Clinical Governance

OVERVIEW

Definition:

• Clinical governance is “a framework through which 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 will flourish.” NHS (UK) Definition
• or more simply, it is a systematic and integrated approach to ensuring services are accountable for delivering high quality health care

COMPONENTS

Clinical Effectiveness (and Evaluation):

• Development of, and adherence to, evidence-based clinical practice pathways; with the view to improved patient outcomes, reduced variation in clinical practice, and decreased health care costs through reduced adverse events.
• Monitored through Clinical Performance Indicators; Audits; M + M data.

Risk Management:

• adverse events monitoring, reporting (eg AIMS, IIMS, RiskMan) and appropriate investigation (eg Root Cause Analysis).
• Risk management processes and procedures (Hand Hygiene; staff immunisation; OH+S and fire training)
• Principles include: openness about errors; emphasis on learning; the obligation to act; limited individual accountability; and the creation of a blame-free culture.

Professional Development and Management:

• Professional credentialing,
• Professional education and training, including Continuing Professional Development,
• clinical research and publications,
• staff satisfaction

Patient and Public Involvement (‘Consumer value’):

• Improved patient knowledge and engagement.
• Examples: policies on open disclosure, consent, confidentiality of patient information, complaint management.

PROBLEMS AND CRITICISM

Additional bureaucracy and barriers to clinical work
Increased costs (eg rostering of ‘credentialed’ staff; competence assessments)
Increased resource requirement
Limitations of voluntary and/or anonymous incident reporting

RESPONSIBILITY

There are multiple layers of clinical governance, with multiple bodies/ individuals responsible:

• National (eg National Safety and Quality in Healthcare Standards)
• Regional (Clinical Excellence Commission and Agency for Clinical Innovation in NSW)
• Local (Clinical Governance Units; Individual Departments; You!)

References and Links

Journal articles

• Phillips CB, Pearce CM, Hall S. Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence. The Medical journal of Australia. 193(10):602-7. 2010. [pubmed]

FOAM and web resources

• Victorian clinical governance policy framework
• Western Australian Clinical Governance System (pillars framework) (from http://www.nmahsmh.health.wa.gov.au)
• NSW Clinical Governance (pdf) (from http://www.health.nsw.gov.au/)