Good governance outcomes for CCGs: A survey tool to support development and improvement of governance

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1 Good governance outcomes for CCGs: A survey tool to support development and improvement of governance Good Governance Institute Part of a programme commissioned by NHS England Publications gateway reference number Good Governance Institute

2 1 Introduction The Good Governance Institute has been commissioned by NHS England to develop a language for governance that is appealing to Clinical Commissioning Groups (CCGs), and a proposed set of outcomes of good governance that can be described and measured. As part of this work we have developed a suite of tools that CCGs can use with minimal external input, to test whether they are achieving good governance outcomes. These tools have been developed with the input and participation of CCGs, and are: a maturity matrix to guide self-assessment against the good governance outcomes a survey to test the views of internal and potentially external stakeholders as to whether the good governance outcomes have been achieved a peer review guide to enable CCGs to learn from peers an observation guide to support the review of CCG meetings such as the governing body a standards and evidence tool to enable CCGs to evidence how they are achieving good governance outcomes The tools have been developed to identify the outcomes of good governance and so the outcomes of the governance of new processes such as collaborative commissioning and co-commissioning read across this work too. The website for this work includes further details of how these tools were developed, as well as downloads of the tools themselves. 1

3 2 A guide to using the survey to support development and improvement of governance This survey tool is designed to help Clinical Commissioning Groups (CCGs) self-assess that they are achieving the expected desirable outcomes of good governance practice. It has been developed from the Good governance outcomes for CCGs: A maturity matrix to support development and improvement of CCGs tool, as part of GGI s CCG governance outcomes programme. We would recommend familiarising yourself with this document before taking the survey. This tool is flexible, and can be used in different parts of the organisation and with different stakeholders in order to gain specific insights into whether the CCG is achieving good governance outcomes. For example, the survey could be used to test the perceptions of: Governing body members only Governing body members and selected/all CCG staff CCG members Leaders in stakeholder or partner organisations The survey is divided into three sections: Section 1 is designed to identify who is completing the survey, for example whether the participant is a member of the CCG Section 2 is closely linked to the aforementioned maturity matrix, requiring a detailed understanding of the CCG s workings, and asks participants to evaluate the CCG in terms of achieving good governance outcomes. In this section, participants are asked to state the extent to which they agree or disagree with a number of statements, with the aim of making explicit the areas the CCG needs to improve Section 3 has been specifically designed to add depth of insight from participants who are not governing body or senior staff members (although the questions are still applicable to them), and looks more broadly at CCG performance Section 2 of the survey is clearly linked to the maturity matrix and is organised under the same headings. Section 3, which aims to offer greater insight from a broader range of stakeholders, can help build a higher level understanding of key elements of the matrix and in particular: Leadership and strategic direction Effectiveness of relationships Membership support Public and community engagement Better decision-making The survey can be taken both online here [insert link] or via downloadable copies available on 2

4 We recommend that, as with any survey, those organising it should: Pilot the survey to iron out glitches and check phraseology Contact participants in advance of the survey, explaining purpose and intention Provide participants with adequate, but not too much, time to complete the survey Explain carefully how the findings will be used, and whether participants remarks are confidential or attributable Have a follow-up mechanism to chase those who do not respond Be clear about whether participants will receive feedback from the survey when completed and if so, how this will be done Governing bodies wishing to gain feedback about particular issues may wish to tailor some specific questions that are not currently included in the survey. 3

5 When to use this survey The survey is a self-reported means of inquiry, and does not bring an informed external eye to the issues a governing body may be facing. Surveys are good ways of testing existing beliefs and hypotheses, but are less effective at unearthing issues that the organisation may previously have been aware of. Surveys give a wider group the opportunity to have their say, and are sound ways of gaining insight from stakeholders. Surveys offer the opportunity to benchmark with other CCGs and to compare and contrast. Surveys can offer temporal comparison too, and enable a CCG to track progress over time. Once developed, they are inexpensive to run. Presenting results The survey will provide raw data, but this has only limited use unless intelligence is applied to the findings to identify the assurances and lessons the data exposes. Analysing survey data is a discrete skill, and we would counsel that a senior individual should be given the task of writing up the survey and presenting the findings to colleagues. While graphic representations of data are a useful way of presenting survey findings these, should be buttressed with narrative explaining what knowledge can be gained from the raw results. 4

