Clinical Governance

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Clinical Governance

• Dr. Hamda Qotba, B.Med.Sc MD ABCM MFPH

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What is clinical governance?
a system through which all of the organizations
in the health system are accountable for
continuously improving the quality of their
clinical services and ensuring high standards of
patient care by creating a facilitative
environment in which excellence will flourish
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• clinical governance is a way of making sure that
  everyone who passes through health system is well
  cared for
• or
• System that enable staff to work in the best
  possible way
• Staff performing to the highest possible standards

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What might that mean in practice

• Put patients /clients/customers first and last
• Improve standards of working
• Learn from experience
• Enable staff and team
• Use information effectively

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The following components have been identified as
necessary

• Clear national standards
• Mechanisms for ensuring local delivery of these
  standards
• Mechanisms for monitoring the delivery of these
  standards

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• key components
• Clinical audit (individual and service )
• National confidential inquiries
• Evidence-based medicine (? Apply to practice )
• Clinical standards (NSFs, NICE, local )
• Manpower planning (including retention )
• Continuing professional development and lifelong
  learning
• Research and development ( including evaluation
  of care )
• Clinical care quality integrated with
  organizational quality

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Other components

• Clinical risk ( self and program (s))
• Complaints
• Job plan and individual performance
• Critical appraisal
• Whistle-blowing

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confidentiality
Clinical standards NSFs
EBM
Risk Management
RD
Clinical Audit
Monitoring Evaluation
National confidential inquiries
Manpower planning
CPD
Job plan
WB
Organization Quality
complaints
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1. Clinical audit

• An audit is an examination or review that
  assesses and reports on the extent to which a
  condition, process or performance matches
  predetermined standards or criteria. It is
  concerned with resource allocation, financial and
  general administrative management and, to a
  certain extent, substantive issues.
• Considered as tool not goal

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2. Evidence-based medicine

• The process of systematically finding,
  appraising, and using contemporaneous research
  findings as the basis for clinical decisions
• Being health professional you should aim to do
  only those medical activity that you have
  evidence it will work successfully

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3. Clinical standards

• Bounds by which all practices in a given area
  will be carried out, in achieving the goals and
  objectives for that area

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4. Research and Development

• This forms the basis for evidence-based medicine.
  The NHS Research and Development strategy was
  launched in 1991 to develop a knowledge-based NHS
  in which decisions (clinical, policy and
  managerial ) would have a sound base.
• This strategy will continue to have pivotal role
  in collecting new evidence, with support from the
  Horizon Scanning Center and the National
  Prescribing Center in identifying new and
  existing interventions.

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5. Risk management

• The process of minimizing risk to an organization
  by developing systems to identify and analyze
  potential hazards to prevent accidents, injuries,
  and other adverse occurrences, and by attempting
  to handle events and incidents which do occur in
  such a manner that their effect and cost are
  minimized.
• Effective risk management has its greatest
  benefits in application to insurance in order to
  avert or minimise financial liability.

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6. Monitoring and Evaluation

• Process of regularly reviewing achievements and
  progress towards the goals (day to day )
• Process measuring the degree to which objectives
  and targets are fulfilled and the quality to the
  result are obtained

Evaluation and audit requires the assessment of
effectiveness and efficiency and the formulation
of recommendations to promote improvement. In
appraising these elements, however, audit differs
from evaluation in orientation or objectives
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7. National confidential inquiries

• The four existing national confidential inquiries
  
• preoperative death, stillbirths and deaths in
  infancy, maternal deaths and suicides
• overseen by NICE.

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8. Job plan and individual performance

• This will highlight areas in the job that are not
  being met, both presently and as the job
  develops.

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9. Continuing Professional Development (CPD)

• This is about developing a culture that
  encourages lifelong learning ( the learning
  organization ) and is an integral part of the job
  plan. Health organization should commit, plan and
  act on investment in people if they are truly
  interested in delivering quality clinical care

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10. complaints

• Complaints will be monitored both externally and
  internally. There will have to be an effective
  local system in place to deal with complaints.
  Documentation will be particularly important in
  order to facilitate external scrutiny.

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11. Manpower planning

• This will establish the required staffing levels
  to achieve acceptable standards of care. However,
  this is not just about recruiting the appropriate
  staff, but also about retaining them.

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12. Whistle-blowing

• This is to be encouraged. If poorly performing
  work colleagues are not dealt with/reported,
  responsibility will be shared. This balance
  between collective and individual responsibility
  must be appreciated.

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13. Critical appraisal

• our ability to critically appraise the strength
  of the evidence available and its application
  should be part of our routine practice.

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14. peer-review

• both internal and external peer-review will be
  an important tool for assessing the effectiveness
  of the clinical governance culture and in
  creating a facilitative environment in which
  excellence can flourish

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success

• For clinical governance to be successful, the
  following must be in place
• Clear lines of responsibility and accountability
• A program of quality improvement activities
• Clear policies aimed at managing risk
• Procedures to identify and remedy poor
  performance.