Clinical Governance

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• Clinical Governance
• Framework

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Clinical Governance
Is defined as

• a framework 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 excellence in clinical care can flourish
• Quality Care and Clinical Excellence 1998

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Why Clinical Governance?

• Because we need to deliver sustainable,
  accountable patient focused quality healthcare

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Clinical Governance in Practice

• Responsibility for quality at a local level with
  clear national standards
• Improves the standard of clinical care
• Reduces variations in outcomes of care
• Up to date evidence of what is known to be
  effective

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Key Papers

• Putting Patients First Quality Care and Clinical
  Excellence (1998)
• Welsh Health Circular - WHC (99) 54(March 1999)
• Improving Health in Wales (Jan 2001)
• Clinical Governance- The First 12 months (Sept
  2001)
• Clinical Governance- developing a strategic
  approach (Sept 2001)

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Key themes of clinical governance-
Improving quality
Risk Management
Audit
Leadership
Developing Information Systems
Evidence-based practice
Continuing Professional Development
Research Development
Communication
Monitoring standards and performance
Setting standards
Patient involvement
Complaints
National Institute for Clinical Excellence
Accountability
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Clinical Governance is about.

• everyone knowing what is supposed to happen,
  and then making sure it does

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Where does it all fit in???
National Institute for Clinical Excellence
National Service Frameworks
Professional
Clinical
Lifelong
governance
self-regulation
learning
Health Inspectorate Wales
Performance Framework
Patient and user surveys
Reference Quality Care and Clinical Excellence.
Putting Patients First. Welsh Office, 1998.
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LHB Responsibilities

• Developing programmes of Clinical Governance
• Ensuring National, Internal and Core Clinical
  Audits take place, and those deemed necessary by
  the LHB.
• Establishing open and learning relationships with
  bodies who may make judgements about quality
  (CHAI/ HIW)

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7 Pillars of Clinical Governance

• Clinical effectiveness
• Risk management
• Patient experience
• Communication effectiveness

• Resource effectiveness
• Strategic effectiveness
• Learning effectiveness

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• Core Values
• Improve standards of care and service delivery
• Structured approach to clinical and non clinical
  risk management
• Foster learning culture of adverse incidents
• Develop effective and efficient information
  systems
• Regular and systematic review of clinical
  information
• Collaborative working with key stakeholders
  (professionals public)
• Facilitate CPD and Staff Education Training
• Audit - ensure appropriate effective
• Research Development

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Clinical Effectiveness

• Providing clinical care in accordance with
  what is known or believed to represent good
  practice and achieving the best possible outcomes

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Clinical Effectiveness

• Make the right decisions about the
  patient/clients condition, needs and
  treatment/intervention
• Provide the care decided upon in the right way,
  consistent with up to date evidence of what makes
  good practice
• Achieve the right outcomes of care

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• 4 STEPS
• TO IMPLEMENTATION

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STEP 1
Leadership/accountability/working arrangements
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Clinical Governance Structure
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CMP Steering Group

• Established August 2003
• Monthly meetings
• Networking LHB/ Trusts/ Primary Care
• To provide recommendations regarding service
  development and provision.
• To discuss procedures and guidelines, both
  existing and newly formulated, ensuring they are
  both achievable and effective.
• To advise on the live running of the programme,
  with regard to achieving agreed performance
  targets.

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CMP Steering Group cont

• To ensure that the work of the CMP is underpinned
  by evidence based practice.
• To review and where appropriate audit relevant
  policies and procedures to ensure that they are
  consistent with current good practice and / or
  legal requirements.
• To ensure that all stakeholders are engaged with
  the strategic planning and operational delivery
  of the service.
• To review specific areas of clinical and
  non-clinical risk, set priorities and recommend
  the action to reduce to those risks.

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CMP Steering GroupMembership

• CMP Project Manager
• Head of Therapy Services
• Public Health Representative
• General Practitioner
• RCT Local Health Board Representative
• Bridgend Local Health Board Representative
• Director of Primary Care
• Clinical Team Leader
• Clinical Psychologist
• Physiotherapy Provider
• District Implementation Manager Jobcentre Plus
• Secretariat

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Implementation

• Structured approach to options appraisal/developme
  nt/action plan
• Links with professional peers/organisations
• Assess appropriate way forward through research
  and consultation
• All feedback to LHB Boards Jobcentre Plus
  Strategic Partnership Group

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STEP 2
Baseline assessment (capacity/capability)
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CLINICAL GOVERNANCE
Baseline Assessment Themes-

• Research and clinical effectiveness
• Use of information
• Consultation and public involvement
• Clinical risk management
• Clinical audit
• Staffing staff management
• Education, training and continuing
• personal and professional development

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CLINICAL GOVERNANCE
Research Clinical Effectiveness

• All staff have access to health libraries
• Networking opportunities
• Clinical Policies
• Professional Registration
• Clinical non clinical audit processes

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CLINICAL GOVERNANCE
Public Patient Involvement

