Clinical governance in the health sector. This presentation covers the issues of liability, accountability, risk management and compliance that all health organisations must address.
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 Boardās Role in Clinical
Governance
3
4. > āCorporate governance is the system by which
companies are directed and controlled. Boards of
directors are responsible for the governance of their
companies.ā
The Cadbury Report 1992
> "the framework of rules, relationships, systems, and
processes within and by which authority is
exercised and controlled in corporationsā
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
8. Healthcare is a Risky Business
Harvard Medical Practice Study, 1991:
> 3.70% of hospital admissions lead to āadverse
eventsā
> 1.85% of hospital admissions lead to avoidable
āadverse eventsā
> 0.50% of hospital admissions lead to āadverse
eventsā resulting in death
> Corresponds to 120,000 avoidable deaths per
annum in USA
Why is Risk Management an
issue in Healthcare?
8
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
ā¦
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
ā¦
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 āLake Wobegonā 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 membersā self-assessment of performance compared with a
typical health service in Victoria
17. > Systems and processes for assurance
> People who understand and can
assess (Management/Board)
skills/experience
> Leadership and culture
Lessons from Bacchus Marsh
17
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 organisationās 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 āmoderately usefulā or āvery usefulā.
Board membersā 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 Healthās 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 ānot at all familiarā with the Commissionās 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 āLake Wobegon effectsā (named after Garrison Keillorās fictional community, in which āall the women are strong, all the men are good looking, all the children are above averageā) is unavailability or underuse of reliable information on peer performance.
In a list of six possible priorities for board oversightāwhich included financial performance, business strategy, and operationsāover 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 boardās Quality Committee.