WEBVTT 1 00:00:00.750 --> 00:00:03.960 Hi, everyone, and welcome to this week's lecture. 2 00:00:03.960 --> 00:00:05.910 We'll be discussing the importance of boards 3 00:00:05.910 --> 00:00:10.230 and good governance to global health organizations. 4 00:00:10.230 --> 00:00:13.470 In global health, boards of directors or boards of trustees 5 00:00:13.470 --> 00:00:16.470 are groups of community, business, and health sector leaders 6 00:00:16.470 --> 00:00:18.600 who play a crucial role in creating the conditions 7 00:00:18.600 --> 00:00:21.510 within which people who deliver and manage health services 8 00:00:21.510 --> 00:00:23.730 are more likely to succeed. 9 00:00:23.730 --> 00:00:26.070 This module covers a wide range of concepts 10 00:00:26.070 --> 00:00:27.900 related to boards and good governance, 11 00:00:27.900 --> 00:00:30.000 with the intention of helping health system leaders, 12 00:00:30.000 --> 00:00:32.310 especially those in low-resource countries, 13 00:00:32.310 --> 00:00:35.460 explore the power of the board to improve their systems 14 00:00:35.460 --> 00:00:36.990 and health outcomes. 15 00:00:36.990 --> 00:00:40.560 In particular, this module goes over the five key practices 16 00:00:40.560 --> 00:00:43.410 and 11 essential elements of a board, 17 00:00:43.410 --> 00:00:44.940 as well as touching upon the importance 18 00:00:44.940 --> 00:00:46.740 of the sustainable development goals 19 00:00:46.740 --> 00:00:49.353 to the development of good boards. 20 00:00:51.900 --> 00:00:54.240 To begin with, and I apologize 21 00:00:54.240 --> 00:00:55.840 for the formatting on the slide, 22 00:00:57.060 --> 00:01:01.950 we'll discuss the concept of smart governance for health, 23 00:01:01.950 --> 00:01:05.640 and smart governance describes leadership 24 00:01:05.640 --> 00:01:09.840 that is stakeholder engaged, mission-driven, 25 00:01:09.840 --> 00:01:12.960 accountable to beneficiaries and resource providers, 26 00:01:12.960 --> 00:01:15.330 mobilizes resources to support the mission, 27 00:01:15.330 --> 00:01:17.790 and demonstrates transparency in all plans 28 00:01:17.790 --> 00:01:22.413 and decision making aimed at accomplishing the mission. 29 00:01:24.120 --> 00:01:27.390 This practice enables leaders and organizations 30 00:01:27.390 --> 00:01:31.353 to be as successful as possible. 31 00:01:33.930 --> 00:01:36.090 As we've discussed before, 32 00:01:36.090 --> 00:01:39.630 the American College of Healthcare Executive Code of ethics 33 00:01:39.630 --> 00:01:44.630 addresses a manager's responsibility to numerous communities 34 00:01:45.060 --> 00:01:47.583 that a manager finds himself in contact with. 35 00:01:48.420 --> 00:01:51.120 These are the organization, the employees, 36 00:01:51.120 --> 00:01:54.063 patients or others served, and the community and society. 37 00:01:55.950 --> 00:01:58.020 It's also important to note that good governance 38 00:01:58.020 --> 00:02:01.830 enhances stronger health systems and greater health impact. 39 00:02:01.830 --> 00:02:04.350 Good board work not only helps health sector leaders 40 00:02:04.350 --> 00:02:05.970 better accomplish their work, 41 00:02:05.970 --> 00:02:07.830 but it also has benefits for health systems 42 00:02:07.830 --> 00:02:10.200 and the populations they serve. 43 00:02:10.200 --> 00:02:12.517 Good governance creates the conditions in which the, quote, 44 00:02:12.517 --> 00:02:14.970 "Eight rights improve health systems 45 00:02:14.970 --> 00:02:16.587 to achieve better outcomes." 