The document discusses healthcare governance and patient safety. It introduces clinical governance, which emerged in the UK after highly publicized patient safety breaches. An inquiry found that babies died at high rates after cardiac surgery due to staff shortages, lack of leadership, a lax approach to safety, and lack of management monitoring. The Institute of Medicine reported in 1999 that 2-4% of deaths in the USA are caused by preventable medical errors. The document recommends governance practices for quality improvement and patient safety such as having a quality committee, ensuring a written quality plan is reviewed annually, and routinely reviewing quality indicators.

1. Healthcare Governance
And
Patient Safety
Ola H. Elgaddar
MD, PhD, CPHQ, LSSGB
Lecturer of Chemical Pathology
Alexandria University
Ola.elgaddar@alexu.edu.eg

2. Clinical governance as a term that was
first introduced in the 1990s in the National
Health Service (NHS) in the U.K
It emerged after several highly publicised
breaches of patient safety, the most
notable of which was dealt with
extensively by the Bristol Inquiry

3. Babies died at high rates after
cardiac surgery
An inquiry found:
Staff shortages
Lack of leadership
Lax approach to safety
Lack of monitoring by management

4. The context at the time was:
Increased demand on services.
Costs were escalating
Use of litigation when things went wrong,
creating an increased pressure on health
systems to get things right.
Hence, the idea of involving clinicians in
reforms, including governance processes,
took root.

5. The role of the relevant government agency
responsible for health is to specify to
providers what is to be achieved in
exchange for the funding they allocate, with
expectations that the role of the provider of
services is to assure high-quality services
and safety for patients.

6. Health service provision involves the
delivery of millions of services by thousands
of health professionals to hundreds of
thousands of ill patients using complicated
equipment, procedures and processes.
A major difficulty is that a zero error rate,
such as is aspired to in the aviation is not
seriously possible to get close to in health
care.

7. Institute Of Medicine 1999
 2-4 % of deaths in the USA
are caused by preventable
medical errors.
 You cannot blame people but
you should blame the system
 Enhancing systems result in
mitigating error rates and
improving health outcomes.
 President Bill Clinton signed
Senate bill, renaming the
Agency for Health Care Policy
and Research to Agency for
Healthcare Research and
Quality .

8. The Legal and Regulatory
Contexts for Boards’ Activities
In not-for-profit (NFP) hospitals, the roles
and responsibilities of governing boards are
complex and critical to institutional viability
and to fulfilling their community obligation.
NFP hospital governance boards are
legally bound to the duties of care, loyalty,
and obedience.

9. CARE
The duty of care refers to the obligation
of corporate directors to act:
(1) in good faith,
(2)with the care that an ordinarily cautious
person would exercise in like circumstances,
(3) in a manner that they reasonably believe
to be in the best interests of the corporation.

10. A board exercising its duty of care must
consider quality and patient safety in all of
its decisions

11. Obligations:
1. Board gives written bylaws or
mechanisms that ensure the medical staff
is accountable to the governing board for
the quality of care provided to patients.

12. Obligations:
2. Hospital leaders and elected members of
the medical staff should codify standards
and monitor competence of the
credentialed medical staff.

13. Obligations:
3. Board should discuss, investigate, and
monitor performance and allocate
sufficient resources to ensure high-
quality, safe care.

14. loyalty
The board duty of loyalty asserts that NFP
board members owe allegiance in their
discussions and decision making to the
hospital stakeholders (eg, community) rather
than to personal interests or the interests of
other organizations or individuals, including
members of the medical staff.

15. obedience
The duty of obedience requires adherence
to the purpose and mission of the health-care
organization.
It obligates the board to make certain that
institutional policies and practices place a
priority on the quality of patient care.

16. Though boards delegate much work, they are
ultimately accountable for everything that
transpires in the name of the organization.

17. Physician Involvement in Quality
and Patient Safety Oversight
Since the late 1990s, physicians have been
increasingly serving as hospital leaders and
on hospital boards. Yet, whether hospitals
with physicians in senior leadership roles
provide higher-quality care than hospitals
that lack physician leaders is uncertain.

18. The board must create a quality and
patient safety improvement system that is
meaningful, measurable, and manageable.
This requires both technical and adaptive
work.

19. The technical work of improvement
involves identifying known solutions to
performance problems, ensuring patients
reliably receive evidence-based therapies,
and monitoring performance.
Physician involvement in these areas is
essential.

20. Physician involvement is also essential to
adaptive work, which involves changing
attitudes, beliefs, and behaviors needed to
provide high-quality and safe patient care.

21. Boards can collaborate with physicians by
appointing them to leadership roles or by
participating in hospital committees and
medical staff meetings.
With increasing frequency, governing
boards recruit physician members.

22. The physician-trustee role is not easy.
These physicians must balance tensions
and conflicts of interests in advocating for
the medical staff, the hospital, and the
community.
To circumvent those challenges, some
boards recruit physician-trustees who are
not credentialed members of the medical
staff. Most boards also have well-
documented conflict of interest policies to
guide decision making,

23. Recommended Governance Practices
for
Quality Improvement and Patient Safety
1. Boards should have a separate quality
and patient safety committee that meets
regularly and reports to the full board.

24. 2. Boards should ensure the existence and
annual review of a written quality
improvement and patient safety plan that
contains valid measures of performance,
and that is consistent with national,
regional, and institutional quality and
safety goals.

25. 3. Boards should have an auditing
mechanism for quality and safety data,
just as they do for financial data.

26. 4. Boards should routinely hear stories of
harm that occurred at the hospital, putting
a face on the problem of quality and
patient safety.

27. 5. In conjunction with the CEO and medical
staff leaders, boards should identify
specific, measurable, valid quality
indicators consistent with strategic goals
and hospital services, and review
performance against the indicators no
less than quarterly.

28. References
1. Braithwaite J, Travaglia JF. An overview of clinical governance policies,
practices and initiatives. Aust Health Rev 2008: 32(1): 10–22.
2. Department of Health. The report of the public inquiry into children’s heart
surgery at the Bristol Royal Infirmary 1984-1995: learning from Bristol.
London: Stationery Office, 2001.
3. Hindle D, Braithwaite J, Iedema R, Travaglia J. Patient safety: a comparative
analysis of eight inquiries in six countries. Sydney: Centre for Clinical
Governance Research, University of New South Wales, 2006.
4. Amalberti R, Auroy Y, Berwick D, Barach P. Five system barriers to achieving
ultrasafe health care. Ann Intern Med 2005; 142: 756-64.
5. Goeschel CA, Wachter RM, Pronovost PJ. Responsibility for Quality
Improvement and Patient Safety; Hospital Board and Medical Staff
Leadership Challenges. CHEST 2010; 138(1):171–178.
6. Becher EC , Chassin MR . Taking health care back: the physician’s role in
quality improvement . Acad Med . 2002; 77( 10): 953 - 962 .

29. Thank you