Business governance is often dismissed as a management process that just slows down operations and efficiency. In truth, it’s actually the key to better performance for GP surgeries, says former practice business manager Gary Hughes
Imagine a practice that followed no rules in how it managed its operations.
Consider the impact on efficiency, safety and quality if there was no consistency, monitoring or control of how things were done. And think about the damage to trust and relationships, and to the stability and long-term sustainability of a practice that worked in this way.
If you can envisage the effects of this, then you are seeing how important good business governance is. Yet in general practice, it’s an area given little time and attention. That might be because it’s a subject not fully understood by leaders and managers, or it could be there’s a naïve assumption that it’s an area that takes care of itself.
What do we mean by business governance?
Put simply, it’s how the organisation, the practice or primary care network (PCN) is managed at the highest level. In other sectors, the board would perform this role, but in general practice, responsibility for this falls to the partners and practice managers.
Good business governance is more than just a set of rules, it’s a comprehensive approach that ensures your practice runs efficiently, ethically, and effectively. It’s achieved through having the required mechanisms, systems and structures in place, so key principles are upheld. These are the values and standards that are necessary for governing all good businesses and include accountability, transparency, risk management and fairness.
Why should we worry about business governance?
As I’ve already described in the introduction, an absence of good business governance can lead to chaos and catastrophe. Despite this, even when governance is considered, often it’s only as an afterthought and also viewed as a system that just gets in the way and slows down processes. This couldn’t be further from the truth.
In contrast, good business governance will ensure that your practice or PCN operates efficiently, ethically, safely and in compliance with regulations. It provides a framework for decision-making, finance and risk management, and creates a foundation for building trust with staff, patients and other stakeholders. It is a critical component for maintaining high standards, profitability, efficiency and staff morale.
The seven pillars of business governance – a framework for assessment and improvement
The question of how to ensure strong business governance is something that every practice can do by setting aside some dedicated time and following a structured framework.
One such framework that can be used to assess and build improvement plans is the ‘seven pillars of business governance‘, a model which I have devised. It describes governance as being built on the following areas:
- Organisational Structures – a clear hierarchy, defined roles, and transparent decision-making processes.
- Effective Leadership – that drives strategy, culture, and continuous improvement.
- Regulatory Compliance – ensuring adherence to legal requirements, maintaining necessary certifications, and staying updated on changing regulations.
- Financial Management – maximising income, controlling costs, exercising prudence, and transparent reporting to ensure sustainability and quality of services.
- Risk Management – proactive identification, assessment, and mitigation of operational, reputational, and compliance risks.
- Information Governance – secure handling of business information and data, robust IT systems, GDPR compliance, and effective information sharing protocols.
- Stakeholder Engagement – building and maintaining positive relationships with patients, staff, and wider partners.
Using this framework, the practice considers each pillar in turn and follows the simple four steps described below. It’s an exercise that is best completed with input from the whole team in order to collect the most complete assessment of strengths, areas for improvement and how to implement the changes needed.
Step 1: Assessing the strength of your current business governance
The first step is identifying everything that you already have in place to support your business governance. It’s essentially answering the question, ‘what do we do now?’
For each pillar, identify the existing processes, policies, and any governance activities that you have. Examples of these will include job descriptions (organisational structures), development plans (effective leadership), financial reporting (financial management), risk register (risk management), data sharing agreements (information governance) and collaborative working (stakeholder engagement).
The easiest way to collate this is to list each pillar and the current measures alongside them.
Step 2: Identify areas for improvement
After assessing each pillar, determine where gaps exist and what improvements are needed. Key questions to consider include:
- Where are our governance measures ineffective?
- Where do we face the greatest risks and vulnerabilities?
- Where are we not proactive in responding to feedback and regulatory changes?
- How well are our governance measures integrating with our daily operations?
The information you generate here will help you prioritise areas requiring immediate attention and others for longer-term improvement.
Step 3: Develop an action plan
The next step is to create a structured action plan to implement the new measures that will strengthen your business governance. For each pillar you may have a number of actions to take so you can build your improvement plan using the following headings:
- What specifically are you going to do?
- When do you need to do it?
- What is the benefit to the practice, patients or others?
- What extra work is involved?
- What can you stop doing?
- Who will be responsible for the work?
- How will you measure success?
I’d recommend not to be overly ambitious with your timelines and what’s possible to cover, and get others involved to share the workload and maintain engagement.
Step 4: Embedding good business governance into daily operations
One of the most common obstacles to good governance is that it is not treated as an ongoing practice integrated into daily operations and is, instead, seen as a one-off chore to tick a box. The last and crucial piece of your improvement plan is to make the necessary changes and actions to ensure they continue and are embedded into ‘business as usual’.
Business governance is not about creating bureaucracy, it’s about ensuring your practice remains resilient, sustainable, and capable of delivering high-quality patient care.
By building your own strong pillars of business governance and making it part of your normal way of working, your practice can work more efficiently, safer and avoid problems that can cost significant time and money.
Gary Hughes is the founder of Leadership in Practice and the host of the Leadership in Practice podcast. He has been a practice business manager and federation director, has an MBA and a Post Graduate Certificate in Medical Education, and is an experienced facilitator, speaker and trainer.
