Mission-first leadership for higher education

Andrew Corbett-Nolan asks what lessons university leaders might learn from their arts and healthcare counterparts

"The trouble with boards of arts organisations", said the very senior businessman sitting in front of me, "is that they forget that everything they do must be led by the art, not by the money. Money is never the problem when you allow the art to lead." I can’t tell you which massive arts organisation this impressive big shot led (but you’ll know it), but he had nailed the issue that face all boards in hard times in one. Follow what the art—or the patient, or the student, or the citizen—needs, not what the budget can, at this moment, afford. You don’t salami slice your way to success.

So to do this, the board must lead a mission-first organisation focused on purpose. This makes utter sense and when external and tangential targets are imposed, then purpose gets diverted. In healthcare for the past quarter of a century, making boards accountable for the quality of care through clinical governance has been a real bulwark against a purely financially-driven system at times when funding has not matched the needs in growth. Under austerity, when quality wasn’t put first, performance has gone off, productivity dropped, and outcomes such as the average length of life have gone into reverse.

HE under the cosh

Higher education is now under the cosh financially and councils or boards of universities are just not structured or organised in a way that allows them to grip the most important aspect of their responsibility—the quality of teaching and research. The higher education version of clinical governance—academic governance—is very much the poor child without even a Wikipedia entry.

Clinical governance was born in 1998 out of an understanding that in the midst of failure were the roots of learning that would prosper success. It is defined by Sir Liam Donaldson and Professor Gabriel Scally as ‘a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’. It has three main branches: clinical effectiveness (does the healthcare work?), patient experience (is the care acceptable to the recipient?), and patient safety (are we doing no harm?).

Clinical governance is a board accountability, and the relative responsibility of the individual clinician and the organisation they work for has been well worked through. In the early days of clinical governance, the doctors first kept quality and clinical governance very much to themselves but quickly worked out this was unhelpful and unwise because most quality failures are system failures and could only be addressed when the buck stopped with the board and not the individual clinician.

Academics have not yet understood this and (as a generalisation with notable exceptions) universities maintain a bicameral accountability of a council looking after the money and the buildings and the academics keep the quality of the teaching and research to themselves with academic boards.

Failing to look at failure

Perhaps, though, the biggest missed trick is the failure to look at failure. Recently, I have challenged university leaders to say how they learn from failure and in terms of the teaching and research, they just don’t even have an adequate way of describing it. They do examine when large programmes fail, but not when individual students or research initiatives don’t achieve their potential. The metrics around academic performance are very much skewed towards results and not the processes that produce those results. Student satisfaction too is in the foothills.

Of course, health and higher education are different, with much of health being very transactional and there being a massive corpus of research around clinical effectiveness. However, GGI believes there are lessons to be learned and, in particular, identifying and studying failure can no longer be blanked by universities. Academics too must lose their monopoly control of academic governance and fork it over to boards or councils so that universities are ‘led by the teaching and the research’.

Round-table discussion

GGI is drawing together our thinking on this with a round-table event on Monday, 28 October, to kick-start some serious discussion on this. Our key lines of enquiry are:

1. To understand any shared and differential drivers, what would constitute a simple one-page summary of the timeline for the development of both clinical governance and academic governance?
2. Is there an academic equivalent to the element of clinical governance that was to do with driving:
   1. evidence-based protocols and guidelines (clinical effectiveness)
   2. learning from failures and near-misses (patient safety)
   3. understanding what is important to service users (patient experience)?
3. Who or what (e.g., the board) is the prime locus for clinical and academic governance accountability?
4. What is the unique contribution of clinical governance and academic governance to their relevant sectors?
5. Is there any sense of primacy for, or integration with, clinical governance and academic governance with mainstream corporate governance within the two sectors?
6. Are regulators getting the best from local clinical governance and academic governance systems?
7. Are both clinical governance and academic governance multi-professional?
8. What are the arrangements for the top ‘board’ and executive leaderships for taking assurance around clinical governance and academic governance?

In short, if the thoughtful plutocrat who said that boards of arts organisations ‘must be led by the art’ were to run a university, what would he be saying?

Are these key lines of enquiry for our round-table event the right ones? We’d be delighted to hear any further suggestions for topics to cover. Please get in touch with your ideas.