• Programmes are accessible and equitable
• Clients are involved in negotiating their
• action plans and are kept informed of any
• developments
• Client perspective Client Participant
• Robust methods of communication
• Confidentiality
• Client feedback

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CLINICAL GOVERNANCE
Education, Training Professional Development

• Education Training opportunities for staff
• Training policies
• Identification of training needs
• Support to undertake training
• Training portfolios
• Supervision and reflective practice

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CLINICAL GOVERNANCE
Risk Management

• Incident reporting processes established
• Risk Management training sessions
• Monitoring of incidents
• Lessons learned
• Audits of risks and Safe Systems of Work
• Lone working policies in place

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CLINICAL GOVERNANCE
Staffing Staff Management

• Standards for recruitment
• Joint staffing
• Professional registration (Health Professions
• Council)
• Induction
• Workforce performance
• Accountability

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CLINICAL GOVERNANCE

• Use of Information
• Caldicott training regarding P.I.D.
• Electronic information systems
• Data collection for monitoring and service
• development
• Standards for clinical data recording
• Reporting Management Information

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CLINICAL GOVERNANCE
Strategic Effectiveness

• Service strategy
• Jobcentre Plus liaison
• Workforce planning
• Patch management
• GP Liaison
• Financial Planning
• Service development groups, modules, etc.
• Reducing inequalities hard to engage groups
• Public relations
• Promoting the service

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STEP 3
Strategic Development action plan
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CMP DEVELOPMENT STRATEGY
9 Priority Areas-

• Financial perspective
• Human Resources
• Staff Training Development
• Service Development Innovation
• Communication
• Operational excellence
• Collaboration and Partnership
• Performance
• Risk Management

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CMP DEVELOPMENT STRATEGY

• Financial Perspective
• Activities-
• To draw up an annual financial plan projecting
  expenditure for the forthcoming year and
  communicate this to Jobcentre Plus.
• To ensure accurate accounts of all expenditure
  are kept.
• To monitor expenditure on a monthly basis and
  make best use of available resources.

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CMP DEVELOPMENT STRATEGY

• Financial Perspective
• Key outcomes-
• Enabling investors to allocate appropriate
• resources in line with their fiscal plans.
• Effective performance management through
• both the Local Health Board and Jobcentre
  Plus
• Ability to demonstrate that all funds are being
• effectively managed
• Provision of a robust audit trail

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CMP DEVELOPMENT STRATEGY
Human Resources

• Activities-
• To further analyse the staffing requirements to
  develop CMP to its full potential.
• To ensure an adequate skill mix within the team
  in order to deliver the service across the three
  identified healthcare categories.
• To ensure that all CMP staff participate in the
  annual appraisal and personal development
  planning process in order to monitor performance
  and identify training needs.

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CMP DEVELOPMENT STRATEGY

• Human Resources
• Key outcomes-
• The service will be adequately resourced with
  appropriate staffing levels to meet service
  demands
• That there is an adequate skill and knowledge
  base within the practitioner team to deliver the
  service to its full potential.
• The development of a well trained and motivated
  team to deliver CMP

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CMP DEVELOPMENT STRATEGY
Staff Training Development

• Activities-
• To produce a staff training needs analysis via
  the PDP process
• To look at strategic skills requirements in order
  to ensure that staff have the relevant expertise
  and competencies to deliver CMP.
• To develop cross agency masterclass training
  sessions for specific health conditions
• To encourage the sharing of knowledge across the
  multi-disciplinary team.

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CMP DEVELOPMENT STRATEGY

• Staff Training Development
• Key outcomes-
• Identification of training needs within the team
• Well trained and motivated practitioners.
• All practitioners use up-to-date and
  evidence-based practice
• Cross agency training opportunities

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CMP DEVELOPMENT STRATEGY
Service Development Innovation-

• Activities
• To achieve innovation and improvement by
  involving and encouraging practitioners to
  critically examine working practices and suggest
  better ways of working and opportunities for new
  developments.
• To develop a broad and effective range of CMP
  service provision for customers to access.
• To develop a culture based around quality
  improvement and clinical governance ensuring that
  staff are aware of their responsibilities in
  relation to audit, clinical effectiveness, risk
  management, managing information, etc.

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CMP DEVELOPMENT STRATEGY
Service Development Innovation-

• Key outcomes-
• An improved service for clients offering a
  broader range of service provision.
• Improved cost effectiveness by managing demand
  more effectively.
• Making better use of staffing and resources
• Increased staff motivation by involving them in
  service developments

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CMP DEVELOPMENT STRATEGY
Communication-

• Activities-
• To continue to raise awareness and understanding
  of the CMP across a range of stakeholders and the
  wider NHS community.
• To to provide regular, relevant update reports
  to key partners and stakeholders,
• To provide quality assured information to
  customers in order to keep them informed.
• To ensure that staff meetings continue with
  suitable frequency in order for the team to be
  kept up-to-date with developments and to share
  information.
• To continue to work on communication and liaison
  with Personal Advisors in order to communicate
  client outcomes and to increase confidence in
  referring.
• To monitor communication processes and their
  effectiveness and to make any necessary
  adjustment to bridge
• any gaps.

