Clinical GovernanceClinical Governance

Dr. Hamda Qotba, B.Med.Sc; MD; Dr. Hamda Qotba, B.Med.Sc; MD; ABCM; MFPHABCM; MFPH

What is clinical governanceWhat is clinical governance??

‘‘a system through which all of the a system through which all of the organizations in the health system are organizations in the health system are accountable for accountable for continuously improvingcontinuously improving the the qualityquality of their clinical services and of their clinical services and ensuring high standards of patient care ensuring high standards of patient care by creating a facilitative environment in by creating a facilitative environment in which excellence will flourish ‘ which excellence will flourish ‘

““clinical governance is a way of making sure clinical governance is a way of making sure that everyone who passes through health that everyone who passes through health system is well cared for”system is well cared for”

oror

System that enable staff to work in the best System that enable staff to work in the best possible waypossible way

++Staff performing to the highest possible Staff performing to the highest possible

standardsstandards

What might that mean in practiceWhat might that mean in practice

Put patients /clients/customers first and Put patients /clients/customers first and last last

Improve standards of workingImprove standards of working Learn from experience Learn from experience Enable staff and teamEnable staff and team Use information effectivelyUse information effectively

The following components have been identified The following components have been identified as necessaryas necessary

Clear national standards Clear national standards

Mechanisms for ensuring local delivery of these Mechanisms for ensuring local delivery of these standardsstandards

Mechanisms for monitoring the delivery of these Mechanisms for monitoring the delivery of these standardsstandards

Identify standardsIdentify standardsApply standardsApply standardsMonitor standardsMonitor standards

Evidence-based Evidence-based medicinemedicine

Manpower planning Manpower planning Clinical auditClinical audit

Clinical standardClinical standardContinuing professional Continuing professional development and development and lifelong learning lifelong learning

job planjob plan

Risk management Risk management

National inquiries National inquiries

Complaints Complaints

Monitoring and Monitoring and evaluationevaluation

Whistle-blowing Whistle-blowing

Research and Research and development development

key componentskey components

1.1. Clinical audit (individual and service )Clinical audit (individual and service )

2.2. National confidential inquiries National confidential inquiries

3.3. Evidence-based medicine (? Apply to practice )Evidence-based medicine (? Apply to practice )

4.4. Clinical standards (NSFs, NICE, local )Clinical standards (NSFs, NICE, local )

5.5. Manpower planning (including retention )Manpower planning (including retention )

6.6. Continuing professional development and lifelong learning Continuing professional development and lifelong learning

7.7. Research and development ( including evaluation of care )Research and development ( including evaluation of care )

8.8. Clinical care quality integrated with organizational quality Clinical care quality integrated with organizational quality

Other componentsOther components

Clinical risk ( self and program (s))Clinical risk ( self and program (s))

ComplaintsComplaints

Job plan and individual performance Job plan and individual performance

Critical appraisalCritical appraisal

Whistle-blowingWhistle-blowing

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1. Clinical audit 1. Clinical audit An audit is an examination or review that assesses and reports on the An audit is an examination or review that assesses and reports on the

extent to which a condition, process or performance matches extent to which a condition, process or performance matches predetermined standards or criteria. It is concerned with resource allocation, predetermined standards or criteria. It is concerned with resource allocation, financial and general administrative management and, to a certain extent, financial and general administrative management and, to a certain extent,

substantive issuessubstantive issues . .

Considered as tool not goal Considered as tool not goal

2. Evidence-based medicine2. Evidence-based medicine

The The process of systematically of systematically finding, appraising, and using , appraising, and using contemporaneous contemporaneous research findings as the findings as the basis for for clinical decisions

Being health professional you should aim to do only those Being health professional you should aim to do only those medical activity that you have evidence it will work medical activity that you have evidence it will work successfullysuccessfully

33 . .Clinical standardsClinical standards

Bounds by which all by which all practices in a in a given area will be carried out, in achieving the will be carried out, in achieving the goals and and objectives for that area for that area

44 . .Research and DevelopmentResearch and Development

This forms the basis for evidence-based medicine. The This forms the basis for evidence-based medicine. The NHS Research and Development strategy was launched NHS Research and Development strategy was launched in 1991 to develop a knowledge-based NHS in which in 1991 to develop a knowledge-based NHS in which decisions (clinical, policy and managerial ) would have a decisions (clinical, policy and managerial ) would have a sound base. sound base.

