Presentation examining what clinical governance is and how it helps to ensure quality care.

1. Faculty of Health and Social Care
Clinical Governance
David Stonehouse
Senior Lecturer
edgehill.ac.uk

3. Learning Outcomes
The Student will be able to
■ Explore Idea of Quality in health care.
■ Examine the “Temple Model Of Clinical
Governance.”
■ Recognise own responsibilities with
regards to Clinical Governance.
■ Briefly Explore concept of a Learning
Organisation.
the University of choice
edgehill.ac.uk

4. Why Clinical Governance?
■ Major failings in the NHS highlighted
in 1990s and 2000.
- Bristol Royal Infirmary
- Dr. Shipman
- Kent & Canterbury cervical smear
tests
- Breast-screening services in Exeter.
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5. Definition
“A system through which NHS
organisations are accountable for
continuously improving the quality of
their services and safeguarding high
standards of care, by creating an
environment in which clinical
excellence will flourish.”
Sir Liam Donaldson, Chief Medical Officer, (2002)
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6. Placing Quality At The
Heart Of The NHS
Without it there is unfairness. Every
patient wants to know that they can
rely on receiving high-quality care
when they need it. Every part of the
NHS & everyone who works in it
should take responsibility for working
to improve quality. (Department of Health,
1997)
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7. Clinical Governance is
about quality and how it can be
achieved and guaranteed through
our service to our patients.
“an umbrella term for everything that
helps to maintain and improve high
standards of patient care” (Royal
College of Nursing, 2003:9).
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8. Duty Of Quality
■ Legal Obligation: The Health Act 1999.
■ Clear lines of responsibility &
accountability for quality of clinical care
■ Chief Executives are accountable
- Clinical Governance Board/Committee
(Reports to Trusts Main Board)
- Annual Report Must Be Produced.
- All staff are responsible for the quality of
care they deliver.
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9. Culture For Clinical
Governance To Flourish
■ No-blame
■ Questioning
■ Learning culture
■ Excellent Leadership
■ An ethos where staff are valued &
supported as they form partnerships
with patients.
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10. Other Cultural Qualities
■ Celebrate success as well as learning
from what is done badly.
■ Overcoming tribalism by improving
understanding of the roles of all
professions.
■ Develop effective team working.
■ Communication with all stakeholders.
■ Commitment to sharing of information.
■ Outward looking approach.
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11. The Temple Model Of
Clinical Governance

12. The Foundation Stones
System Awareness
Systems
Awareness

13. Systems Awareness
“A set of interdependent elements interacting to
achieve a common aim. These elements may be
both human & non-human” (Department of
Health, 2000).
■ Systems awareness looks at the whole process,
as well as the parts, of healthcare delivery, and
the relationships between them.
■ It is about looking outside of your own sphere of
influence or team/department.
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14. The Foundation Stones
Teamwork
Systems
Awareness Teamwork

15. Teamwork
“Without teamwork, the potential of
clinical governance is not
achievable. Cooperation across &
between organisations, between the
NHS and the public it services is
fundamental to building better
structures & safer, high quality care.”
(Hallett & Thompson, 2001)
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16. “If teamwork is performed successfully,
teams can reap benefits for themselves,
patients and patients families.
However, if done badly, the organization
will struggle to meet its objectives, quality
of care and the service being delivered will
diminish, staff morale and satisfaction will
be lowered and patients will have an
unsatisfactory and possibly negative
experience of care.”
(Stonehouse, 2011:350)
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17. The Foundation Stones
Communication
Systems Communication
Awareness Teamwork

18. Communication: Greco,
2000.
■ Being greeted warmly ■ Being respected
■ Being listened to ■ Being given enough time
■ Clear Explanations ■ Having personal
■ Reassurance circumstances considered
when advice or treatment
■ Having confidence in is offered.
the ability of staff
■ Being treated as a person
■ Being able to express & not as a disease.
fear & concern
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19. The Foundation Stones
Ownership
Systems Communication
Awareness Teamwork Ownership

20. Ownership
■ Clinical Governance as a whole.
■ Nurses of their working areas.
■ Patients of their care & treatment.
■ Local community of their health
services.
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21. The Foundation Stones
Leadership
Systems Communication
Awareness Teamwork Ownership Leadership

22. Leadership
“Leadership is critical to the quality of care,
treatment & outcomes, to staff morale & to the
learning climate & opportunities available to
students & others.” (Department of Health,
1999)
■ Traditionally, position of power at the top of the
hierarchical structure.
■ Modern approach, recognises effective
leadership at all levels.
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23. The Pillars
Systems Communication
Awareness Teamwork Ownership Leadership

24. Clinical Effectiveness
RCN (1996) defines it as
“Applying the best available
knowledge, derived from research,
clinical expertise & patient
preferences, to achieve optimum
processes & outcomes of care for
patients.”
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25. Clinical Effectiveness
Three distinct parts
1. Finding & assessing evidence.
2. Implementing the evidence.
3. Monitoring & evaluating the impact,
readjusting practice as necessary,
usually through clinical audit &
patient feedback.
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26. The Pillars
Systems Communication
Awareness Teamwork Ownership Leadership

