Governance Models for the Nonprofit Sector - Are Current Options All There Is?

Many models of governance have been attributed to this sector in Australia - but are they all that exists and are they enough to carry this sector forward?

The Australian Stock Exchange model that is referenced in the Principles of Good Governance takes a very 'legal' and 'regulatory' approach with its emphasis on rules, relationships, systems, processes, control and mechanisms. It looks at things from the perspective of formality and rigidity and whilst it refers to relationships, it does so within a very limited notion of formal relationships, and in so doing keeps the board in an arms-length relationship with constituents. In many cases it keeps board members, other than the Chairperson, at arms length to the CEO as well. In such a legalistic and formal model the prospect of a wide range of stakeholders to potentially feel disengaged is possibly quite high.

This model is however the one that appears to formally address many of the governance challenges that currently exists within the corporate world and perhaps, if adhered to in both principle and practice, would hopefully overcome many of the excellent examples of very poor corporate governance application that we have all become more and more familiar with in the Australian commercial world. Well known names have been embroiled in the aftermath of poor governance.

Another model often quoted in Australia is the Tricker model which seeks to delineate, along a mufti level plain, between functional aspects of inward and outward looking activity, past, present and future focus, and conformance and performance type activities. These plains are further categorized by reference to the key board functions of accountability, strategy formulation, supervision of executive activities and finally policy making.

But the question remains - is the way board governance handled in the nonprofit sector delivering for the 'communities'  that they serve, in terms of outcomes being consistent with those community expectations, and for that matter, societal expectations, or are we falling short because the focus is potentially too heavy on the legal and regulatory requirements that support the prospects of legal liability should something go wrong?

Is innovation being somehow starved for the sake of legal fundamentals? Whilst there is no doubt that efficient well run nonprofit organisations must be a fundamental aim of all who work and interact with these organisations, is there another way of delivering this whilst maintaining the confidence of those who fund these bodies?

Small to mid-sized incorporated nonprofits are experiencing massive resource challenges and yet boards remain, in many cases, stuck within the framework of complete separation between executive and managerial demarcations. In this manner, are nonprofits in Australia getting the most out of their boards?

Having difficulties with the Australian public hospital system? Try dealing with a public medical specialist unit – that’ll make you sick!

I always thought that to get a picture of the general ‘health’ of a society, one of the many indicators could well be the state of its public health system, with regards both the skills and quality of its technical expertise, how that expertise is applied in the delivery of the services for which it exists, and of course the technology and facilities that it provides.

If this is a measure, then Australia is starting to fail. Perhaps this decline has been far more advanced than I have noticed in the past. In fact, maybe the only reason I have started to notice, is the fact that I recently had to put my faith in this system owing to a medical complaint that was not straight forward and remains undiagnosed – not for want of me trying to get a diagnosis, but rather, the communication and operational inabilities of a certain, and nameless, public specialist unit attached to a major Sydney based public hospital.

Without labouring too much on the details, as these do not really add much to the overall points that I raise, the problems could best be sequentially highlighted as follows:

• Not being able to make direct contact with a living human being in the Unit, irrespective of the perceived urgency of the problem. The only contact numbers that are provided to the patient, or in fact, the patient’s General Practitioner for that matter, is an answering machine.

• Discovery that the answering machine is not checked regularly. In fact my personal experiences were that the answering machine appears not to be checked for days on end. In one case I was told that was due to the staff member being away ill, which begs the question as to due processes within the Unit. Are there only certain staff that are able to work an answering machine? Or are staff so scarce that this is a superficial function that can be overlooked?  In the second instance, there was no reason given other than to change the subject during the course of the conversation.

• Being exposed, as a patient, to potential internal political machinations within the Specialist Unit. At one point I was advised verbally by the particular person I was speaking to, who was medically qualified but not a doctor, that he/she was unsure of the “current internal politics that resulted in the doctor not making contact with you regarding your status despite me having advising him via email on two occasions to do so.” As the patient, I am not sure if I really want to, or in fact need to know, what is going on within the unit or not. Just provide the service! Remember – I am the one with the condition that they appear not to have the answer to at this stage. Do I really care what’s going on between the doctors, the nurses and the administration? Call me naive, but somehow I don’t believe this knowledge will result in an improvement to my condition.

• Being offered a suggested but unconfirmed diagnosis by a senior nurse of the Specialist Unit without hearing from the doctor – something that I actually thought was illegal?

• Not being in receipt, as at the date of this blog entry, of test results which were called for by the doctor and therefore remaining in the dark as the diagnosis. I should also add at this point, that the senior nurse provided her unconfirmed diagnosis despite her not having access to the test results either! My General Practitioner has not been informed of anything by the Specialist Unit, other than of course that I was scheduled to have some tests. (You know – the ones that no-one can give me the results of!)

As an endnote to this saga, I can now unfortunately confirm the following:

• It has been slightly in excess of three weeks from the time of completing a certain test and for which no results have been forthcoming. Frustrating, considering that I was advised that results would be available for the specialist to interpret within 72 hours.

• I have since been overseas attending a conference in the United States. During my last conversation with the aforementioned senior nurse, I indicated that I would be flying overseas and expressed concern as to precautions that I may need to take should an episode occur whilst overseas. She indicated that she would ensure the doctor would get back to me before I left. (I await this event, and am now back in Sydney).

• My blood pressure remains in normal range, something I am quite impressed with, considering the pressure of not knowing places on you – but then again I am only the patient and I am convinced that not all doctors recognise the importance of keeping this poor sucker up-to-date with their condition. Bedside 101 may not have been on all doctor’s university experiences.

Readers of this blog can let me know if I am overreacting to these set of circumstances or have they experienced this sort of sub-standard patient care in the Australian public health system – the one that is meant to be one of the best in the world and yet seems to want to vie with some of the more poorer performing systems in the western world.

Conclusion at this point – fantastic system – as long as you don’t need to interact with it. Good luck as we all get older. And I pity those elderly who can’t advocate for themselves.