One of the risks in governance isn't missing data, but data we've become used to seeing. Eight falls last month become six this month; medication incidents remain broadly stable, training compliance sits at 96% and most actions are green. On the face of it, there may be little to cause concern.

Governance systems are designed to help organisations understand quality, identify risk and maintain oversight. The information they produce is essential, but it can also create a level of reassurance that isn't always matched by what is happening in practice.

A recurring number on a dashboard can gradually become an expected number. Actions are closed because the required tasks have been completed, training reaches its target and an audit scores 95%. Taken together, the picture may appear reassuring, but it still leaves an important question: has the underlying risk actually changed?

Research into healthcare performance measurement has identified some of the unintended consequences of relying heavily on measures and targets. Mannion and Braithwaite describe, among others, “measurement fixation” and “tunnel vision”, where attention can become concentrated on what is being measured rather than the wider purpose behind it. Measurement is not the problem; the risk comes when achieving the measure begins to matter more than what it was intended to tell us.

Training compliance is a good example. It tells us that training has been completed, but not whether staff are consistently applying their learning in practice. Closing an action confirms that something has been done, but not whether it solved the problem. An audit score reflects what was found within the sample reviewed; on its own, it cannot tell us what care feels like to the person receiving it.

False assurance does not necessarily come from inaccurate information. It can come from expecting data to tell us more than it can.

Familiarity presents another problem. Research into safety has explored how departures from expected practice can gradually become normalised when they occur repeatedly without an obvious adverse outcome. It is worth considering what this means when reviewing information that appears month after month. If falls remain at Six, Seven or eight every month, is that evidence of stability, or has five or six simply become the number we expect to see?

The falls figure alone cannot answer that. Understanding what is happening means looking at who is falling, when and where incidents occur and whether there are patterns involving medicines, mobility, hydration or staffing. It also means looking at care records, listening to what staff are noticing and, importantly, hearing from the people receiving care.

CQC expects providers to use information about risk, performance and outcomes to monitor and improve quality. Research into care-home leadership also highlights the influence of leadership, staff involvement and organisational support on person-centred care. Good governance therefore depends not only on having information available, but on being willing to question what that information appears to show.

Governance gives us information and oversight. Meaningful assurance tests whether what we think we know reflects reality.

A green dashboard should inform the conversation, not end it.

 

References

Banja, J. (2010) ‘The normalization of deviance in healthcare delivery’, Business Horizons, 53(2), pp. 139–148. doi: 10.1016/j.bushor.2009.10.006.

Care Quality Commission (2025) Governance, management and sustainability. Assessment framework: Well-led. Last updated 7 January 2025.

Mannion, R. and Braithwaite, J. (2012) ‘Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service’, Internal Medicine Journal, 42(5), pp. 569–574. doi: 10.1111/j.1445-5994.2012.02766.x.

Moenke, L., Handley, M. and Goodman, C. (2023) ‘The Influence of Care Home Managers’ Leadership on the Delivery of Person-Centred Care for People Living with Dementia: A Systematic Review’, Journal of Nursing Management, 2023, Article 9872272. doi: 10.1155/2023/9872272.

 

About the author

Cheryl Baird is a Registered Nurse and adult social care consultant specialising in quality assurance, governance and regulatory improvement. Having held senior operational and quality leadership roles across social care, Cheryl now works with providers to strengthen assurance, improve quality and move beyond compliance towards evidence of meaningful and sustained improvement. www.cherylbairdconsultancy.co.uk