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