The focus on patient safety is an international phenomenon. Patient safety is an integral component of the quality of care. The governance of patient safety ‘encompasses panoply of regulatory processes that directly or indirectly intend to manage, prevent or limit iatrogenic events in oral health care services’.

1. 9
idatimes.ida.org.in
IDA
The IDA Times Mumbai December 2011
CMYK
CMYK
DENTAL PRACTICE
Clinical Governance: As Drive for
Patient Safety in Clinical Dentistry
and treatment options.
(2) Information about the care de-
livered by dental staff.
3) Information about the working of
the clinical governance systems.
Informed Consent Back-
bone for Clinical Gover-
nance
Accepting the information needs
of patients, using data from clinical
audit and evidence-based dental
practice helps dentist to make de-
cisions about what ought to rea-
sonably be included as part of the
discussion with dental patient prior
to clinical decision making. Clinical
guideline development provides an
opportunity for standardizing infor-
mation that can be discussed with
dental patients prior to instigation
of any procedures, investigations
or treatment and allows practitio-
ners causative to the development
and introduction of the guidelines
to reinforce the need for consent to
be taken aptly. Understanding the
concepts of implied and expressed
consent and the distinction between
written and verbal consent, is very
important for dental clinical teams
to avoid the difficulties in the deliv-
ery of oral health care, by avoiding
malpractice claims from patients.
Clinical Governance Pro-
motes Safety Culture
Term culture is often used broadly
to describe ``the way things are done
around here’’ (Walshe, 2000). Cul-
ture of an individual health organiza-
tion is noted as shaping the clinical
governance that is enacted (Konteh,
2008). Features that distinguish the
best healthcare organizations are
their culture but evidence on how
to define a `good’ culture and on the
methods required to promote one
is largely lacking in the healthcare
field (Scally, 1998). A desirable cul-
ture, together with good leadership
and recognition of the importance
of education and research, has
been promoted for clinical gover-
nance (Scally, 1998). Clinical gov-
ernance is supposed to break the
cultural entrapment by promoting
evidence-based dentistry, encour-
aging patient/carer involvement and
facilitating multidisciplinary team
work. Cultural entrapment means
the process by which people get
locked into lines of action, subse-
quently justify those lines of action,
and search for confirmation that
they are doing what they should be
doing (Weick, 2003).
The architects of clinical governance
have long argued that achieving the
right culture is the most important
element in implementing the clini-
cal governance program in health
care organizations. Changing the
culture in order to promote safer
healthcare processes has been em-
phasized as the main issue in every
effort to improve patient safety. The
five cultural components are sys-
tems awareness, teamwork, com-
munication, ownership and lead-
ership. It represents the areas in
which Organization share ``beliefs,
attitudes, values and norms of be-
havior’’ (Davies, 2000) in order to
deliver sustainable quality improve-
ment in healthcare. Clinical gover-
Dr. Shoeb Ahmed.
E-mail: - drshoeb_2k@yahoo.com
Dr. Irfana Sultana.
E-mail: - irfana.anwar@gmail.com
Introduction
“Knowing is not enough; we must
apply. Willing is not enough; we
must do.”
- Goethe.
The focus on patient safety is an
international phenomenon. Patient
safety is an integral component of the
quality of care. The governance of pa-
tient safety ‘encompasses panoply of
regulatory processes that directly or
indirectly intend to manage, prevent
or limit iatrogenic events in oral health
careservices’.TheInfluenceofHealth
Inquiries on Clinical Governance Sys-
tems in a case Study of the Douglas
Inquiry focus on patient safety within
the health industry, which has led to
extensive adoption of the term clini-
cal governance. This term is used to
describe the systems and processes
that a healthcare organization has in
place that add to the maintenance
of patient safety, accountability and
nance is supposed to promote a
patient-centered continuous quality
improvement paradigm for excel-
lence in dental clinical care that will
establish an open organizational
culture. The dental hospitals board
team is to be effective in implemen-
tation of clinical governance, it is
very important to have a greater un-
derstanding of the culture of the or-
ganization, as well assess its capa-
bility and capacity before it begins
to work on clinical governance.
Multidisciplinary Path-
ways of Care (MPCs) /
Integrated Care Pathways
(ICPs) Enhance Clinical
Governance:
The essence of clinical governance
is the setting and monitoring of
standards in delivering clinical care.
Care pathways integrate standards,
clinical guidelines and outcome
measures. The regular appraisal of
local dental practice against best
dental practice guidelines is at the
heart of clinical governance. Care
pathways provide dental team with
the prospect to consider what best
practice should be, and then imple-
ment it in everyday dental practice,
while constantly monitoring devo-
tion with those best dental practice
guidelines through variance track-
ing. By its nature a care pathway
promotes good communication
between members of a dental team
and encourages them all to work to-
gether in harmony. A well managed
dental pathway in which lessons
are learnt by careful scrutiny of the
variance will lead to the fruition of
a well structured plan in which pa-
tients have the best possible care
delivered in a reliable approach.
This is the desired outcome of clini-
cal governance that care pathways
facilitate in clinical dentistry.
A multidisciplinary pathway of care
(MPCs) is a simple tool which al-
lows the dentist to demonstrate
a safe, well considered and high
quality package of oral care for
common dental conditions so that
he or she can satisfy the demands
of clinical governance. Integrated
care pathways (ICPs) integrate all
the anticipated elements of oral
care and treatment of all members
of the multidisciplinary team, for a
patient or client of a particular case-
type or grouping within an agreed
time frame, for the achievement
of agreed outcomes. Any deviation
from the plan is documented as a
`variance’; the analysis of which
provides information for the re-
view of current practice’’ (Johnson,
1997a).
Conclusion
The goal of clinical governance is
based on the philosophy of con-
tinuous quality improvement. The
biggest challenge for dental orga-
nizations, and dental teams is to
implement and integrate all quality
initiatives under one framework. To
achieve this standard framework,
the role of culture, leadership, staff
training and education are impor-
tant. Clinical governance has given
all dental organizations a statutory
duty to seek quality improvements
in oral healthcare within their own
organizations.
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responsibility for patient safety. The
introduction of clinical governance
is therefore aimed at improving the
quality of clinical care at all levels of an
organization by consolidating, codify-
ing, and standardizing organizational
policies and approaches, particularly
clinical and corporate accountability.
(Scally, 1998). Clinical governance
demands a major shift in the val-
ues, culture and leadership, to place
greater focus on the quality of clini-
cal care and to make it easier to bring
about improvement and change in
clinical practice. Clinical governance
helps in examining and measuring
patient outcomes to ensure optimum
quality of care (Balding, 2005).
Clinical Governance
Depends on Right Clinical
Information
Timely and accurate information
epitomize the dental staff to see
their performance and benchmark
it to the performance they want to
observe and provide the motivation
to engage in changes to develop
and improve dental services. Clini-
cal information is required to moni-
tor actual performance against the
set standards and also provides
assurance to the dental hospital
board and the community that oral
care is working to a satisfactory
standard and in this way enables
the dental staff to take contentment
in the quality of their work. Clinical
information systems ensures that
the monitoring is accurate and cost
effective and through facilitating ac-
cess to information on policies and
guidelines which can help to ensure
that appropriate care is delivered in
all clinical situations. Information
components which help in clinical
governance are -
(1) Information to dentists and pa-
tients about the guidelines, policies