6 3 Survey questions Section 1, to identify who is completing the survey A. Please name the CCG you are using this survey to evaluate B. Are you associated with (e.g. a member of, work for) the CCG? C. Are you a clinician? D. Are you a GP? E. Do you work for a GP practice that is a member of the CCG? F. Have you held an official position within the CCG? G. Is your main work with any of the following? a. An NHS Provider b. A non-nhs healthcare provider c. A local authority d. A commercial organisation not providing healthcare services e. A third sector organisation f. Another kind of organisation (please state in the comments box below) g. You do not work H. In your main work, are you a member of a governing body or a board? I. Aside from your main work, are you a member of a governing body or a board? J. Are you currently a member of the governing body of the CCG identified in question A? 5

7 Section 2 evaluation of CCG in terms of achieving good governance outcomes Please rate the following factors in accordance with how you believe they currently apply to your CCG: Clarity of Purpose Undecided Purpose and vision articulated in CCG documentation, and has been formally agreed. The governing body and others in leadership roles have knowledge of the purpose and vision of the CCG. Most of membership are able to articulate purpose and vision. Decisions made by the CCG are consistent with vision. CCG objectives, strategy and business plans are consistent with mission and vision. External stakeholders recognise the CCG s approach and understand its aims. The CCG s vision has influenced partner organisations. Do you have any further comments on clarity of purpose? 6

8 Leadership and strategic direction Undecided CCG leadership and strategic goals agreed and published. Governing body members are clear on their roles, both individually and as part of a group, on the governing body. The governing body is focusing on reaching the strategic goals and are using instruments such as the assurance framework to deliver these. Business / operational plans are in place, and reflect marketplace context and strategic goals. CCG membership agrees that CCG leadership has added value to achieving CCG goals. The CCG is starting to change the local health and social care market by achieving its goals, and this is recognised by partner organisations. Clinicians new to leadership roles are involved in CCG business. CCG leaders work effectively together in support of agreed goals. Succession planning for clinical leaders is in operation. Do you have any further comments on leadership and strategic direction? 7

9 Effectiveness of relationships Undecided The CCG has articulated the key relationships and behaviours internally and externally that will help deliver the CCG goals. The CCG s working approach can be characterised by being purposeful but thoughtful about the quality of relationships internally and with key partners. There is early evidence that local providers, partner organisations, and other stakeholders recognise an effective working relationship, supported by an appropriate set of behaviours. Local providers, partner organisations, and other stakeholders agree that the CCG is materially influencing their plans and performance. Effective working relationships with local providers, partner organisations and other stakeholders are seen as a key element of the successful achievement of goals for all. Do you have any further comments on effectiveness of relationships? 8

10 Membership Undecided CCG membership participates in voting, member activities, and attends membership forums. Members generally engaged in CCG business and participate at various levels in decision-making. Members comply with decisions and policies agreed by the CCG. Members are confident that their CCG is achieving change and reaching some goals. Members agree they contribute to their CCG performance and consider their CCG model better than alternatives. There is competition for CCG leadership places. Constructive participation with CCG business by membership is the norm. Do you have any further comments on membership support? 9

11 Public and community engagement Undecided The CCG has agreed with the public and local community ways they can be involved. Public involvement is evident in the work of the CCG. The CCG has agreed approaches to transparently reporting issues to the public. Public and community engagement in decisions is real and has impact Leaders in the CCG value community input as a source of insight that helps make better decisions. The local community are advocates for the ways in which the CCG is working. Do you have any further comments on public and community engagement? 10

12 Quality and safety structures and systems Undecided The CCG has identified improvements to standards it wishes to make. CCG plans value research and the development of clinical professionals both amongst CCG members and in local providers. CCG decisions and operational plans can be linked to formal CCG structures and systems to improve care standards in line with the evidence-base. Systems are in place that enable the CCG to deliver its duty of care, including safeguarding. The CCG is starting to gather evidence that better care standards are being introduced locally. Clinical audits within primary care and in providers are showing that local practice delivers care to accepted standards of practice. A collaborative approach across the health and social care economy to drive quality is evident. The CCG has formalised new responsibilities such as collaborative commissioning. Do you have any further comments on quality and safety structures and systems? 11

13 Focus on outcomes Undecided Processes connected to beneficial outcomes are known and included in CCG operational plans. Desired improvement in outcomes agreed, and good baseline data is used by key players in CCG. There have been identifiable changes in referral patterns towards operational goals. There have been measurable improvements in metrics related to better outcomes and reported patient experience. The CCG is well sighted on early signs of shift in indicators of population health. Do you have any further comments on focus on outcomes? 12