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Communication
CMP DEVELOPMENT STRATEGY

• Key Outcomes-
• Well informed staff up-to-date with key
  developments
• Customers will be well informed regarding the CMP
  and its provision
• Accurate and contemporary information will be
  readily available for partners and stakeholders
• Further enhancement of the links which have been
  developed between employment services and health
  services.

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Operational Excellence

• Activities-
• To continue to learn about the whole systems
  approach to the delivery of Pathways to Work in
  order to fully support the process, and improve
  its overall effectiveness and performance.
• To monitor data to gain insight into overall
  performance and make any necessary improvements
  to enhance service delivery.
• Practitioners will be encouraged to value and
  understand the significance of audit and how it
  can help with the development and quality
  assurance of service delivery.
• Audit systems and processes are established to
  facilitate continuous development and
  improvement.
• Promoting research awareness and the development
  of core skills in the assessment, appraisal and
  implementation of evidence based practice.
• To ensure demand is managed within agreed
  timescales by undertaking quarterly reviews of
  appointments systems and reviewing practitioners
  caseloads regularly.

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CMP DEVELOPMENT STRATEGY
Operational Excellence

• Key outcomes-
• The provision of accurate and contemporary
  management information
• Improved client care via audit outcomes
• Improved performance and the delivery of an
  efficient service

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CMP DEVELOPMENT STRATEGY
Collaboration Partnership

• Activities-
• To create a mechanism to capture the views of
  clients regarding their experiences with the CMP
• To process client information and feedback, and
  incorporate the results into service planning and
  decision making processes.
• To identify a client as a service user
  representative.
• To review communication mechanisms between the
  CMP and clients in order to ensure their
  effectiveness.
• To ensure that all CMP practitioners involve
  clients in decision making about their care.

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CMP DEVELOPMENT STRATEGY
Collaboration Partnership

• Key outcomes-
• A more responsive service for clients.
• Improved outcomes of care and better health for
  clients by involving them in the process.
• Reducing health inequalities by narrowing the gap
  between the worst off and the best off in our
  communities.
• Enhancing client management
• Enhanced levels of customer satisfaction.
• Improved client perspective of the CMP.
• The ability to offer clients a much wider range
  of opportunities and choices.

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CMP DEVELOPMENT STRATEGY
Performance

• Activities-
• To measure performance and success by identifying
  outcome measures and undertaking audits against
  them
• To ensure that all CMP activities make a
  contribution to intended outcomes by undertaking
  regular reviews of service components.
• To guide planning and resource allocation, i.e.
  focusing activities and resources.
• To ensure quality data capture and to monitor the
  effectiveness of data management processes

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CMP DEVELOPMENT STRATEGY
Performance

• Key outcomes-
• The delivery of an effective and efficient
  service
• A pattern of service delivery which is flexible
  and meets clients needs
• The ability to identify any gaps in service and
  make improvements
• Staff will have clear goals and objectives.
• Improved service clarity in order to effectively
  direct resources

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CMP DEVELOPMENT STRATEGY
Risk Management

• Activities
• To undertake a risk assessment of all working
  processes addressing clinical and non-clinical
  risk and ensuring safe systems of work.
• To deliver risk management training to all CMP
  staff
• To ensure that any risks identified will be
  prioritised and appropriately managed
• To ensure all staff are aware of their
  responsibilities in relation to risk management
  and adverse incident reporting mechanisms
• To encourage openness ensuring that lessons
  learned are shared with staff across the CMP.

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CMP DEVELOPMENT STRATEGY
Risk Management

• Key outcomes-
• Improved quality of care for clients
• Maintain a safe environment for clients and staff
• Reduce any potential financial loss
• Demonstrate to clients, partners and
  stakeholders that we have an efficient and safe
  service.

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STEP 4
Reporting arrangements
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Clinical Governance in Action

• RAID model for change
• Review
• Agree
• Implement
• Demonstrate

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• R
• Review/ Think Through
• D A
• Document RAID Model Agree/
  Consensus
• Demonstrate
• Data Generation
• I
• Implement/ Deliver

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Review

• Starting point - where are we now?
• Looking at audit, documentation and
• process
• Listening to patients/clients and staff
• Gathering information

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Agree

• Gain consensus
• Shape the future
• Formulate recommendations
• Build teams

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Implement

• Project management
• Expect and deal with resistance
• Motivate and support staff
• Dealing with transition
• Priorities

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Demonstrate

• Project analysis
• Plan next objectives
• Identify lessons
• Show the differences

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Clinical Governance Can.

• Provide a better experience for staff
• Provide a better experience for Patients/clients
• Improve the quality of care for Patients/clients
• Make the changes you want to make happen

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Overall Benefits of Clinical Governance

• Risks are reduced
• Adverse events are detected, openly investigated
  and lessons learned
• Good practice is encouraged and disseminated
• Systems are in place to ensure continuous
  improvement in clinical care