Governance in Healthcare: Turning Tension into Trust

Through governance, we see how healthcare systems manage tension, surface truth, and build (or erode) trust — the real indicators of their culture.

In healthcare, governance is often treated as a checklist — something procedural, administrative, even bureaucratic. But the truth is more complex: governance is culture work. It exposes how an organisation really handles truth, trust, and tension.

When governance conversations arise — about record-keeping, communication, or patient feedback — the technical details are rarely the hardest part. What’s hardest is what sits beneath them: emotion, ego, hierarchy, fear. We like to imagine governance as neutral, but it isn’t. It’s deeply human.

The Emotional Undercurrent

When a clinician’s judgment is questioned, the response often isn’t about the data — it’s about identity. Defensiveness, justification, silence: these reactions tell us that what’s at stake isn’t just performance, but belonging.

Leaders who understand this emotional undercurrent don’t rush to blame or appease. They know that regulation without reflection creates compliance, not learning. They approach governance as both procedural and relational — as a chance to strengthen culture, not fracture it.  In this light, feedback becomes a mirror: showing how we handle discomfort, power, and proximity.

When Reflection Meets Resistance

Even well-intentioned governance discussions can stir deep emotion. A question meant for learning can be heard as an accusation. A procedural review can awaken insecurity or shame. This is why leadership presence matters. When emotion rises, leaders must ground the space — to be curious, not combative; composed, not controlling. 

Integrity isn’t about never faltering — it’s about how you recover with grace.

The aim isn’t to silence feeling, but to contain it safely enough that learning can happen. Governance without grace risks hardening culture. But grace without governance risks safety. Leadership means holding both.

Boundaries, Power, and Trust

Many governance issues are really boundary issues in disguise. When managers blur friendship with authority, or colleagues trade accountability for loyalty, governance quietly erodes. The team becomes emotionally enmeshed — kind, perhaps, but unclear.

Boundaries aren’t barriers; they’re the structures that let care and accountability coexist. In mature systems, clear boundaries protect everyone: patients, clinicians, and leaders alike. They signal that governance isn’t about control — it’s about collective integrity. When culture is healthy, people don’t fear governance; they trust it.

Governance as Culture Work

True governance requires leaders to model emotional maturity, not just technical competence. It asks us to translate policy into presence — how we listen, how we decide, how we restore trust when things go wrong.

Governance isn’t just a process — it’s a mirror. It shows how our systems handle emotion, power, and integrity. How do you balance empathy with accountability when tensions rise?

At its best, governance builds the kind of culture where learning is safe and accountability is shared. It’s where people know that raising a concern isn’t betrayal, but contribution. In that sense, every governance conversation is a culture moment: an opportunity to show what your system values when no one’s watching.

Turning Tension into Trust

Tension isn’t the opposite of trust; it’s often the pathway to it. Handled well, tension sharpens systems, clarifies standards, and deepens relationships. When leaders approach governance as culture work, they move the conversation from “Who’s at fault?” to “What can we learn?” 

When has a governance or feedback discussion in your organisation revealed more about your culture than your compliance?

They see every disagreement as data. In healthcare, that shift can mean the difference between blame and belonging — between fear and integrity. Because in the end, governance isn’t just about compliance. It’s about care.

Jasmine Gill MC Optom

EMCC-Accredited Executive & Leadership Coach @ EvolvExplore