What are the lessons for leading and managing during difficult times? Boards will need to be explicit in their decision making if they are to avoid reputational risk and judicial review. TRISCO Board considered the following Principles for Disinvestment:

1. 1. 1. The organizationis committed to improving the health of the community and the quality, responsiveness and effectiveness of services.
      2. The organizationhas limited budgets but will work with others to lever resources from within and outside the community.
      3. The organizationwill always seek to do the right thing first, and then take resourcing decisions.
      4. We will regularly assess our organization’s positionin terms of financial management, service delivery and strategic change.
      5. We will seek tospeed up system reform and re-engineering.
      6. We will scenario plan for the future, exploring the impact of decreasing amounts of growth.
      7. We will critically review our organization’spriorities and develop plan Bs for those we cannot put off.
      8. We will engage with our stakeholdersand communities in decision-making and share our decisions taken.
      9. We will be positive and optimistic.

Straightforward method of checking whether an organization is being proactive:

1. 1. 1. Assess your position in terms of financial management, service delivery and strategic change. Where are you delivering and where are you struggling? What are your strengths and weaknesses and those of your key partners?
      2. Speed up system reformand re-engineering. Do not wait.
      3. Review your team’s capabilityand capacity. It needs to be match fit. If you have team weaknesses address them now.
      4. Assess the strengthand depth of your inter-organizational relationships. The first meaningful conversation should not be about the impact of the economic downturn.
      5. Scenario plan for the future, exploring the impact of decreasing amounts of growth.
      6. Critically review your organization’spriorities and develop Plan Bs for t hose you cannot put off. Start incorporating risk assessment in planning.
      7. Be honest and realistic with staff because above all else they will be looking for leadership. Don’t withhold difficult messages. Staff will want the opportunity to contribute to solutions to wicked problems.
      8. Seek external helpif necessary, but be very specific about the outcomes you want.
      9. Keep your nerveand maintain a balanced perspective. Do not panic. Plan ahead. Future-gazing is an activity that far too few boards spend time on.
      10. Be positive and optimistic.It is OK for leaders to say they do not always have the answers, but negative emotions are infectious in organizations.

Conclusion

Good governance needs to be at the heart of the current reforms of the NHS. It is vital for the development of a vibrant healthcare market that will continue to provide high quality healthcare. Those who are working to further improve existing healthcare organizations or developing the new CCGs and HWBs need to understand and apply the principles of good governance. It is important to think through how these principles should best be applied to their own local situation. The opportunities that come with getting the right governance system in place is that a useful balance will be struck between flexibility and proper risk management, and between control and freedom to innovate. Patients and local communities will be confident in the system, and governance will become proportionate, and an asset to an organization rather than an irksome series of tasks. These principles, allied to carefully considering how your organization can be of good governance knowledge, will ensure higher quality healthcare and proper governance.