This strategy will continue to have pivotal role in collecting This strategy will continue to have pivotal role in collecting new evidence, with support from the Horizon Scanning new evidence, with support from the Horizon Scanning Center and the National Prescribing Center in identifying Center and the National Prescribing Center in identifying new and existing interventions. new and existing interventions.

55 . .Risk managementRisk management

The The process of minimizing of minimizing risk to an to an organization by developing by developing systems to to identify and identify and analyze potential hazards to to prevent prevent accidents, , injuries, and other , and other adverse occurrences, and by attempting to occurrences, and by attempting to handle events and incidents which do handle events and incidents which do occur in such a manner that their effect occur in such a manner that their effect and cost are minimized. and cost are minimized.

Effective risk management has its greatest Effective risk management has its greatest benefits in application to insurance in benefits in application to insurance in order to avert or minimise financial liability. order to avert or minimise financial liability.

66 . .Monitoring and EvaluationMonitoring and Evaluation

Process of regularly reviewing achievements and progress towards the Process of regularly reviewing achievements and progress towards the goals (day to day )goals (day to day )

Process measuring the degree to which objectives and targets are Process measuring the degree to which objectives and targets are fulfilled and the quality to the result are obtainedfulfilled and the quality to the result are obtained

Evaluation and audit requires the assessment of effectiveness and efficiency and the formulation of recommendations to promote improvement. In appraising these elements, however, audit differs from evaluation in orientation or objectives

77 . .National confidential inquiriesNational confidential inquiries

The four existing national confidential The four existing national confidential inquiries inquiries

preoperative death, stillbirths and deaths in preoperative death, stillbirths and deaths in infancy, maternal deaths and suicides infancy, maternal deaths and suicides

overseen by NICE. overseen by NICE.

8. Job plan and individual performance8. Job plan and individual performance

This will highlight areas in the job that are This will highlight areas in the job that are not being met, both presently and as the not being met, both presently and as the job develops. job develops.

99 . .Continuing Professional Development (CPD)Continuing Professional Development (CPD)

This is about developing a culture that This is about developing a culture that encourages lifelong learning ( the learning encourages lifelong learning ( the learning organization ) and is an integral part of the organization ) and is an integral part of the job plan. Health organization should job plan. Health organization should commit, plan and act on ‘investment in commit, plan and act on ‘investment in people’ if they are truly interested in people’ if they are truly interested in delivering quality clinical caredelivering quality clinical care

1010 . .complaintscomplaints

Complaints will be monitored both externally Complaints will be monitored both externally and internally. There will have to be an and internally. There will have to be an effective local system in place to deal with effective local system in place to deal with complaints. Documentation will be complaints. Documentation will be particularly important in order to facilitate particularly important in order to facilitate external scrutiny.external scrutiny.

1111 . .Manpower planningManpower planning

This will establish the required staffing levels This will establish the required staffing levels to achieve acceptable standards of care. to achieve acceptable standards of care. However, this is not just about recruiting However, this is not just about recruiting the appropriate staff, but also about the appropriate staff, but also about retaining them.retaining them.

1212 . .Whistle-blowingWhistle-blowing

This is to be encouraged. If poorly This is to be encouraged. If poorly performing work colleagues are not dealt performing work colleagues are not dealt with/reported, responsibility will be shared. with/reported, responsibility will be shared. This balance between collective and This balance between collective and individual responsibility must be individual responsibility must be appreciated. appreciated.

1313 . .Critical appraisalCritical appraisal

our ability to critically appraise the strength our ability to critically appraise the strength of the evidence available and its of the evidence available and its application should be part of our routine application should be part of our routine practice.practice.

1414 . .peer-reviewpeer-review

both internal and external peer-review will both internal and external peer-review will be an important tool for assessing the be an important tool for assessing the effectiveness of the clinical governance effectiveness of the clinical governance culture and in creating a facilitative culture and in creating a facilitative environment in which excellence can environment in which excellence can flourishflourish

successsuccess

For clinical governance to be successful, the For clinical governance to be successful, the following must be in place:following must be in place:

Clear lines of responsibility and accountability Clear lines of responsibility and accountability A program of quality improvement activities A program of quality improvement activities Clear policies aimed at managing riskClear policies aimed at managing risk Procedures to identify and remedy poor Procedures to identify and remedy poor

performance.performance.