46 00:02:17.520 --> 00:02:21.480 These rights are the right number of health workers, 47 00:02:21.480 --> 00:02:24.150 the right quality of health workers, 48 00:02:24.150 --> 00:02:26.760 the right mix of health workers, 49 00:02:26.760 --> 00:02:30.060 the right facilities in which people can work, 50 00:02:30.060 --> 00:02:32.640 the right budgets and financing, 51 00:02:32.640 --> 00:02:35.640 the right medicines, equipment, and supplies, 52 00:02:35.640 --> 00:02:38.100 the right clinical care protocols, 53 00:02:38.100 --> 00:02:40.623 and the right cultural appropriateness of care. 54 00:02:42.870 --> 00:02:45.690 The idea of good governance can be a shallow false promise, 55 00:02:45.690 --> 00:02:48.660 and one that's often broken if it's not understood 56 00:02:48.660 --> 00:02:50.910 and demanded by all those who lead, manage, 57 00:02:50.910 --> 00:02:53.040 and deliver health services. 58 00:02:53.040 --> 00:02:54.630 Good governance does not just happen 59 00:02:54.630 --> 00:02:56.310 because you hope it will. 60 00:02:56.310 --> 00:02:57.990 Hope is not a strategy. 61 00:02:57.990 --> 00:02:59.700 Good governance is more likely to be achieved 62 00:02:59.700 --> 00:03:01.050 if you make a personal commitment 63 00:03:01.050 --> 00:03:04.050 to explore the many facets of good and poor governance, 64 00:03:04.050 --> 00:03:07.803 then take actions to embrace the good and combat the poor. 65 00:03:10.620 --> 00:03:12.180 The sustainable development goals 66 00:03:12.180 --> 00:03:15.660 and the millennium development goals helps to pave the way 67 00:03:15.660 --> 00:03:17.760 for better governance. 68 00:03:17.760 --> 00:03:20.430 The sustainable development goals were published 69 00:03:20.430 --> 00:03:24.850 by the United Nations, and lay out benchworks 70 00:03:26.040 --> 00:03:28.593 that the global community should try to accomplish. 71 00:03:29.520 --> 00:03:33.690 These include no poverty, zero hunger, quality education, 72 00:03:33.690 --> 00:03:36.723 care for the Earth and the oceans, et cetera. 73 00:03:37.860 --> 00:03:42.270 There's a number of goals, and they can seem lofty 74 00:03:42.270 --> 00:03:44.130 and hard to achieve, 75 00:03:44.130 --> 00:03:47.380 but that's one reason why sustainable government is so key 76 00:03:48.600 --> 00:03:51.690 to be able to attain these goals 77 00:03:51.690 --> 00:03:55.053 in an ethical and uncorrupt way. 78 00:03:56.820 --> 00:03:59.460 So now when we talk about governance, 79 00:03:59.460 --> 00:04:02.523 there's numerous different levels that that takes place at. 80 00:04:05.430 --> 00:04:10.080 The textbook separates them into four basic levels, 81 00:04:10.080 --> 00:04:11.913 ranging from global to local. 82 00:04:13.380 --> 00:04:18.380 The first, the global level, the macro governance, 83 00:04:18.600 --> 00:04:20.730 refers to governance across nation states, 84 00:04:20.730 --> 00:04:22.770 such as the World Health Organization, 85 00:04:22.770 --> 00:04:25.440 the World Trade Organization, and the Global Fund. 86 00:04:25.440 --> 00:04:28.170 These are often called multilateral organizations, 87 00:04:28.170 --> 00:04:31.503 and they have stakeholders in many different countries. 88 00:04:33.000 --> 00:04:36.003 The next level, the meso level, 89 00:04:36.870 --> 00:04:41.870 refers to national leadership and national governance, 90 00:04:41.940 --> 00:04:43.800 so within a nation state. 