources. Few things are more frustrating to owners of scarce resources than feeling beholden to more masters than can be reasonably satisfied with limited resources. Effective governance can and should do the favor of establishing the decision-making rubric to protect these often-overburdened resources. Improvement teams comprise the innovators and early adopters who drive improvement and inspire others to follow.
These team members play critical roles in permeating the vision and protecting priorities.