Clinical Governance Presentation by Michael Gorton AM - 21 July 2016
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Clinical governance in the health sector. This presentation covers the issues of liability, accountability, risk management and compliance that all health organisations must address.
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Clinical Governance Presentation by Michael Gorton AM - 21 July 2016
- 1. Clinical Governance Michael W Gorton AM, Principal 21 July 2016
- 2. > Liability: > Entity > Individuals > Vicarious Liability > Accountability: > Delegation > Reporting > Risk Management: > Legal Risk > Financial Risk > Business Risk > Compliance: Corporate Governance 2
- 3. > Investigation into Wesley Hospital's response to legionnaires' disease by: Sean Parnell and Sarah Elks > AN investigation into the Legionella outbreak at a Brisbane private hospital will examine whether enough precautions were taken and whether the alarm was raised soon enough The Australian, 10.13 am, 7 June 2014 "the board has the complete responsibility for clinical outcomes of the organisation" The Board’s Role in Clinical Governance 3
- 4. > “Corporate governance is the system by which companies are directed and controlled. Boards of directors are responsible for the governance of their companies.” The Cadbury Report 1992 > "the framework of rules, relationships, systems, and processes within and by which authority is exercised and controlled in corporations“ ASX Corporate Governance Principles Clinical Governance in context 4
- 5. > Risk Management > getting it wrong less often > Quality Assurance > getting it right more often > Clinical Governances > roles and responsibilities > systems and processes Risks 5
- 6. Source: Robert I. Tricker, International Corporate Governance: Text Readings and Cases, New York: Prentice Hall, 1994, p.149 Clinical Governance in context 6 Compliance roles Performance roles Provide accountability Strategy formulation Monitoring and supervising Policy making Past and present orientated Future orientated External role Internal role Approve and work with and through the CEO
- 7. 7
- 8. Healthcare is a Risky Business Harvard Medical Practice Study, 1991: > 3.70% of hospital admissions lead to “adverse events” > 1.85% of hospital admissions lead to avoidable “adverse events” > 0.50% of hospital admissions lead to “adverse events” resulting in death > Corresponds to 120,000 avoidable deaths per annum in USA Why is Risk Management an issue in Healthcare? 8
- 9. 9
- 11. > Purpose and scope of clinical governance The Clinical Governance System 11 • Improved patient care • Patient satisfaction • Quality control and improvement • Cultural change • Risk mitigation • Compliance • Cost management • Competitive advantage • Stakeholder satisfaction Summarised • Risk management • Leadership and culture • Patient experience
- 12. > Quality: > Incident reporting and review > Morbidity and mortality review > Credentialing and privilege > Clinical Practice Guidelines > RCA/Sentinel Events > Audit (personal and system) > Policies > Education and training Risks 12
- 13. > Legal Issues > QP Registration > Legal professional privilege > FOI > Patient confidentiality > Defamation > Subpoena > Coroner > Whistleblower legislation cf. Open Disclosure – apology protection Risks 13
- 14. Quality-related activities at Board level % (n=82) Quality performance is on the agenda at every Board meeting 79 Board regularly reviews data on medication errors/hospital acquired infections 77 … Board members receive formal training that covers quality of care 52 Board has a strategy relating to communication with patients & families 51 Board monitors quality and safety of care against external benchmarks 50 … Board receives quality of care data analysed according to the cultural and linguistic background of patients (including ATSI background) 32 Board members receive training on healthcare disparities 22
- 15. The “Lake Wobegon” effect 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Worse About the same Better or much better PercentageofBoardmembers Overall quality of health care Safe and skilled workforce Experience or satisfaction of patients and families with health care Identifying, managing and reporting health care incidents Board members’ self-assessment of performance compared with a typical health service in Victoria
- 16. Perceptions of influence 0% 10% 20% 30% 40% 50% 60% 70% Chief Executive Director of Nursing Board Quality Committee Medical director Other clinical leaders Quality manager Board Chair or Board Patients; community Rankedfirstorsecondmostinfluential
- 17. > Systems and processes for assurance > People who understand and can assess (Management/Board) skills/experience > Leadership and culture Lessons from Bacchus Marsh 17
- 18. 18 QUESTIONS
- 19. The information contained in this presentation is intended as general commentary and should not be regarded as legal advice. Should you require specific advice on the topics or areas discussed please contact the presenter directly. Disclaimer 19
- 20. 20 Michael W Gorton AM Principal Telephone: 9605 1625 Email: mgorton@rk.com.au
- 21. Level 12, 469 La Trobe Street, Melbourne, VIC 3000 P: +61 3 9609 1555 Level 8, 28 University Avenue, Canberra, ACT 2601 P: +61 2 6171 9900 Liability limited by a scheme approved under Professional Standards Legislation
Editor's Notes
- A majority of boards had established quality and safety goals (84% of boards) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). By contrast, only half of boards assessed the organisation’s quality and safety against external benchmarks, and less than a quarter provided members with training on health care disparities. When asked Board members about the adequacy of current training in quality and safety, 90% of board members (218/233) indicated that additional training would be “moderately useful” or “very useful”. Board members’ familiarity with key quality-related policies, indicators, and standards was uneven. The vast majority of members were familiar with major Victorian documents, including the Department of Health’s Quality of Care Report guidelines. There was substantially less familiarity with major national documents. For example, more than a third of Board members said they were “not at all familiar” with the Commission’s Australian Charter of Healthcare Rights.
- Almost every respondent (225/231) believed the overall quality of care delivered by their health service was the same or better than the typical Victorian health service. None rated it as worse, although 6 members said they did not know how their health service compared and a small fraction (<1%) rated it as worse on particular dimensions of performance (e.g. having a safe and skilled workforce). One recognised cause of these so-called “Lake Wobegon effects” (named after Garrison Keillor’s fictional community, in which “all the women are strong, all the men are good looking, all the children are above average”) is unavailability or underuse of reliable information on peer performance.
- In a list of six possible priorities for board oversight—which included financial performance, business strategy, and operations—over 80 percent of Board members identified quality of care as one of the top two priorities. Yet members generally considered their boards to be a relatively minor force in shaping the quality of care. As you can see here, less than 10% of members named the board or the board chair as the first or second most influential actor in determining quality, although 21% did name the board’s Quality Committee.