Module 3. Session 33.1 DCST Clinical governance
Prepared by J Moorman
What is clinical governance
Clinical governance is a framework which helps all clinicians to continuously improve the quality of their
services and safeguard standards of care – by creating an environment in which excellence in clinical care
will flourish
Systematic approach to and central to quality assurance and quality improvement
Why is clinical governance needed
Quality of care varies across all facilities, levels of care.
Quality of care in many facilities is not as good as we
would like it to be.
Health care providers are accountable to “public service”
and so we need be able to show what we do well – and
acknowledge where we can do better
What does that actually mean
CG is about every member of staff recognising their role
in providing quality of care
CG is about improving care using whatever method is the
most suitable
So – find aspects of care that need improvement, making
plans to improve them and monitoring your success
What's good about clinical governance
Can demonstrate what is good (this is not always about identifying what is wrong)
Earn and retain trust of patients and colleagues
Traditionally there have been five pillars of CG
Three key domains1. Clinical effectiveness
Evidence based practice Clinical audits Clinical guidelines
2. Patient safety Risk management Adverse event
3. Patient experience Complaints management Patient information Patient involvement
Pillar 1. Clinical effectiveness 6 R’s
Clinical effectiveness is ensuring the right care is provided
to the right patient who is informed and involved in their
care at the right time by the right clinician with the right
skills in the right way.
What does “right care” mean
Production and dissemination of evidence-based clinical guidelines
What does “right way "mean
Evaluation of compliance to these guidelines
Audit
performance of clinical care processes and clinical
outcomes are measured.
These performance measures, as well as peer review and
clinical audit, are used to evaluate and improve
performance.
quality improvement activities are reviewed externally.
Other clinical effectiveness strategies
Quality improvement activities are coordinated, planned, prioritised
and have sustainability strategies in place.
Involvement of clinicians in designing and planning systems and
services so that they are efficient and improve delivery and clinical
outcomes.
Clinicians actively involve consumers as partners in their care.
Pillar 2 – Risk management
Providing health care is risky
Risk to patients
Risk to health care providers
Risk to organisation
Ensuring the safety of everyone who comes into contact with healthcare services is one of the most important challenges facing
health care today.
Common risks
Failure / delay in diagnosisInadequate treatment / managementAttitude of staffMedication errorsAdministration errorsInadequate examinationFailure to communicate with patients!!
How do we do manage risks?
1. Assess how patients may be harmed – identify at risk patients – foreigners, elderly, mentally ill, institutionalised.
2. Prevent or manage risks - checking credentials of staff and training
3. Report and analyse incidents – critical events, complaints, reviews (documents for example)
4. Learn from such incidents – morbidity and mortality meetings
5. Implement solutions to minimise the likelihood of them re-occurring.
Critical event auditing
"individual cases in which there has been a significant
occurrence (not necessarily involving an undesirable
outcome for the patient) are analysed in a systematic
and detailed way to ascertain what can be learnt about
the overall quality of care and to indicate changes that
might lead to future improvements".
Aim of adverse event monitoring
Identify events in individual cases that have been critical (beneficial or detrimental) to the outcome
Instigate a culture of openness and reflective learning
Enable identification good practice
Seven steps to critical event monitoring
1. Identify adverse event
2. Information gathering
3. Team meeting – honest, non-threatening, respectful atmosphere
4. Analysis of event
What happened
Why did it happen
What has been earned
What has been changed
5. Agreement, implementation and monitoring change
6. Write it up
7. Report, share and review
Barriers to the process
Time
Honesty
Potential for emotionally uncomfortable experience
Group dynamics
Conflict of loyalties for staff
Motivation
Concerns about confidentiality
Lack of challenge and insularity
Complaints
Complaints can be an indicator of problems with the care you are
giving
Isolated complaints aren’t always the issue – its the patterns of
complaints
System should enable complaints to be dealt with positively and
constructively
Complaints should inform future planning
Pillar 3. Patient experience1) Providing information to patients about quality
So that consumers are empowered to participate in their care Need to have clear, open and respectful communication More than education – what they can expect
2) Ensuring their experience is good Services respond to the diverse needs of consumers with humanity Rights and responsibilities of patients are promoted to community,
consumers, carers and clinicians Improving the way services are delivered by increasing awareness and
understanding of the consumer perspective, their needs and what matters to them most
Pillar 3. Patient experience (2)
1) Monitoring their experience Complaints management Client satisfaction surveys
2) Ensuring participation in planning, improvement and monitoring of services
Consumers provide feedback on clinical care and services learn from it
Approaches to engaging communities Focus groups Interviews Patient satisfaction surveys
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