How do boards and executive teams promote human rights, quality and safeguarding?

Alan Hough from Purpose at Work suggests they follow these seven steps.

In last week’s article, I talked about the increasing expectations on boards and executive teams for promoting human rights, quality and safeguarding in human services. From the royal commissions, commissions of inquiry and regulators, we know that the ground has shifted: good intentions are no longer good enough. And nor should they be when the lives and welfare of the people we support and of staff are at risk.

However, members of governing bodies and executive teams are not usually present at the time of service delivery. Moreover, many directors have no background in service delivery, having been recruited to the board for other skills. So, what are the practical steps that boards and executive teams can take in promoting quality and safe service delivery?

I suggest that there are seven steps.  

First: Understand rights and responsibilities. 

Directors have both ethical and/or legal obligations for ensuring that organisations observe human rights, and that services are of quality and are safe. The emphasis on human rights is strongest in the disability sector, but I predict it will become increasingly important in other human service sectors including aged care. Directors also need to understand their responsibilities under the law. These responsibilities vary by sector, jurisdiction and the organisation’s legal status, but are increasing across time.

Second: Know about the people supported, and the people supporting them. 

Understanding the profile of the people your organisation supports helps in understanding the risks of service provision. For example, what proportion of the clients you support have higher level needs? Likewise, knowing about the profile of your staff can help understand risks. For example, many organisations will find it useful to monitor their use of true casuals or agency staff, not because these staff are inherently unsafe or untrustworthy, but because there are risks if staff are not familiar with the needs of the people they are supporting.

Third: Know the risks. 

Following on from the previous point, it is important for boards and executive teams to have a working knowledge of the organisation’s risk profile for service delivery. The Aged Care Royal Commission found that the aged care system “does not deliver uniformly safe and quality care for older people”. Its interim report is rich in lessons about the risks in aged care and how easy it is to cause harm. Likewise, for people with disability, reports by the NDIS Commission, the NSW Ombudsman, the Queensland Public Advocate and the Victorian Disability Services Commissioner identify the common causes of preventable death or harm.

Fourth: Ensure that the basics are right. 

Sophisticated responses to risk make little difference if the fundamentals are not right. This requires ensuring that everyone involved in the organisation – from the frontline to the board room – has the right attitudes and values. It also requires that the fundamentals of service delivery are right. Whether it is called person-centred practice, family-centred practice, re-enablement or recovery, it is fundamental that service delivery is based on the needs and preferences of the person supported.

Fifth: Assure that the risks are addressed. 

How does a director or executive assure that risks are addressed, when they are not present at the time that service delivery occurs? The answer is that they can’t – at least not directly – but they can create the conditions for quality and safe service delivery. Attending to the organisation’s culture, ensuring that recruitment is based on values and skills, and investing in learning and development are just some of the strategies boards and executive teams can use.

Sixth: Understand when things are going right, and wrong. 

The board and executive team need mechanisms to ensure that they are well-informed about service delivery. Obviously, it is important to know the views of clients and of staff about the services delivered. It is important to learn from complaints and other feedback and from incidents. There can also be a role for internal and external audit. But I caution about too much control. As Professor Sidney Dekker states: “Cultures of compliance seem to have become more popular than cultures of trust, learning and accountability. A culture of compliance is a culture that puts its faith in fixed rules, bureaucratic governance paper trails, and adherence to protocol and hierarchy rather than local expertise, innovation and common sense.”

Seventh: Embed learning and action. 

Identifying problems is of no value unless learning and action follows. This includes the need for building learning “loops”. For example, when an incident occurs, there needs to be assurance of “closing the loop”, i.e. checking that promised action is taken. I also advocate for “triple loop learning” from incidents: applying learning at the local level, extending that learning across the organisation, and even extending that learning across the sector.

Besides these seven steps, there are also important issues of inclusion and expertise to consider. For example, disability advocates have been vocal about the inclusion of people with disability on boards of disability service providers. The Royal Commission into Victoria’s Mental Health System argued that both consumers and carers are needed on boards and on staff. The Aged Care Royal Commission has questioned whether boards in that sector have adequate expertise in service delivery. Among those boards which use board committees, one emerging trend is to have a committee of the board devoted to quality and safeguarding, in order to build and utilise expertise. 

Boards and executive teams that address these issues will help promote human rights and help improve quality and safety in their organisation’s service delivery.

This is the second article of a three-part series. To learn more about the program Right on Board: Governing for Human Rights, Quality and Safeguarding visit purposeatwork.com.au or email alan@purposeatwork.com.au.

See part one: Boards need to be concerned about human rights, quality and safeguarding