Transcript CLINICAL GOVERNANCE

CLINICAL GOVERNANCE
M S Arul Inban
Carmarthenshire VTS HDR
3 May 2005
What is clinical governance?
• Clinical governance is a system for improving the standard of
clinical practice.
• Clinical governance was first described in a government White
Paper on health in 1997 as ‘a new system in NHS Trusts and
primary care to ensure that clinical standards are met, and that
processes are in place to ensure continuous improvement,
backed by a new statutory duty for quality in NHS Trusts’.
• Clinical governance is a powerful, new and comprehensive
mechanism for ensuring that high standards of clinical care are
maintained throughout the NHS and the quality of service is
continuously improved.
DEFINITION of clinical governance?
• Clinical governance is the 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.
• It is a framework to describe activities in NHS which
aim to improve or maintain the quality of patient care.
• It is also a vehicle for delivery of uniform and quality
clinical care throughout the country.
Why, clinical governance?
• Alleged decline and disparity in standards and quality
of health care provision.
• Series of publicised lapses in quality of health care
prompted doubts in the minds of patients and public
about the overall standards of care they may receive.
• Increase in number of complaints.
• Increased public awareness of health care provision.
• Increased patients’ and carers’ expectations and
demands from the health care system.
• Patients have the right to quality health care.
• Public / Govt. have responsibility to ensure quality
health care.
• It is an agenda of modernising NHS.
• Financial issues might have priority over Quality in
health care system.
What are the elements of
clinical governance?
Education and Training
• In the modern health service, it is no longer acceptable for any
clinician to abstain from continuing education after
qualification because too much of what is learnt during training
becomes outdated too quickly.
• Continuing Professional Development has become a
professional requirement for all health care professionals.
• It is the responsibility of the employer and the relevant
professional body to ensure that the health care professionals
are up-to-date.
• Different systems have emerged to support CPD.
Postgraduate Education Allowance (PGEA) for GPs
CPD programmes for hospital doctors
Post Registration Education and Practice (PREP) for nurses
Trained educators to support such approaches (e.g. GP tutors)
Clinical Audit
• Clinical audit is the the refining of clinical practice by review of
clinical performance.
• It involves the measurement of performance against agreed standards.
• A cyclical process of improving the quality of clinical care.
• Audit has been part of good clinical practice for generations.
• Participation in audit has been a requirement of NHS trust employees,
including doctors, and protected time has been provided.
• It is facilitated by trained staff and committees in NHS trusts, and
through Medical Audit Advisory Groups (MAAGs) in primary care.
• Medical audit has moved to become Clinical Audit, as it involves all
members of the clinical team, at all levels.
• With all its previous experience and history of audit activity, it
becomes an effective contributor to quality improvement in the clinical
governance framework
• Management cost pressures have made it difficult to sustain a
comprehensive programme of clinical audit activity, particularly in
primary care where audit has not been underpinned by contractual
arrangements.
Research and development
• Good professional practice can be possible only in the light of
evidence from research.
• The development of research practices and research networks
in primary care, along with the national research and
development programmes is essential.
• Guidelines, Protocols and Implementation Strategies and all
other similar tools for promoting quality of health care can be
possible only through research evidence.
• Quality of care can only be assured through Evidence Based
Medicine.
• R & D is the backbone of Evidence Based Medicine.
• Promoting research in the operational practice of Clinical
Governance should be an agreed national priority.
• However, Funding is always an issue.
Research
Audit
• Attempts to define ‘best
practice’
• Usually involves testing
hypothesis or experimenting
new methods
• May involve intrusion beyond
normal clinical activity
• Ethical Committee approval
& Patients’ Consent is a
must
• Involves allocating patients
randomly ( treatment /
placebo)
• May involve collaboration
with manufacturers
• Attempts to find whether
‘best practice’ exists locally
• Usually involves setting
standards (never involves
hypothesis or experimenting)
• Does not involve intrusion
beyond normalclinicalactivity
• EC approval & Patients’
Consent is needed when the
public involved directly
• Involves selecting a rep.