27. How Effective is this Risk Management?

28. Risk Management
Effectiveness
“The identification, evaluation &
control of potential adverse
outcomes that threaten the delivery
of appropriate care to patients.”
(O‟Neil, 2000)
■ Clear risk management policies in
place.
■ Incident reporting & acting upon.
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29. Adverse Events & Near-
misses
■ Adverse event is defined as “An
event or omission arising during
clinical care & causing physical or
psychological injury to the patient.”
■ Near-miss can be defined as “An
occurrence which, but for luck or
skilful management, would in all
probability have become an incident”
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30. Adverse Events
■ Occur in around 10% of admissions or at a rate
of an estimated 850,000 adverse events a year.
■ Cost approx. £2 billion a year in additional
hospital stays alone.
■ 400 people die or are seriously injured in
adverse events involving medical devices every
year.
■ Every year £400 million is paid out in settlement
of clinical negligence claims.
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31. The Pillars
Systems Communication
Awareness Teamwork Ownership Leadership

32. Patient Experiences
■ National Patient Survey
■ Interviews
■ Patient Diaries
■ Focus Groups / Patient Forums
■ Patient Tracking
■ Consultation With Voluntary Groups.
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33. Learning from & Dealing
With Complaints
■ Provide an opportunity for nurses to see
themselves and their service as others see them
and to identify the issues, which concern users.
■ Rectify a past mistake & enable services to be
put right for the future.
■ Well handled it can increase a patients trust in
the service.
■ Identify adverse events and near misses which
otherwise might have gone undetected.
(Stonehouse, 2012)
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34. Nurses Role
■ Take complaints seriously.
■ Local resolution.
■ Good communication.
■ Fully involve patients/carers in
decisions.
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35. The Pillars
Systems Communication
Awareness Teamwork Ownership Leadership

36. Communication
Effectiveness
■ Staff to patient
- Written
- Verbal
In just about every complaint there will
have been a breakdown in
communication.
■ Staff to the organisation as a whole.
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37. The Pillars
Systems Communication
Awareness Teamwork Ownership Leadership

38. Resource Effectiveness
■ How are resources used, & for what
benefits?
■ Is there waste in time, money,
equipment?
■ Is best use being made of all
available resources?
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39. The Pillars
Strategic
Effectiveness
Systems Communication
Awareness Teamwork Ownership Leadership

40. Strategic Effectiveness
■ Making sure that Clinical
Governance is written into all
organisational planning.
■ That the direction of the organisation
is to continually deliver a quality
service that is continuously looking
to improve.
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41. The Pillars
Strategic
Effectiveness
Learning
Effectiveness
Systems Communication
Awareness Teamwork Ownership Leadership

42. Learning Effectiveness
■ Making sure that lessons really are
being learnt and acted upon, from:-
- Complaints
- Adverse incidents
- Research
- Patient & Staff feedback.
- Becoming a Learning Organisation.
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43. Learning Organisation
“Where people continually expand
their capacity to create the results
they truly desire, where new &
expansive patterns of thinking are
nurtured, where collective aspiration
is set free, & where people are
continually learning how to learn
together.” (Senge, 2006:3)
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44. Key Features Of A
Learning Organisation
■ Open Systems Thinking.
■ Improving Individual Capabilities.
■ Team Learning.
■ Updating Mental Models.
■ Sharing A Cohesive Vision.
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45. Patient – Professional
Partnership
Strategic
Effectiveness
Learning
Effectiveness
Systems Communication
Awareness Teamwork Ownership Leadership

46. So For Your Job Interview!!
Question: What is Clinical Governance?
Answer:
It‟s about quality. How I can ensure and
constantly improve the quality of care I
deliver, through on-going training, following
policies and procedures, through teamwork
and communication, complaints
management, leadership and improving and
listening to the patients experience.
the University of choice

47. Bibliography
Department of Health (1997) The New NHS: Modern and Dependable.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/d
ocuments/digitalasset/dh_4014486.pdf (Accessed 29/10/2012).
Department of Health (1999) Making A Difference: strengthening the
nursing, midwifery and health visiting contribution to health and healthcare.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsP
olicyAndGuidance/DH_4007977 (Accessed 29/10/2012).
Department of Health (2000) An Organisation with a memory.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/d
ocuments/digitalasset/dh_4065086.pdf (Accessed 29/10/2012).
Hallett, L. & Thompson, M. (2001) Clinical Governance: A Practical Guide
For Managers. London: HSJ Public Sector Management.
O‟Neil, S. (2000) Effective Risk Management Strategies, Professional Nurse
Royal College of Nursing (1996) The Royal college of Nursing Clinical
Effectiveness Initiative – A Strategic Framework. London, RCN.

48. Bibliography
Royal College of Nursing (2003) Clinical Governance: An RCN Resource
Guide. London: RCN.
Senge, P. M. (2006) The Fifth Discipline: The Art & Practice Of The Learning
Organization. New York: Currency Doubleday.
Stonehouse, D. (2011) „Teamwork, Support Workers And Conduct At
Work.‟ British Journal of Healthcare Assistants. Vol 05. No 07. pp350-54.
Stonehouse, D. (2012) „Why Complaints Are A Positive For Support
Workers.‟ British Journal of Healthcare Assistants. Vol 05 No 07. pp39-40.