It's risky out there...

Listen to the news these days and, aside from sporting triumphs, it’s sometimes hard to see beyond the doom and gloom. If you are a leader do not despair, you can navigate a safe path by keeping your Board Assurance Framework (BAF) up-to-date.

What’s a BAF? Essentially it is a means to assure the board that there are clear objectives, that the potential risks to success have been identified clearly, assessed, and that robust plans that work are in place to deal with whatever is thrown at you.

Putting one together, or updating one, is very simply about projecting into the future and anticipating what might happen. You don’t need a crystal ball or special powers, you’ll find that your knowledge of the environment in which you work, enhanced with the knowledge of your colleagues can generate a pretty accurate picture of what might happen.

Quick note – it’s not all about what could go wrong, this is also about imagining what could happen that you can take advantage of and being prepared to take that advantage.

The principles can be applied to any enterprise.

This blog if focussed on the health and care system. It is based on an article in The Guardian by Nicola Davis.

For the purposes of this blog, I have created generic objectives. You of course will have your own emphases but this should help you update your BAF.

Objective 1: To support the community to keep well and provide timely interventions when needed.

Risk: If there is a new wave of Covid infections in the autumn and winter, community illness and hospitalisations will increase, leading to pressures on the wider system and worse outcomes for patients. Likelihood: Likely (4) Impact: Major (4) Risk score: Significant (16)

What can be done to control the risk? That depends somewhat on what part of the system you work in. It could include:

1) Offering vaccines/boosters to vulnerable people and all over 50s.

2) Reinforcing good hygiene including wearing of masks in crowded/poorly ventilated places.

What assurances will you see i.e. how will you know if these measures are working?

1) Increased number of fully vaccinated population

2) Lower numbers of infections/hospitalisations than modelling suggests and/or in comparable parts of the country/world.

Risk: If influenza hits harder than in previous years (due in part to waning levels of immunity in the population) then more people will be vulnerable to catching flu leading to increased community sickness and an increase in hospitalisations.

Likelihood: Likely (4) Impact: Major (4) Risk score: Significant (16)

What can be done to control the risk?

1) Promoting the uptake of flu vaccines

2) Promoting flu avoidance

What assurances will you see?

1) Increased proportion of people receiving the vaccine, particularly in vulnerable groups.

2) Lower numbers of infections/hospitalisations than modelling suggests.

Risk: If not enough is done to support people through the cost of living crisis then more people will not be able to keep themselves well (due to not eating properly and not heating homes adequately), leading to increased demand for health and care services.

Likelihood: Likely (4) Impact: Significant (4) Risk score: 16

What can be done to control the risk?

1) Lobby decision-makers to assess the need and invest in mitigating measures.

2) Work in conjunction with health and care providers and commissioners, community groups, charities, and faith organisations to understand where support is needed and facilitate support getting to those in most need.

What assurances will you see?

1) Positive impact of lobbying

2) Positive feedback from networks and the community that support is at sufficient levels

3) No increase in numbers of people seeking health interventions due to malnutrition and coldness related illness.

Objective 2: To have a robust workforce in place to maintain high quality service

Risk: If not enough isdone to fill vacancies and increase staff retention in health and care organisations then there will not be enough staff to meet existing demand and increased demand (see above risks) leading to longer waiting times and worse outcomes for patients, and

increased stress and sickness absence for those staff who are in post.

Likelihood: Likely (4) Impact: Major (4) Risk score: Significant (16)

What can be done to control the risk?

1) Step up recruitment from overseas

2) Increase investment in staff welfare interventions and devolve some training/support budgets to local teams to respond to immediate needs.

3) Ensure staff voice is heard at board level and that proportionate actions in response to concerns are implemented.

4) Lobby decision-makers for an adequate pay increase, particularly for lower paid staff.

What assurances will you see?

1) Reduction in vacancy levels

2) Decreased reliance on agency staff

3) Increase in staff satisfaction levels

Objective 3: To ensure good custody of taxpayers’ money ensuring

Risk: If the pay award is not fully funded then additional savings will need to be found from elsewhere leading to potential cuts in services, increased waiting times, and worse outcomes for patients.

Likelihood: Likely (4) Impact: Moderate (3) Risk score: High (12)

What can be done to control the risk?

1) Pre-emptive work to identify existing inefficiencies where savings can be made safely

2) Ensuring there are no perverse incentives for not generating savings and that no one is penalised for making savings.

3) Open conversations across health and care systems to identify blockages and inefficiencies and reshaping services accordingly.

What assurances will you see?

1) Improved assurances from value for money audits

2) Robust financial reporting with projections and early implementation of mitigations

3) Expenditure not exceeding income.

Conclusions

Obviously this is a very high-level assessment of what could be useful to have in your BAF. Do these risks, controls, and assurances resonate with you? How are you managing risk and how confident are you feeling about the next 6-12 months?

Photo credits (all Dreamstime except Be Kind):

Doom/Gloom: Adonis1969

Business Vision: Microvone

Covid Graph: Renegadewanderer

Influenza: Leyasw

Be Kind: John Cameron (Unspalsh)

Jobs: Boarding1now

Currency: Aoutphoto