14 Better decision-making Undecided The CCG has agreed how it will make decisions, and this includes using evidence, reliable data as the foundation to making sound decisions. Matters for decision by the CCG are supported by evidence and data. Matters for decision are supported by clear, high-quality papers, and discussions clearly involve considering the evidence. There is a consensus amongst the membership and stakeholders that CCG decisions have been thoughtfully made and are fair. Conflicts of interest issues are routinely recognised and managed. CCG decisions are robust and could not be overturned or changed as a result of poor process. Local providers, partner organisations and other stakeholders consider that CCG decisions are fair and sound. Do you have any further comments on better decision-making? 13

15 Control systems Undecided The essential architecture of good governance and quality/performance / financial systems are in place in the CCG, and an agreed operating model is in place. Control and assurance systems are starting to routinely identify outlier behaviours and rectify these. Instruments such as the assurance framework and risk register are known and understood by governing body members. The governance mechanisms in place at the CCG are useful and reliable. Governance arrangements at the CCG are valued by CCG members. Do you have any further comments on control systems? 14

16 Legal compliance Undecided The governing body members are aware of their legal duties and CCG plans reflect achieving these. The legal duties of the CCG are discussed by the governing body. CCG performance reports and reviews of operations show progress towards goals relating to legal duties. The CCG s legal duties are understood by local providers and partner organisations. Local providers, partner organisations and other stakeholders value the CCG as delivering on its statutory duties. The Governing Body s business reflects delivering the NHS constitution. Do you have any further comments on legal compliance? 15

17 Organisational effectiveness Undecided Plans in place for developing organisational effectiveness Personal development plans agreed for key staff and governing body members The governing body has reviewed its own practices and made improvements to its work. Internal stakeholders are confident of organisational effectiveness. Do you have any further comments on organisational effectiveness? What changes would most improve the performance of the CCG? 16

18 Section 3 questions specifically designed to add depth of insight from participants who are not governing body or senior staff members Please indicate the level of effectiveness that you believe the CCG has achieved in the following areas: Very ineffective Ineffective Undecided Effective Very Effective Stakeholder engagement in CCG decisions. Ensuring clarity around legal obligations of the CCG. Communicating strategic goals with all stakeholders. Focus on outcomes in CCG decision-making. Achieving strategic goals. Reference to evidence base in strategic and operational plans. How would you rate the performance of the CCG leadership in terms of delivering long-term organisational aims? Very good Good Fair Poor Very poor know - Please rate your satisfaction with the level of public and community involvement in the CCG operations. Very Satisfied Satisfied Neither satisfied or unsatisfied Unsatisfied Very unsatisfied know 17

19 In your view, what makes this CCG different to other CCGs in the country? Based on your experience with the CCG, please choose an answer which best matches the following statements: - I value my relationship with the CCG. Untrue not the case at all Modest progress has been made towards meeting the aspirations in the statement The CCG is working hard at meeting this statement and good progress is being made This statement is mostly true most of the time, but further work is still needed This statement is completely true of this CCG - I am pleased with the achievements of the organisation. Untrue not the case at all Modest progress has been made towards meeting the aspirations in the statement The CCG is working hard at meeting this statement and good progress is being made This statement is mostly true most of the time, but further work is still needed This statement is completely true of this CCG - I am confident that the CCG has effective relationships with local providers, partner organisations and other stakeholders. Untrue not the case at all Modest progress has been made towards meeting the aspirations in the statement The CCG is working hard at meeting this statement and good progress is being made This statement is mostly true most of the time, but further work is still needed This statement is completely true of this CCG 18

20 - The CCG is failing to improve the health and well-being of the local community it serves. No Opinion Please enter any additional comments here: - I trust the leadership of this CCG. No Opinion Please enter any additional comments here: - The quality of patient care is more important to the leadership of the CCG than financial balance. No Opinion Please enter any additional comments here: - I am confident that the CCG is contributing to better care for patients and their families. No Opinion Please enter any additional comments here: 19

21 - What changes would most improve the performance of the CCG? Please indicate the extent to which you agree or disagree with the following statements: Undecided CCG decisions are thoughtfully made and are fair. I have confidence in the overall organisational effectiveness of the CCG. The CCG has failed to communicate its legal duties to all stakeholders. The CCG has agreed ways of involving the public and local community. I have confidence that the CCG is achieving positive change and reaching some goals. Leaders in the CCG do not value community input when making decisions. It is not clear to me what the CCG s strategic goals are. 20

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