91 00:04:43.800 --> 00:04:45.690 It's usually entrusted to Ministry of Health, 92 00:04:45.690 --> 00:04:47.460 though some countries might have a mix of entities 93 00:04:47.460 --> 00:04:48.960 engaged in health matters, 94 00:04:48.960 --> 00:04:50.550 like the Ministry of Higher Education, 95 00:04:50.550 --> 00:04:52.920 the Food and Drug Administration, 96 00:04:52.920 --> 00:04:55.020 the Environmental Protection Agency, 97 00:04:55.020 --> 00:04:57.483 and the Ministry of Youth or Women. 98 00:04:58.740 --> 00:05:01.860 Next, the micro level refers to governance 99 00:05:01.860 --> 00:05:04.170 via oversight of institutions, public or private, 100 00:05:04.170 --> 00:05:05.910 within a country's health sector, 101 00:05:05.910 --> 00:05:08.970 such as governing body for hospitals, health care centers, 102 00:05:08.970 --> 00:05:11.163 or provincial district health councils. 103 00:05:12.060 --> 00:05:15.210 And finally, the nano level of governance 104 00:05:15.210 --> 00:05:19.110 refers to governance within institutions or organizations. 105 00:05:19.110 --> 00:05:21.210 That's like a hospital organization in South Africa 106 00:05:21.210 --> 00:05:22.350 that might have governing bodies 107 00:05:22.350 --> 00:05:24.570 for each community hospital. 108 00:05:24.570 --> 00:05:26.280 Most leaders are going to deal with governance 109 00:05:26.280 --> 00:05:29.160 at institutional levels, but it's important to understand 110 00:05:29.160 --> 00:05:31.293 all four levels of governance. 111 00:05:33.210 --> 00:05:35.760 So next, it's important to note 112 00:05:35.760 --> 00:05:39.780 that governance is a key enabler of health. 113 00:05:39.780 --> 00:05:43.020 So as we've discussed, 114 00:05:43.020 --> 00:05:45.660 governance can benefit health systems, 115 00:05:45.660 --> 00:05:48.510 and this flow chart outlines one of the ways 116 00:05:48.510 --> 00:05:52.050 in which good governance, good leadership, good management, 117 00:05:52.050 --> 00:05:56.550 and good governing can improve health systems 118 00:05:56.550 --> 00:05:58.260 through strong management systems, 119 00:05:58.260 --> 00:06:00.630 enhancing the overall work environment, 120 00:06:00.630 --> 00:06:03.540 and creating responsive health systems 121 00:06:03.540 --> 00:06:06.123 that can use resources effectively. 122 00:06:07.230 --> 00:06:11.100 These can in turn lead to lower costs and better qualities, 123 00:06:11.100 --> 00:06:13.170 and result in sustainable health outcomes 124 00:06:13.170 --> 00:06:15.570 that help to meet sustainable development goals. 125 00:06:18.150 --> 00:06:19.800 So now it's interesting to think about 126 00:06:19.800 --> 00:06:22.890 how your career might interface with smart governance. 127 00:06:22.890 --> 00:06:25.080 I know we won't all go on to become leaders 128 00:06:25.080 --> 00:06:29.160 of global health organizations, but you'll interact 129 00:06:29.160 --> 00:06:32.070 with governing structures in numerous ways. 130 00:06:32.070 --> 00:06:34.290 You might be serving on a board 131 00:06:34.290 --> 00:06:37.830 or you might be subject to a board's policies, 132 00:06:37.830 --> 00:06:40.710 and wherever you fall, it's important to understand 133 00:06:40.710 --> 00:06:43.590 these key concepts, especially in ways 134 00:06:43.590 --> 00:06:45.210 that you might be able to offer guidance 135 00:06:45.210 --> 00:06:47.823 and suggestions on ways to make governance better. 136 00:06:49.710 --> 00:06:51.420 So now we'll talk a little bit about the roles 137 00:06:51.420 --> 00:06:54.690 and responsibilities of different members of a board. 