governance - what does it matter?

In response to the American election results, I turned to the comfort of reading. I can't do anything about the result, but I can certainly be curious about it. I have far too many books on my TBR (to-be-read) shelf, many of which are political (thanks to a politics book box from the Book Grocer), so I picked Trumpocracy: The Corruption of the American Republic by David Frum off the shelf. While I am still reading the book, in a twist that I didn't see coming (but probably should have), it has already reinvigorated my love of governance. One quote in particular has stuck with me, and I want to reflect on how it could apply to health settings.

I think healthcare, being a "caring" industry, risks giving organisations a false sense of security that healthcare workers are inherently good people who will collectively "do the right thing". As a result, it is tempting to deprioritise governance activities for those seen to have a more significant impact on direct patient care. However, it is naive to think that the long-established power dynamics within a didactic healthcare system have little effect on care delivery and care outcomes. These dynamics are many and layered - between historically hierarchically clinical professionals, management versus clinical decision makers, clinicians versus patients, and adults versus children. If done well, governance is a mechanism to help keep these power imbalances in check.

The number of required governance activities can feel overwhelming - Child Safety Standards, National Standards, Research Standards, Risk Management Frameworks, Legislative Compliance, incident reviews, and feedback management. Setting up these governance systems is often hard-fought and, if I'm honest, can sometimes feel an awful lot like pushing shit uphill. If you focus for too long on one turd, all the other ones start to roll back down that hill. So, it is about finding ways to make these governance systems work together and, more importantly, work for the organisations and the people within them. As governance managers, we need to identify where there is crossover, minimise duplication and maximise the focus on improving safety and patient outcomes.

This last bit of the quote is quite cynical, particularly when applied to the context of health. That said, even in health, governance is often viewed as a dull, compliance-driven exercise with little value-add. It becomes an annoyance, even for people like me, with governance in their job titles. Governance managers are on an endless journey of chasing audit results, sending compliance checklists, and requesting progress updates on action plans. If there is one thing that takes the joy out of my work, it is feeling like a nag. All this to say, as disappointing as the election results have been, if I can take away one positive, it has strengthened my resolve as to why governance matters. When I return to work in a few months, I will beat my governance drum with more pride and confidence. In a time where anxiety about the future may be heightened, governance is not only essential, it's actually quite comforting! 

So I'm curious: where have you found pockets of unexpected inspiration lately?