Manx Care: Proposal for the Incorporation of a Professional Executive Committee

1. Introduction

The purpose of this document is to propose the strategic incorporation of a Professional Executive Committee (PEC) into the management and governance framework of Manx Care. This proposal is inspired by the model found in NHS primary care trusts and aims to enhance decision-making processes, healthcare delivery, and align with the Health and Care Transformation Programme initiated by the Isle of Man Government.

2. Background

Manx Care, established under the Manx Care Act 2021, is tasked with delivering high-quality, integrated health and social care services. The current management structure has navigated the complexities of healthcare provision effectively. However, the introduction of a PEC could further strengthen governance and strategic oversight.

3. Proposal Overview

The PEC is envisioned to bring professional expertise and executive oversight, with roles and responsibilities clearly defined for each executive member. The committee will report directly to the Manx Care Board and be accountable for strategic planning, monitoring healthcare outcomes, regulatory compliance, and stakeholder engagement.

4. Proposed Management Structure

1. Board of Directors

-The **Board of Directors** oversees the overall governance and strategic direction of Manx Care. It includes both executive and non-executive directors. It should be chaired by an MHK and have a Manx resident majority,

- Responsibilities:

- Setting the vision, mission, and strategic goals.

- Ensuring compliance with legal and regulatory requirements.

- Allocating resources effectively.

2. Professional Executive Committee (PEC)

The PEC comprises a cohesive team of clinicians and managers. It serves as the bridge between clinical expertise and operational management.

- Composition:

- Chair: Elected from local health & care professionals.

- Members:

-          Clinicians: Representatives from various specialties (e.g., physicians, nurses, allied health professionals), from hospital, community & mental health

     - Managers: Operational leaders responsible for service delivery, finance, and administration.

- Roles and Functions:

- Clinical Leadership: Driving evidence-based practice, quality improvement, and patient-centred care.

- Resource Allocation: Prioritizing funding and resources based on clinical need.

- Service Redesign: Collaborating on service development and improvement.

- Commissioning: Engaging in Evidence-based commissioning and strategic planning.

- Clinical Policy Development: Collaborating with specialty teams to formulate evidence-based clinical policies and guidelines.

- Quality Assurance: Regularly reviewing clinical outcomes, patient safety, and adherence to standards.

- Resource Allocation: Participating in budget planning, resource allocation, and service development.

- Risk Management: Identifying and mitigating clinical and operational risks.

 - Engagement and Communication: Engaging with staff, patients, and the public to ensure transparency and accountability

- Guiding Principles:

- Evidence-Based Decision-Making:  Ensure decisions are grounded in research and best practices.

- Patient-Centeredness: Always consider the impact on patients and their well-being. Consider including patient representatives in PEC

- Collaboration: Foster partnerships between clinicians and managers.

- Transparency: Communicate openly with stakeholders.

-Clinical Leads and Subcommittees

- Within the PEC, establish clinical leads for key areas (e.g., mental health, primary care, acute services).

- Create subcommittees to address specific issues (e.g., quality improvement, workforce development, finance).

- These subcommittees will include both clinicians and managers, working together to achieve organisational goals.

Governance Framework

- Develop a robust governance framework that aligns with the PEC's responsibilities.

- Regular Reporting and Accountability

The PEC will report directly to the board of directors. Regular updates on performance, achievements, and challenges will be shared. The PEC will also engage with the council of governors, fostering a strong link between the hospital and its members. Regularly review and update terms of reference, ensuring clarity on roles, responsibilities

5. Alignment with Manx Care’s Mandate

The PEC will support Manx Care’s mandate by providing strategic leadership, enhancing the quality of healthcare services, ensuring effective resource utilization, fostering a culture of continuous improvement, and engaging with stakeholders to align services with community needs.

6. Meeting Financial Targets

The PEC will aid in meeting financial targets through strategic financial oversight, budget management, value-based care models, technology investment, performance metrics, and regulatory compliance.

7. Enhancing Efficiency and Reducing Waiting Lists

The PEC could potentially enhance efficiency and contribute to the reduction of waiting lists by streamlining decision-making, optimizing clinical operations, allocating resources effectively, monitoring performance, promoting innovation, and engaging stakeholders.

8. Fit with the Health Transformation Programme

The proposal complements the Health and Care Transformation Programme by ensuring strategic alignment, operational efficiency, quality and safety, stakeholder engagement, resource management, innovation, and governance and accountability.

9. Cultural improvement

There have been many reports of the cultural difficulties within the organisation.

-          The PEC can provide clear leadership and a shared vision, which are essential for fostering a positive organizational culture. By setting strategic priorities and aligning them with the organization’s values, the PEC can create a sense of direction and purpose¹.

-          Employee Engagement: The PEC can enhance employee engagement by involving staff in decision-making processes and considering their feedback. This inclusion can improve morale and create a culture of collaboration and trust².

-          Communication**: Effective communication channels established by the PEC can ensure that all employees are informed about organizational goals, changes, and achievements, which can help in building a transparent and open culture².

-          Performance Management: The PEC can implement performance management systems that align with the organization’s cultural values, encouraging behaviours that contribute to the overall success of Manx Care¹.

-          Professional Development: By prioritizing professional development, the PEC can contribute to a culture of continuous learning and improvement, which can help in retaining and attracting top talent¹.

-          Recognition and Reward: The PEC can oversee recognition and reward systems that acknowledge and incentivize the desired cultural behaviours, reinforcing the values of the organization².

-          Cultural Guardians: As a governing body, the PEC can act as the ‘cultural guardians’ of Manx Care, ensuring that the organizational culture is maintained and strengthened over time².

-          Change Management: The PEC can lead change management initiatives, helping the organization to adapt to new challenges while maintaining its core cultural values¹.

-          Diversity and Inclusion: The PEC can promote diversity and inclusion within the organization, which is key to creating a respectful and dynamic culture².

-          Quality and Safety: By emphasizing quality and safety in healthcare delivery, the PEC can instil a culture of excellence and accountability¹.

-          By involvement of PEC members in the appointment of senior management posts.

10. Potential Drawbacks and Mitigation Strategies

Potential drawbacks include complexity in decision-making, cost implications, risk of bureaucracy, management vs. Leadership focus, resistance to change, regulatory overload, and professional interests. Strategies to mitigate these drawbacks include establishing a clear governance framework, conducting cost-benefit analysis, implementing streamlined processes, investing in leadership development, developing a change management strategy, seeking regulatory guidance, ensuring balanced representation, and promoting shared decision-making

11. Conclusion

The integration of a PEC within Manx Care’s management structure represents a progressive step towards enhancing the quality and governance of healthcare services. The proposal sets the foundation for a robust and dynamic leadership team that will drive Manx Care towards excellence in healthcare provision.