138 00:06:54.690 --> 00:06:56.790 Although legislation and regulations may guide 139 00:06:56.790 --> 00:06:58.410 the forming of the governing body, 140 00:06:58.410 --> 00:07:00.240 the terms of reference are often very general 141 00:07:00.240 --> 00:07:02.280 with few concrete guidelines. 142 00:07:02.280 --> 00:07:04.470 Managers should expect to help draft these guidelines 143 00:07:04.470 --> 00:07:07.740 for the composition and work of their governing boards. 144 00:07:07.740 --> 00:07:09.510 The fundamental role of a governing board 145 00:07:09.510 --> 00:07:11.220 is to protect the mission of the organization 146 00:07:11.220 --> 00:07:13.820 by accomplishing certain essential oversight duties. 147 00:07:14.700 --> 00:07:17.310 Each board member's primary responsibility is to refine 148 00:07:17.310 --> 00:07:21.150 and serve the organization's mission by developing, 149 00:07:21.150 --> 00:07:23.580 monitoring, and enforcing specific guidelines 150 00:07:23.580 --> 00:07:25.770 in six key areas: 151 00:07:25.770 --> 00:07:28.920 quality performance; financial performance; 152 00:07:28.920 --> 00:07:32.130 planning performance; management performance, 153 00:07:32.130 --> 00:07:34.080 governance effectiveness; 154 00:07:34.080 --> 00:07:36.153 and community relations and advocacy. 155 00:07:38.550 --> 00:07:40.920 So now we'll get into some essential practices 156 00:07:40.920 --> 00:07:42.663 of good governance. 157 00:07:43.950 --> 00:07:47.542 The first is to create a culture of accountability. 158 00:07:47.542 --> 00:07:49.440 Good boards must establish 159 00:07:49.440 --> 00:07:51.180 and sustain a culture of accountability 160 00:07:51.180 --> 00:07:53.220 through the following activities: 161 00:07:53.220 --> 00:07:55.710 cultivating your personal accountability; 162 00:07:55.710 --> 00:07:57.630 nurturing the accountability of your organization 163 00:07:57.630 --> 00:07:59.220 to its stakeholders; 164 00:07:59.220 --> 00:08:02.790 fostering internal accountability in your organization; 165 00:08:02.790 --> 00:08:05.820 measuring performance; sharing information; 166 00:08:05.820 --> 00:08:07.710 using technology to support accountability; 167 00:08:07.710 --> 00:08:11.733 and providing smart insight and oversight, among others. 168 00:08:12.630 --> 00:08:17.630 Next, it's important to develop stakeholder engagement. 169 00:08:19.020 --> 00:08:21.210 Engagement must be optimized to ensure willingness 170 00:08:21.210 --> 00:08:23.790 to help implement decision support. 171 00:08:23.790 --> 00:08:25.410 Activities that will help 172 00:08:25.410 --> 00:08:29.370 to ensure good stakeholder engagement are as follows: 173 00:08:29.370 --> 00:08:31.590 extend sincere stakeholder invitations 174 00:08:31.590 --> 00:08:34.170 and achieve sincere stakeholder engagement; 175 00:08:34.170 --> 00:08:36.960 building trust; engaging with patients; 176 00:08:36.960 --> 00:08:38.460 collaborating with other sectors; 177 00:08:38.460 --> 00:08:40.803 and practicing gender-responsive governance. 178 00:08:42.570 --> 00:08:47.250 Next, it's very important to set a strategic direction 179 00:08:47.250 --> 00:08:49.290 in an organization. 180 00:08:49.290 --> 00:08:51.270 Different activities that can help to promote this 181 00:08:51.270 --> 00:08:53.670 are defining the target population health goals, 182 00:08:53.670 --> 00:08:56.580 establishing a shared vision among key stakeholders, 183 00:08:56.580 --> 00:08:58.620 creating a successful strategic plan, 184 00:08:58.620 --> 00:09:00.970 and reporting progress to the key stakeholders. 