Clinical and corporate governance

 

Good governance practices are vital to the safe and effective operation of any organisation; nowhere more so than in the health sector. Claro’s lawyers have been immersed in governance issues for many years, including policy structure and clinical oversight, conflicts of interest, and administrative law obligations. Our lawyers appear in judicial reviews, train board members and advise on policies, practices and procedures.

When it comes to governance:

  • induction and training of new board members is essential for sound, consistent, decision making
  • the problem is not conflicts of interest, but how they are identified and managed
  • the first place a regulator will look is the organisation’s policy and procedure manual.

 

Examples of work done by Claro lawyers:

Governance processes relating to shared arrangements between regulatory authorities under the Health Practitioners Competence Assurance Act (HPCA). As part of a government initiative, authorities have been working more closely together. We have advised a number of regulatory authorities on shared arrangements including decision-making, sharing costs and other collaborations.

Memoranda of understanding clarifying roles and responsibilities between professional colleges and health regulatory authorities. Professional colleges regularly act as the agent of regulatory authorities for the purpose of assessing the adequacy of prospective registrants. Professional colleges also provide recertification programmes to health practitioners on behalf of the regulatory authorities. We have advised colleges and regulatory authorities on their different but interfacing responsibilities and roles, and have drafted memoranda of understanding addressing such issues.

Conflicts of interest involving DHB board members who also hold other public office. Tensions often arise between the responsibilities of board members to the DHB (and to the Minister) and members’ other responsibilities. Elected members sometimes feel accountable to their constituents. We have been involved in a number of complex conflicts of interest cases, including cases involving members who are strongly and publicly opposed to decisions being made by their board. Our advice includes consideration of responsibilities under the NZ Public Health and Disability Act, the Crown Entities Act, and the guidelines issued by the Office of the Auditor-General. We have assisted boards take the extreme action of suspending members.

Clinical governance committees, structures and processes for private hospitals. We have advised a number of private hospitals on appropriate clinical governance structures; including the roles and responsibilities of hospital committees, credentialing committees, medical advisers, and the hospitals’ boards. The nature of the relationship between private hospitals and practitioners who hold privileges to work at private hospitals result in unique governance and management issues. The regulators’ focus on the legal responsibilities of private hospital operators for what happens in their hospitals increases the importance of having clear and well defined clinical governance structures.

Process management for a deeply divided board with repeated attempts by two members to have the Chair removed. Members’ votes split evenly with the Chair abstaining. Our lawyers advised throughout the matter on legal and governance issues, including legislative obligations, general governance and conflict of interest procedures, and responsibilities to the Minister. A clear process was advised, risks were identified and managed, and the board received training on governance issues.

Development of clinical governance, legal compliance and risk management policies, procedures and guidelines so that these are easy to understand for staff across the organisation. We have complemented those policies, procedures and guidelines by the development of information sheets and checklists, which set out key principles in simple, non-legalistic terms.

A public law audit of a crown entity’s exercise of statutory functions and objectives, including a review of all of its substantive policies, procedures and processes, with reference to the NZ Public Health and Disability Act, the Crown Entities Act, and previous cases against the crown entity. A substantive report following the audit was prepared. The majority of our recommendations were implemented through review, consultation and amendment of relevant policies, procedures and processes.

 

Training we offer

  • We run training programmes and induction sessions for new members to Boards, including District Health Boards and Regulatory Authorities. This training includes an introduction to the key pieces of legislation the member/s will be working with, and guidance on good governance processes, including dealing with conflicts of interest and good decision-making. For more information on these training programmes, contact Jonathan Coates or Anita Miller.
  • We regularly run seminars and workshops on organisations’ duties and obligations in the provision of health and disability services. We also run the Health Law Intensive in collaboration with the University of Otago. This course is designed specifically for senior clinicians, board members, chief executives and managers working in the New Zealand health sector. For more information, contact Jonathan Coates or Anita Miller.