Assurance Frameworks:
How do you know what you need to know?
Guy’s and St Thomas’ (GSTT)

Foundation Trust – 2004

900 year history

Three hospitals on 2 separate sites

~750,000 patient contacts per year

Annual Budget £700m

~9,000 staff
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The N.E.D.s’ dilemma

Changing accountability/roles for NEDs

CEO turnover

Increased regulatory framework
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The Regulatory Framework

Healthcare Commission

Monitor or SHA

Primary Care

Special Authorities

Local Authorities

Patients and Public
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So in the past, how did we
know what we needed to
know?
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Different strokes for different folks

Using King’s Fund support mechanisms

Direct liaison with frontline staff

‘NED only’ meetings within the trust

Close working with executive directors
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Do these strategies still
work in the new world?
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What is the New World?

New processes/behaviour to support new
form of regulation

Changing emphasis for committees

‘Comply or Explain’

Media scrutiny
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So…..what do you know now?
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What we found………

Data vs. Information

Process vs. Outcome

Management vs. Assurance
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What we found…(contd.)

Measuring what matters

Imbalance of proactive vs. reactive

Dilution factors
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Process vs. Outcome
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This means…….
understanding the difference between:

Policy

Practice

Performance
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So where did we go next…..?
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Start of a long journey…..

Review of risk policy, practice & performance

Assurance directory, map and training

Strengthen BAF

Review of committee structures

Map of organisational policies
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Assurance Framework

Purpose of framework

Perception of its functionality

Process of population
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Using the BAF

Accountability

Differentiating controls & assurances

Value of assurances
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Committee Structures

Does one size fit all?

Breadth & depth of assurance agenda

Meaningful involvement
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So what else?
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Challenges Faced

Tensions created

Critique is not criticism – Executive
sensitivities

Information overload

Creating effective filters

Establishing intelligent information
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What now?

Shifting the balance to assurance

Understanding new risks

Developing knowledge and skills

Maintaining the horizon scanning

Comparing ourselves internationally
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Assurance Frameworks:
Anna Tapsell, Non-Executive Director
Eileen Walsh, Director of Assurance