185 00:09:02.640 --> 00:09:05.130 Next, stewardship of resources 186 00:09:05.130 --> 00:09:08.610 is of utmost importance in any organization. 187 00:09:08.610 --> 00:09:11.610 Resources like labor, equipment, supplies, money, 188 00:09:11.610 --> 00:09:13.810 and other things are often in scarce supply. 189 00:09:14.760 --> 00:09:16.950 Activities that help to promote their efficient use 190 00:09:16.950 --> 00:09:18.540 are as follows: 191 00:09:18.540 --> 00:09:21.090 wisely raising and using resources; 192 00:09:21.090 --> 00:09:23.490 practicing ethical and moral integrity; 193 00:09:23.490 --> 00:09:24.930 measuring performance; 194 00:09:24.930 --> 00:09:27.903 and eradicating corruption, among others. 195 00:09:29.160 --> 00:09:31.650 And finally, continuous improvement 196 00:09:31.650 --> 00:09:35.700 of the aforementioned principles is very important. 197 00:09:35.700 --> 00:09:38.070 So improvement of the above practices helps 198 00:09:38.070 --> 00:09:40.770 to sustain an effective and high-performing board. 199 00:09:40.770 --> 00:09:42.720 Different activities that help to promote this 200 00:09:42.720 --> 00:09:45.360 are cultivating governance competencies, 201 00:09:45.360 --> 00:09:47.220 building diversity in the board, 202 00:09:47.220 --> 00:09:49.770 performing regular governance assessments, 203 00:09:49.770 --> 00:09:51.450 and making governance policies, 204 00:09:51.450 --> 00:09:54.213 and using different cutting edge technologies. 205 00:09:56.250 --> 00:09:58.800 Finally, the infrastructure of an organization 206 00:09:58.800 --> 00:10:00.723 and its governance structure matters. 207 00:10:02.460 --> 00:10:05.460 So there's various key systems and infrastructure elements 208 00:10:05.460 --> 00:10:07.770 that will affect people's ability to participate effectively 209 00:10:07.770 --> 00:10:11.850 in governance decision making processes and practices 210 00:10:11.850 --> 00:10:14.310 to maximize the vitality of organizations 211 00:10:14.310 --> 00:10:15.663 and their governing bodies. 212 00:10:16.680 --> 00:10:20.310 These include the size and structure of the board, 213 00:10:20.310 --> 00:10:23.850 the excellent committees, the board information systems, 214 00:10:23.850 --> 00:10:27.180 the job descriptions, the orientation process, 215 00:10:27.180 --> 00:10:29.916 and ongoing assessment and refinement. 216 00:10:29.916 --> 00:10:32.850 These elements are described in depth 217 00:10:32.850 --> 00:10:34.550 in the textbook chapter this week. 218 00:10:36.120 --> 00:10:38.270 And finally, I'll leave us with a question. 219 00:10:40.080 --> 00:10:45.080 One possible difficulty or obstacle that can arise 220 00:10:46.050 --> 00:10:47.850 in an organization is the governing body 221 00:10:47.850 --> 00:10:50.970 improperly trying to influence the hiring of relatives. 222 00:10:50.970 --> 00:10:52.860 And I encourage you to think 223 00:10:52.860 --> 00:10:55.800 as we reflect on the readings this week, why is this bad 224 00:10:55.800 --> 00:10:59.370 and what can be done to fix, prevent, or inoculate this? 225 00:10:59.370 --> 00:11:03.000 And what specific cultural factors 226 00:11:03.000 --> 00:11:05.590 or setting factors might play a role 227 00:11:06.510 --> 00:11:08.550 in the different strategies to combat this, 228 00:11:08.550 --> 00:11:10.950 depending on where your organization is working?