The establishment of new integrated care services in diverse settings across NSW represents an innovative approach to providing primary health care for the community. HealthOne NSW services involve a range of participants and stakeholders that varies from site to site and can include the NSW Ministry of Health, Local Health Districts, general practitioners, Medicare Locals, Local Government authorities, non-government organisations and other service providers. These participants come together through a governance structure that can begin to be established early in the service planning process and continues to be developed as the service itself is developed.
HealthOne NSW services require new ways of working for all concerned, and the establishment of suitable governance arrangements which meet individual and collective needs and comply with relevant legislation.
In the context of the HealthOne NSW services, corporate governance refers to the arrangements, structures and processes for decision-making in relation to corporate and organisational issues and the roles and responsibilities of the participants in relation to the financial, contractual and business arrangements for the service.
The three broad areas requiring the formalisation of processes for decision-making in HealthOne NSW services are:
- the nature and mechanisms for delivery of integrated primary care services to the community;
- premises/site for service delivery – property arrangements, ownership, leasing/licensing, fit-out and financing;
- corporate governance – the overarching administrative framework for the development and ongoing operation of the HealthOne NSW service.
The HealthOne NSW Governance Guidelines have been developed to assist and guide Local Health Districts and other parties in the establishment of suitable, workable corporate governance arrangements for HealthOne NSW services. The recommended approach and resources in the document have been informed by the experiences of existing HealthOne NSW services with multiple configurations.
Clinical governance relates to specific clinical decisions relating to aspects of quality care, safety and client needs. Clinical governance integrates clinical decision-making in a management and organisational framework and requires clinicians and administrators to take joint responsibility for the quality of clinical care delivered by the organisation.
There are many dimensions to sustainability. In a general sense they can be grouped into the following six domains:
- political - taking into account local, state and national political contexts;
- institutional - relationships between and within institutions;
- financial - availability of general funds, specific funds and incentives;
- economic - affected by interactions between funding models and models of care, staff time and workload issues;
- client - dependent on expectations, experience and out of pocket costs for clients; and
- workforce - staffing profile, skills and staff motivation.