- 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
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.
- 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
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
- 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/)
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.