The characteristics of effective governance of healthcare quality in Australian public hospitals

© 2018 Dr. Alison Mary Challis BrownPatients are sometimes harmed in the course of receiving hospital care. Increased awareness of harm and a board’s ultimate responsibility for healthcare quality have focussed attention on processes of governance. Research in this field, through cross-sectional surveys undertaken mainly in the US, has found variable engagement in a limited set of governance processes. Survey evidence indicates a positive association between boards more engaged in these healthcare quality processes and healthcare quality outcomes, but is unable to explain variable engagement. Emerging research has begun to illuminate a number of factors, such as communication and trust, mediating engagement in healthcare governance. This thesis builds on existing research to investigate the characteristics of effective governance of healthcare quality in Australian public hospitals. Through a comparative case study of eight hospital networks in Australia this thesis investigates both how board members and managers work together to govern healthcare quality, and factors that influence engagement in that work. A conceptual framework is developed to guide the empirical investigation. This framework, mapping commonalities between governance and related team literatures, outlines taskwork, input and teamwork constructs influencing governance. The empirical evidence presented in this thesis provides a more comprehensive understanding of healthcare quality governance processes than previously described in the literature. A range of factors influencing engagement are identified through comparing and contrasting cases with different levels of taskwork engagement. Most framework constructs are found to influence engagement in taskwork processes, however, several modifications and additions are made to constructs. These changes are reflected in the revised framework, the Healthcare Governance Performance Framework (HGPF). The HGPF brings together, for the first time, a comprehensive range of factors influencing the effective governance of healthcare quality, some of which have received little attention in the literature to date. These factors are found to interact in complex and unique patterns at each case. The HGPF provides a sound basis for undertaking theory-led research in healthcare governance. This study finds effective corporate governance of healthcare quality is characterised by board members and managers who are engaged, focussed, vigilant and reflective. The results of the study highlight the need for investment in board member and management skill development, healthcare quality governance guidelines, healthcare quality data and evidence