Dr Catherine Chen Jean Ai, KPP(G), Sarawak Kursus “Clinical Governance”, 9 – 11 Nov 2009, Sematan, Kuching
Oct 26, 2014
Dr Catherine Chen Jean Ai, KPP(G), SarawakKursus “Clinical Governance”, 9 – 11 Nov 2009,
Sematan, Kuching
Why Clinical Governance?Traditional Concept: well trained staff, good
facilities and equipment = high std of healthcare.
In 1980s: Total Quality Management (TQM) concept and continuous improvement concept - viewed as management driven with no clearly defined role for clinical staff.
In 1990s: emphasis on evidence-based medicine and research
Clinical Governance: systematic approach to improving quality of patient care within a health system.
CLINICAL GOVERNANCENHS DEFINITION
A system through which an organization is accountable for continuously improving quality services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish – Scally & Donaldson (NHS 1998)
CLINICAL GOVERNANCEKEY ELEMENTS
Effective leadershipPlanning for qualityEducation and trainingRisk managementResearch and developmentTransparencyClinical effectivenessClinical audit
CLINICAL GOVERNANCEKEY ELEMENTS
Effective LeadershipA well led organisation will have clear vision,
values, plans, guidelinesThese would be communicated effectively to
all staffGood leadership empowers teamwork,
encourages openness, creates high-trust environment
CLINICAL GOVERNANCEKEY ELEMENTS
Planning for qualityPlan based on:- Objective assessment of patients’ needs and views- Assessed exposure to clinical risk- Regulatory requirements- Staff capabilities and training needs- Realistic comparison between present
performance and best practice standardsOwnership of the plan at all levels (not just
management generated)
CLINICAL GOVERNANCEKEY ELEMENTS
Education and TrainingContinuing professional development (CPD)Professional duty of clinicians to remain up-
to-date
CLINICAL GOVERNANCEKEY ELEMENTS
Risk managementRisks: human error, poor organisation, lack
of clear guidelines Errors and accidents cause patient
discomfort, incur costs, may result in loss of life.
Risk management involves managing and monitoring staff and patient safety – reduce errors and accidents, improve quality.
CLINICAL GOVERNANCEKEY ELEMENTS
Risk managementRisk to Patient - compliance to statutory
requirements; regular systems review; audit critical event; learn from complaints
Risk to Practitioner - immunization against infectious diseases; safe work environment; worker safety guidelines; good practice
Risk to Provider/Organization – poor quality is a threat to organisation. Need to ensure high quality employment practice; safe environment; well designed policies.
CLINICAL GOVERNANCEKEY ELEMENTS
Research & developmentPromotion of research: - critical appraisal of literature - project management - development of guidelines & protocolsData must be valid, up to date, presented in
useful manner e.g. highlight shortfalls in stds, differences in outcomes, time trends
Timely application of research findings
CLINICAL GOVERNANCEKEY ELEMENTS
Transparency – openness in discussion of clinical governance issues
Poor performance and poor practice often thrives behind closed doors
“No blame culture” enables system flaws to be identified.
Any organisation providing high quality care has to show that it is meeting the needs of the population it serves.
CLINICAL GOVERNANCEKEY ELEMENTS
Clinical effectiveness - a measure of the extent to which a
particular intervention worksNeed to consider: - appropriateness of intervention - whether it is value for money - safety of patient and care providers
How to provide clinically effective care?
Competence and skill development among personnel
Accreditation/ credentiallingRegular review of proceduresRedesign of services to improve delivery of
care, initiate changes in response to error or complaint
Develop and enhance leadership skillsMentoring
CLINICAL GOVERNANCEKEY ELEMENTS
Clinical auditA Quality Improvement process that seeks to
improve patient care and outcomes through systematic review against explicit criteria and the implementation of change
Aims to ensure patients receive the most effective, up to date, appropriate treatment, delivered by clinicians with the right skills and experience.
CLINICAL AUDITIMPORTANCE & BENEFITS
Identifies & promotes good practiceImprovements in service deliveryImprovements in service outcomesEvidence of service effectiveness & cost-
effectivenessOpportunities for training & educationPromotes efficiency in resource utilizationImproves working relationships &
networking at all levels
ROLE OF CLINICAL AUDIT TEAMHelp specialties develop audit programsAssist clinical staff in carrying out auditsIdentify audit issues linked to risk
management, complaints, health & safety and litigation
Teaching, advice & consultationAudit process: planning; data entry &
analysis; report writing; presentation; implement change; monitoring
CLINICAL AUDITAREAS TO AUDIT
STRUCTURE – The availability & organization of resources and personnel
PROCESS – Activities pertaining to service resources
OUTCOME – Effect of activities on health or well-being of service user, i.e. changes for individual attributed to clinical intervention received
CLINICAL AUDITWHO SHOULD BE INVOLVED
Clinical & non-clinical staffService usersManagersOther key stakeholders
CLINICAL AUDITTHE AUDIT PROCESS
Establishment of audit team: Team leader & members; special expertise
Determination of areas to be audited: critical areas for more in-depth and frequent audit
Preparation of audit checklists: against work processes and best practice
Consultation with auditee managementGround logisticsAudit scheduleOpening meeting
CLINICAL AUDITTHE AUDIT PROCESS
Audit implementation: examination of documents; interviews; site verification
Analysis, report writing & presentation
Ensuring remedial, continuing improvement & preventive measures are implemented
Closure
CLINICAL AUDITHALLMARKS OF SUCCESSFUL AUDIT
Patient-oriented planningPatient-outcome based
Are patients given the best care?Are they better?Do they feel better?
CLINICAL AUDIT VS RESEARCHClinical audit is not research but interrelated
i.e. uses research methodology to assess practice (Black, 1992)Research provides basis for defining good
quality care & best practiceClinical audit generates high-quality data for
non-experimental evaluative researchEffectiveness & cost-effectivenessResearch needs on assessment of high quality
care
EFFECTIVE CLINICAL GOVERNANCE
Culture of trust & honesty; adverse events discussed openly
Organizational commitment to continuous improvement
Clear role delineation & accountabilityRigorous system to identify, monitor &
respond to problems in patient careEvaluating & responding to key aspects of
clinical performance
REFERENCES
“Clinical governance and clinical audit” – Dr Husna Abbas, Pengarah Penggalakan, Kawalan dan Amalan Pergigian, KKM (lecture given during Kursus Pemantapan Pegawai Pergigian, 2009)
Halligan A, Donaldson L. “Implementing clinical governance: turning vision into reality”. BMJ 2001 June 9; 322(7299): 1413-1417.
NHS Scotland Educational Resources. “Clinical Governance” 2007.
Thank You!