Sample (but not allocating
patients randomly in groups)
• May involve collaboration
with patients
clinical effectiveness
• In patients who have had a total hip replacement, the use of low
molecular weight heparins as thromboprophylaxis, in
comparison with standard heparins,
• resulted in a reduction of total deep vein thrombosis (DVT) from
149 of 685 patients (22%) to 117 of 735 patients (16%) and of
proximal DVT from 86 of 685 patients (13%) to 40 of 735 (5%)
patients.
• Therefore,in order to prevent one episode of proximal DVT, 14
patients would need to be treated with low molecular weight
heparin instead of standard heparin.
clinical effectiveness
• Research & Development to ensure improvements to patient
care
• Guidelines to reduce unwanted variations in practice
• Education to ensure practitioners know what best practice is
• Clinical Audit to ensure best practice is taking place locally
• Outcome measurement to ensure we are achieving best
practice
• Cost – Effectiveness to ensure value for money
To put it simply, it is about, Doing
the Right Thing > at the Right Time > to the Right People
Risk management
• Providing health care is a risky business
• Risks are associated with everything we do
• Risks may arise from environment, procedures, interventions,
treatment and so on
• Risks can be to
the patient
the health care staff
the health care provider organisation
• Risk management is about delivering care safely
• It aims to develop good practice and reduce the likelihood of
harmful incidents occurring
• all risks need to be minimised as part of any quality assurance
programme.
• Reporting incidents, accidents and near misses
When an incident or accident is reported, it should be investigated so
that the situation can be put right and lessons can be learned to
prevent recurrence.
• Risk Assessment
As part of a continuous process all staff should be involved in identifying
potential hazards to patients and themselves.
Risk prevention strategies can then be employed to reduce the chance
of any kind of harm.
• Complaints
Each complaint must be investigated using a standard policy for
managing complaints and action taken.
A number of complaints about the same issue may point to the need for
change in practice to avoid further recurrence.
• Other issues
immunisation of staff
cleaner environment
hand washing
and so on
Openness
• Poor performance and poor practice can too often thrive behind
closed doors.
• All processes which are open to public scrutiny, while
respecting individual patient and practitioner confidentiality, and
which can be justified openly, are an essential part of quality
assurance.
• Open proceedings and discussions about clinical governance
issues can be effective only in a blame free culture and
environment
• The aim should be improving quality, not finding a victim to take
the blame.
Patient Experience
• The customer (patients and users of health care) can provide
valuable feedback on the quality of service they receive.
• It is important to take their views into account when monitoring
existing services and when developing new ones.
• As a result National Patient and User Surveys are being
developed.
Workforce Issues
• Staff should be appropriately qualified to do their job.
• Professional Registration should be up-to-date.
• All staff should have Personal Development Plan and be
supported in their learning needs.
• Appraisal systems should be in place to enable feedback of
performance and areas for improvement.
• Good quality and up-to-date documentation and information are
essential for providing good quality service.
• Record keeping is important for continuity of patient care and
communication.
• Good Communication Skills vital to all staff at all levels
CHIEF
EXECUTIVE
(Accountable Officer)
TRUST
BOARD
CLINICAL GOVERNANCE
COMMITTEE
CLINICAL GOVERNANCE FORUM
DIRECTORATE MULTIDISCLINARY
CLINICAL GOVERNANCE TEAMS
• CHI – Commission for Health Improvement
inspects NHS hospitals to ensure Clinical Governance activities
are in place and are effective
• NICE – National Institute for Clinical Excellence
provide national standards of clinical care against which clinical
practice can be measured
• NSF – National Service Frame Work
guidance document that outlines how health care for a specific
disease or condition can best be provided
• The system of clinical governance brings together all
the elements which seek to promote quality of health
care.
• The challenge to those (we) responsible should not
be underestimated.
• We need to understand the cultures and sensitivities
involved to help health care professionals to review
and justify their performance.
• Many clinicians are still apprehensive about clinical
governance and feel the changes involved could be
an unnecessary intrusion.
All the activities of CLININICAL GOVERNANCE are
only in the BEST INTERESTS of HEALTH CARE
PROFESSIONALS and their PATIENTS
THANK YOU
(means ‘THANK YOU’ in ‘Wingdings’ font language)