COVID -19 VACCINATION PROGRAM PLANNING, IMPLEMENTATION & MONITORING – the role of governance

This post is a follow up on my post A Disciplined Approach To Develop And Deliver The COVID-19 Vaccination Program

One of the key elements of this disciplined approach is the design of a target operating model. Part of the twelve essential components of a target operating model relates to having the right "organization, governance, and management models." This post focus on the “governance” component.

Every vaccination program will have different types of groups to support them in decision making. Some of the more common groups include:

1. Steering Committee (Internal and External)
2. Technical Advisory Committee,
3. Stakeholders Advisory Committee, and
4. Program Implementation Committee

Clarity of the roles and the inter-relationships between them is fundamental to avoid confusion, delays, duplication, fragmentation, and unnecessary conflict. Meetings agendas of these groups will be stack with “important” items. Discussions at these meetings will raise plenty of views, opinions, and perspectives on a wide range of competing priorities. The challenges of distinguishing the importance from trivia, the urgent from strategic for this program when the context, environment, and timeline is continually changing should be evident. If your organization or program is facing this dilemma, it is time to take a hard look at the governance model and a re-set maybe necessary.

The requirements of a post-implementation review is another important reason for this governance re-set. One of the areas of the review will be the role that governance played. The details set out below will likely form part of the review.

This article focuses on essential aspects of a governance model.

Governance

Strong governance is as important as having a strong program team to ensure a successful COVID-19 vaccination program. Both play different and complementary roles that provide the necessary checks and balances that a COVID-19 vaccination program needs.

Governance is more than having a "steering committee", "expert advisory committees,"and "oversight committees." The effectiveness of any governance is getting the synergy between:

1. clarity of mandate, authority, and accountability
2. skills, knowledge, experience, and diversity of members
3. right agenda and communication of governance meetings
4. proper chairing of meetings, and
5. appropriate, timely, and high-quality decision making

Clarity of mandate, authority, and accountability

Too many governance groups are setup without clarity of mandate, authority, and accountability. The person(s) setting up any governance group should provide a "terms of reference" document that sets out the following:

1. the scope and mandate
2. the authority and accountability
3. process and ability to amend or vary the scope, mandate, authority or accountability
4. reporting requirements and frequency
5. term of appointment
6. decision-making process – consensus or voting on each agenda item. If voting, the percentage required to carry any motion put forward
7. appointment of the chair, deputy chair, and acting chair
8. the quorum for any meeting
9. form of the meeting – public or private
10. attendees of meetings

All members should understand and be committed to all of the above. It is a best practice that the first meeting of any governance group confirms its "terms of reference."

It is important to have a record any governance group has discussed, understands, and agrees on the terms of reference for their appointment.

If this has not been done, there should be an agenda item on “terms of reference” at the very next governance meeting. The agenda paper recommendation should read “the board/committee have discussed, understands and agrees with the terms of reference of appointment”

Skills, knowledge, experience, and diversity

A strong governance board requires members to have the right mix of skill, knowledge, experience, and diversity. The importance of a Covid-19 vaccination program requires those appointed to be:

1. experience and skill in governance,
2. knowledgeable of both implementing a vaccination program as well as of Covid-19, and
3. diverse to bring broad perspectives and views in governance discussions and decision making.

The Covid-19 vaccination program is and will be a complex venture and requires strong governance. The potential for delays, fragmentation, cost overruns, and failure is high. Regardless of whether the appointments are internal or external, it is certainly not the time to appoint members that do not meet these criteria.

Right agenda and communication of governance meetings

The agenda for governance meetings needs to cover items that provide insight into how the program is progressing. From the very beginning, the board should be clear on the program's essential elements that require their oversight. There should also be a regular process to review whether new elements should be added to the list.

Setting the agenda for any meeting should be a disciplined process. The chair should discuss with members and program Senior Responsible Officer before setting the agenda of any meeting. The agenda should have:

1. Strategic overview of the scope of the program
2. Key operational items needing board input:
3. Significant changes in internal and external drivers and environment crucial to the program

Under each of the heading, the chair should decide for specific agenda items:

1. Why and for what purpose each item is on the agenda?
2. What information and the level of details required?
3. What other related parts of the program that should be discussed?

Every agenda item should have the following purpose:

1. Discussion for the understanding of the issues
2. Discussion on the options to address the issues
3. Decisions required to resolve and advance the issues

The outcome of every board meeting should be properly communicated to different interested parties. The content to be communicated need to be appropriate for each stakeholder. Some of the obvious interested parties include:

1. “owners/Ministers” who appointed them
2. program team
3. other stakeholders

Chairing of governance meetings

In any meeting, the charing often determines the usefulness of the meeting. The chair of the meeting sets the tone of the meeting. Some important key roles of a chair include:

1. discussions and inputs into agenda items are relevant, respectful, and professional
2. ensuring all members contribute and provide their perspective on every agenda item
3. managing diversity and disagreements of perspectives in the meeting
4. ensuring that all agenda items are given due consideration
5. ensuring that members requesting for specific items to be on the agenda take responsibility to lead and summarise the resulting discussions or decisions
6. summarizing the outcome of all agenda items at the end of the meeting and
7. outlining the key communication messages from the meeting for various stakeholders

The complexity of challenges for a COVID-19 vaccination program requires a chair that ensures every meeting is a master class in governance at the highest level. The minutes of meetings should bear witness to this high quality of chairing.

Appropriate, timely, and highquality decision making

Every agenda item deserves proper consideration by members. To that end, any agenda item needs to have clarity of purpose, appropriate, and timely information. Agenda items typically should be tabled for members discussion to:

1. understanding of important issues. In which case, the recommendation in agenda papers should be for members to “note and provide comments."
2. consider options to address a set of issues that already have been discussed to achieve a common understanding. In which case, the recommendations in agenda papers should be for members to "noted options, provide feedback including any new options."
3. make a decision on the preferred option based on previous discussions on options and a sound understanding of the issues

An understanding session is to listen to all perspectives and not require members to agree or disagree on the different perspectives discussed. An exploring options session requires members or program staff putting up any option to demonstrate whether all perspectives from the understanding session has been taken into account. Finally, a decision-making session needs to demonstrate that all options have been properly explored and why a particular option has been recommended.

For straightforward and non-complex agenda items, all three purposes may be possible in one meeting. However, it is important that complex issues go through three distinct phases of understanding, exploring options, and finally deciding.

Final word

A successful COVID-19 vaccination program is considered an important driver to re-open economies and societies. The pressure to stand up a successful program in 2021 will be enormous.

Having a fit for the purpose governance model as part of a target operating model can be the difference between a failed, mediocre, or successful COVID 19 vaccination program.

Following the disciplined approach to have a fit for purpose governance will provide documentary evidence for any future review or inquiry into how well the COVID-19 vaccination program was developed and delivered.

Developing and delivering a COVID 19 vaccination will be a career-defining responsibility for any Cabinet member, Secretary, or Director-General of Health. Those doing it on their behalf will also be defined by how well the COVID-19 vaccination program is developed and delivered. Selecting the right governance model and the right people to fill these roles may very well be career defining decisions for all concern.

Chai Chuah 12th October 2020 Wellington, NEW ZEALAND

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