The Case for Independent Assurance in Care Governance
Mark Rigotti GAICD’s recent AICD article, “Why care governance must be central to board strategy”, resonated with me, particularly the idea that governance can look strong on paper, while outcomes still fall short where it matters most.
Over the last decade, Projects Assured has worked with a range of not-for-profit and care-giving organisations supporting significant transformation programs under intense scrutiny, with real impacts on Australians. A consistent theme is that boards can be well-intentioned, capable and diligent, and still be exposed to blind spots created by the way information flows upward through the organisation.
That is where independent assurance matters, not as another “layer” of reporting, but as a different line of sight. Rigotti uses the phrase “When assurance isn’t insight”. I agree with the problem he is pointing to. Assurance can become performative, with lots of activity and limited learning. Done properly, it tests whether the information system itself is fit for purpose, especially in care settings where blind spots have real human consequences.
Assurance complements good governance
Boards are being asked to carry more accountability than ever, and in many cases they are trying to meet that accountability with the same tool they have always used: management reporting. The AICD has noted that management reporting remains the primary mechanism for monitoring care outcomes, even as expectations rise and scrutiny intensifies.
While it is rational for boards to seek additional insight from management, requesting more detail from within the system is sometimes like asking a fish to describe the water. The response can be entirely reasonable (“What’s water?”), and limited in perspective by immersion.
Modern organisations are increasingly specialised. That specialisation is necessary, but it comes with a trade-off. Risks can sit in the gaps between functions, measures and hand-offs. Independent assurance provides an outside view that helps a board see those cross-functional gaps earlier.
The board pack is not the same as assurance
A board pack tells directors what management is seeing and prioritising at a point in time. Done well, it creates structure and a shared base for governance conversations.
At the same time, a board pack reflects the perspective of people who are close to the work. Some risks take longer to show up unless an additional, independent line of sight is built in.
I view this as a design consideration rather than a flaw. Reporting systems tend to privilege what is already defined, measured and discussed.
Projects Assured implements program and project assurance as a practical extension of governance principles around independent review. The lens is different. Our delivery-focused assurance tests whether change programs and operating initiatives are on track to deliver the outcomes the board believes it is governing for, particularly where compliance measures and real-world care experience can diverge.
Oversight works within the information system. Assurance works on it.
Three things assurance does that oversight cannot
Good assurance complements oversight. It is independent and disciplined, and it is designed to do a few things board reporting is not built to do on its own.
1. Test assumptions
In any organisation, reporting gets distilled as it travels upward. In care settings, it is not practical for boards to see every individual story, so we rely on proxies (KPIs, SLAs, satisfaction %, milestones met, houses empty…). Those measures can be useful, and they can also create false confidence if they reward what is easiest to count rather than what matters most. For example, complaint volumes may reflect barriers to complaining, incident reporting may reflect a stronger speak up culture rather than poorer care, and accreditation results can lag lived experience.
2. Surface blind spots early
Blind spots are a predictable feature of complex work. Gaps often sit at the interfaces, between rostering and continuity of care, between policy and practice, and between what the system records and what clients and families experience. Assurance can help surface those gaps earlier, while there is still time to adjust course.
3. Focus on what matters, the signal-to-noise ratio
Boards are often not short of information, but signal. In care governance, reporting volume can grow without improving visibility of the lived experience or emerging potential for harm. Good assurance is prioritising, risk-based and evidence-based, and focused on what is (or will become) material.
The goal of assurance is not more information. It is better signal.
What this looks like in practice
In one major non-profit transformation program, our independent assurance team assessed delivery confidence as materially at risk. Routine reporting conveyed progress, with a capable and genuinely dedicated management team in place. The review identified conditions limiting the likelihood of success, including omissions in the integrated plan and areas of low stakeholder confidence due to patchy communications. These were quiet failures, likely to severely impact timelines and adoption, with real impacts on the consumers of the care service. The value of our review was in the practical, prioritised recommendations that the team adopted early – weeks before the final, polished report was formally submitted.
The board’s dilemma, grip without overreach
There is a tension that experienced directors will recognise. As governance pressure increases, it can be tempting to move closer to operations and ask for more reporting. Assurance can help boards maintain line of sight with evidence and perspective, without requiring directors to cross the line into management.
The question boards can ask
A useful question for any board is: are we looking at signal, or noise? Independent assurance adds value when it helps boards and executives align on what is materially true, what is materially at risk, and what evidence supports that view.
Good governance needs more than oversight. It needs assurance.