The pipes and wires of good governance by Philippa Slinger

Philippa Slinger, senior GGI associate and former director of nursing, NHSE/I improvement director, NHS trust CEO and system chief executive explains why she does what she does

I started out as a nurse and worked my way to become a director of nursing. For five years I watched my CEO do his job and thought ‘I could do that’.

When he left, I applied for the job – and got it. It was only then I realised that absolutely everything and anything that happened in that organisation was my responsibility.

Stuff started coming into my in-tray that I had absolutely no idea how to manage, but I muddled through until I got my next job, as chief executive of Berkshire Healthcare, a start-up trust where we had to take services out of four existing organisations and bring them all together to create a new one.

Pipes and wires

One of the non-executive directors at Berkshire had worked a lot in the aviation industry. He knew a lot about patient safety and governance and he used to talk about it all the time. I used to think it was nothing more than mindless bureaucracy. But he went on about it so much that I started to learn about it despite myself, and introduced systems and processes across the trust.

It was only then that I realised you didn’t need to know about everything. If you’ve got the right pipes and wires in your organisation, you can push something into the right pipe or wire and you’ll know that the right people are going to look at it and do something with it. Then it will come back to you with some sort of progress update. All of that happens provided you make the pipes and wires work effectively.

It’s like the first fix of the electrics and plumbing in a new build; if it’s not done correctly, when someone goes to turn on the light, nothing happens. The analogy being the raising of a risk or concern, the witnessing of a serios incident; without the pipes and wires, the issue may never be known, managed and future occurrence mitigated.

After five or six years at Berkshire Healthcare, I felt like a glorified administrator because stuff would come in and I’d push it down a pipe or a wire to be dealt with. And I realised that this massive load you had to take on and worry about and be accountable for as a chief exec wasn’t so worrying after all because you knew it was being handled.

Life-saving governance and dispensable leaders

My time at NHSE/I taught me that if you walk into a special measures trust you absolutely understand why governance is so important. Because people can come to serious harm where there isn’t governance. Risks aren’t identified, issues aren’t raised, the important stuff doesn’t reach where it needs to reach to be actioned... In every special measures trust I’ve ever been to, the biggest issue has been a lack of governance and an understanding of its importance in patient safety.

Stable and long-term leadership is generally a good thing but sometimes that means that everything works because the leaders know who to call and where to go for the information they need. That is great, but may mean that the essential pipes and wires needed to ensure effective governance is missing as it hasn’t been needed.

One of the most important things you can do as a leader is to make sure you’re dispensable – that there’s nothing that is completely dependent on you. Because if the whole system of decision-making and authority depends on you saying yes or no, or knowing who to speak to, it all falls apart when you go.

A well-governed organisation

A well-governed organisation is one that means you can manage the accountability as a chief executive – it means you can sleep at night – but most importantly it means reduced risk of harm to patients.

I like it when you help put in governance systems and you see people visibly begin to relax because the stress of everything they’re trying to carry without having those systems and processes in place begins to dissipate and they absolutely know that things are being dealt with. That’s why I do what I do.