Whose decision is this? How professional and operational governance differ in a complex health system

Ms Elizabeth Dalla Santa1, Ms Andrea Bramley1,3, Dr Debra Mitchell1,2

1Monash Health, Melbourne, Australia, 2Monash University, Melbourne, Australia, 3La Trobe University, Melbourne, Australia

Background: Governance structures form the foundation of safe and effective patient-centred care. Professional governance upholds regulatory standards, ensures employees are appropriately qualified, credentialed and working within their agreed clinical scope of practice. Operational governance ensures sustainable and effective use of resources. When allied health employees report operationally to a manager of different professional background, the delineation between operational and professional governance can be unclear. This interplay in complex healthcare organisations can create ambiguity resulting in inconsistencies in the implementation of professional standards.

Aim: To develop an organisation-wide allied health RACI (Responsible, Accountable, Consulted, Informed) Matrix, to determine ultimate accountability for professional governance within a complex, metropolitan healthcare organisation.

Method: An iterative process of focus groups and interviews with allied health leaders, which explored the function of various roles in professional and operational governance process. Drawing from initial interviews, case studies such as recruitment and performance management were created and explored. A RACI Matrix and Implementation Tool was developed and embedded in the Allied Health Governance procedure.

Results: Allied Health leaders (n=41) from across the organisation participated in a single or series of focus groups to determine who was accountable and responsible along operational and professional reporting lines. The in-depth consultative process created high levels of engagement amongst a diverse allied health workforce, deepening understanding of governance. Through the creation of shared language, the RACI Matrix, and implementation tool support managers in decision making.

Conclusion: The RACI Matrix provides guidance and clarity to allied health leaders in their governance roles.


Liz is the Manager of Physiotherapy & Exercise Physiology (subacute) and Allied Health Workforce Advisor for the Workforce, Innovation, Strategy, Education & Research unit at Monash Health, Melbourne. She holds a Master of Health Management (UNSW) and is undertaking her Master of Business Administration (AGSM). Liz has a clinical background in paediatric physiotherapy and is currently Principle Investigator for two funded research projects at Monash Health. She has a passion for leading teams with a strategic and innovative focus, fostering a sustainable and contemporary allied health workforce.

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