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Clinical governance requires board directors to go beyond ‘traditional’ governance practices

Clinical governance requires board directors to go beyond ‘traditional’ governance practices

According to the Australian Charities and Not-for-profits Commission (ACNC), there are about 60,000 registered charities in Australia, working in a range of areas including health, education, social welfare, religion, culture, human rights, the environment and animal welfare.  The latest AICD NFP study seeks to explain the unique challenges facing boards and directors in the not for profit (or for purpose) sector.

The 2022–23 study has again been conducted in organisations working with the nation’s most vulnerable individuals.  It’s clear they’re under increased pressure and scrutiny. 

‘We’re seeing directors spending more time on their role.  The expectations from society probably means that will continue to increase,’ the report states.

The complexity of the issues facing organisations in the NFP sector means they face challenges measuring their progress towards achieving their purpose. 

Among organisations that provide care or support services, 60 percent said they relied upon ‘CEO and management reports’ to ensure service recipients received appropriate care and support.  Only 16 percent of health and residential aged care, and 12 percent of social services organisations used their expert care committees to ensure the appropriateness of care and support for recipients. 

In response to the findings, the report asks a couple of key questions relating to clinical governance:

  • Does a traditional governance model enable directors to really understand the quality of care provided or the effectiveness of their organisation?
  • Will directors need to get their hands ‘dirty’ or have their ‘noses further in’ to the operations of their organisation? 

Those of us involved with clinical governance over a long period know that we do have to get our ‘noses further in’ to enact our role as the ones ultimately accountable for care quality and for the safety of those we serve. 

We have to dive down. We are required to assure ourselves that executives are implementing clinical governance systems to manage clinical risk and support staff to provide consistently good care.  This requires more questions about operations than you might see in other governance committees such as Finance and Audit.  Of course, board directors can’t tell the executive how to provide good care.  But they can – and must – seek assurance that executives:

  • Know how to provide consistently good care (the consistency is challenging)
  • Are implementing those standards and systems with staff, to support staff
  • Monitor system effectiveness and know how to manage change for concrete and lasting improvement.

Accessed on 19/02/23 at:

The Australian Institute of Company Directors (AICD) Not-for-Profit Governance & Performance Study 2022-23.  AICG Feb 2023. Accessed at: