Clinical Governance


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

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Clinical Governance

  1. 1. Faculty of Health and Social Care Clinical Governance David Stonehouse Senior Lecturer
  2. 2. 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
  3. 3. 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.the University of choice
  4. 4. 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)the University of choice
  5. 5. 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)the University of choice
  6. 6. 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).the University of choice
  7. 7. 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.the University of choice
  8. 8. 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.the University of choice
  9. 9. 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.the University of choice
  10. 10. The Temple Model OfClinical Governance
  11. 11. The Foundation Stones System Awareness SystemsAwareness
  12. 12. 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.the University of choice
  13. 13. The Foundation Stones Teamwork SystemsAwareness Teamwork
  14. 14. 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)the University of choice
  15. 15. “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)the University of choice
  16. 16. The Foundation Stones Communication Systems CommunicationAwareness Teamwork
  17. 17. 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 & concernthe University of choice
  18. 18. The Foundation Stones Ownership Systems CommunicationAwareness Teamwork Ownership
  19. 19. Ownership■ Clinical Governance as a whole.■ Nurses of their working areas.■ Patients of their care & treatment.■ Local community of their health services.the University of choice
  20. 20. The Foundation Stones Leadership Systems CommunicationAwareness Teamwork Ownership Leadership
  21. 21. 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.the University of choice
  22. 22. The Pillars Systems CommunicationAwareness Teamwork Ownership Leadership
  23. 23. 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.”the University of choice
  24. 24. Clinical EffectivenessThree distinct parts1. Finding & assessing evidence.2. Implementing the evidence.3. Monitoring & evaluating the impact, readjusting practice as necessary, usually through clinical audit & patient feedback.the University of choice
  25. 25. The Pillars Systems CommunicationAwareness Teamwork Ownership Leadership
  26. 26. How Effective is this Risk Management?
  27. 27. 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.the University of choice
  28. 28. 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”the University of choice
  29. 29. 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.the University of choice
  30. 30. The Pillars Systems CommunicationAwareness Teamwork Ownership Leadership
  31. 31. Patient Experiences■ National Patient Survey■ Interviews■ Patient Diaries■ Focus Groups / Patient Forums■ Patient Tracking■ Consultation With Voluntary Groups.the University of choice
  32. 32. 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)the University of choice
  33. 33. Nurses Role■ Take complaints seriously.■ Local resolution.■ Good communication.■ Fully involve patients/carers in decisions.the University of choice
  34. 34. The Pillars Systems CommunicationAwareness Teamwork Ownership Leadership
  35. 35. Communication Effectiveness■ Staff to patient - Written - VerbalIn just about every complaint there will have been a breakdown in communication.■ Staff to the organisation as a whole.the University of choice
  36. 36. The Pillars Systems CommunicationAwareness Teamwork Ownership Leadership
  37. 37. 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?the University of choice
  38. 38. The Pillars Strategic Effectiveness Systems CommunicationAwareness Teamwork Ownership Leadership
  39. 39. 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.the University of choice
  40. 40. The Pillars Strategic Effectiveness Learning Effectiveness Systems CommunicationAwareness Teamwork Ownership Leadership
  41. 41. 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.the University of choice
  42. 42. 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)the University of choice
  43. 43. Key Features Of A Learning Organisation■ Open Systems Thinking.■ Improving Individual Capabilities.■ Team Learning.■ Updating Mental Models.■ Sharing A Cohesive Vision.the University of choice
  44. 44. Patient – Professional Partnership Strategic Effectiveness Learning Effectiveness Systems CommunicationAwareness Teamwork Ownership Leadership
  45. 45. 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
  46. 46. BibliographyDepartment of Health (1997) The New NHS: Modern and Dependable. (Accessed 29/10/2012).Department of Health (1999) Making A Difference: strengthening thenursing, midwifery and health visiting contribution to health and healthcare. (Accessed 29/10/2012).Department of Health (2000) An Organisation with a memory. (Accessed 29/10/2012).Hallett, L. & Thompson, M. (2001) Clinical Governance: A Practical GuideFor Managers. London: HSJ Public Sector Management.O‟Neil, S. (2000) Effective Risk Management Strategies, Professional NurseRoyal College of Nursing (1996) The Royal college of Nursing ClinicalEffectiveness Initiative – A Strategic Framework. London, RCN.
  47. 47. BibliographyRoyal College of Nursing (2003) Clinical Governance: An RCN ResourceGuide. London: RCN.Senge, P. M. (2006) The Fifth Discipline: The Art & Practice Of The LearningOrganization. New York: Currency Doubleday.Stonehouse, D. (2011) „Teamwork, Support Workers And Conduct AtWork.‟ British Journal of Healthcare Assistants. Vol 05. No 07. pp350-54.Stonehouse, D. (2012) „Why Complaints Are A Positive For SupportWorkers.‟ British Journal of Healthcare Assistants. Vol 05 No 07. pp39-40.