1. Marcus Stephen Hospital Keningau 16 March 2016 SANDAKAN
CLINICAL GOVERNANCE
Marcus Stephen
Hospital Keningau
16 March 2016
SANDAKAN

2. Learning Outcome Staff will be able to:-
Explore Idea of Quality in Health Care
Examine the Model of Clinical Governance
Recognize own responsibilities with regards to Clinical Governance.
Briefly explore concept of a Learning Organization

3. Definition
“A system through which NHS organizations 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.”
Sir Liam Donaldson, CMO 2002

4. Other Definition
Clinical Governance is about quality and how it can be achieved and guaranteed through our service to our patients.
It is an umbrella team for everything that helps to maintain and improve high standards of patient care

5. Clinical Governance is about….
………Everyone knowing what is supposed to happen, and then making sure it does

6. CLINICAL GOVERNANCE
Suggest to be answerable for your clinical action and performance
Responsibility for learning and Improving quality at every level
Reduce harm and improves patient safety
Reduce variations of clinical outcome
Evidence of the best practice
Promotes transparency and openness
Bridge the gap
Promotes and encourages good practice
Minimizes and mitigates the healthcare and clinical risks
Is a way of learning and sharing
Improves quality of care

7. Clinical Governance Framework
Accountability
Clinical Governance
Risk Management
Clinical Audit
Clinical Effectiveness
Complaint & Complement
Service User & Staff Experience
Compliance & Standard
Stakeholder Involvement
Learning & Sharing
Improving Quality of Care
System & Process
Excellent Outcome
CPD
Transparency

8. “Whoa! Watch where that think lands, we’ll probably need it.’

9. Framework for Integrated Quality, safety and Risk Management
Assurance 6
4 Policies
Capacity & Capability 3
Monitoring & Review 5
Communication 1
Accountability 2
Patient / Services Users

10. Six Core Processes and Programmes (Donabedian’s Process”)
Clinical Effectiveness and audit.
QA or HAS studies and evidence-base practice
Patient Centred – Multi- professional working and collaboration.
Involvement of patients / service users and the public / community
Risk management and patient safety
The risk management process according to ISO Risk management Principles and guidelines on implementation
Knowing high priority risk
Patient Safety
Occupational safety, health and welfare
Environmental and fire Safety
Incidents and complaints reporting/recording, analysis and learning
Staffing and Staff Management
Service Improvement
Learning and sharing Information

11. Placing Quality At The Heart of NHS
Without it, there is unfairness.
Every patient wants to know that they can rely on receiving high-quality care when they need it.
Every part of the NHS & everyone who works in it should take responsibility for working to improve quality

12. Duty of Quality Legal Obligation
Clear lines of responsibility & accountability for quality of clinical care
Chief Executives are accountable
Clinical Governance Board / Committee (Reports to Trusts Main Board)
Annual Report Must Be Produced
All staff are responsible for the quality of care they deliver

13. Culture For Clinical Governance To Flourish
No-blame
Questioning
Learning Culture
Excellent Leadership
An ethos where staff are valued & supported as they form partnership with patients

14. Other Culture Qualities
Celebrate success as well as learning from what is done badly
Overcoming tribalism by improving understanding of the roles of all professions
Develop effective team working
Communication with all stakeholders
Commitment to sharing of information
Outward looking approach

15. The Foundation Stones Patient – Professional Partnership
Clinical Effectiveness
Risk Management Effectiveness
Effectiveness
Patient
Communication Effectiveness
Resource
Strategic
Learning
System Awareness
Teamwork
Communication
Ownership
Leadership
Patient – Professional
Partnership

16. System Awareness
A set of interdependent elements interacting to achieve a common aim. These elements may be both human and non-human
System awareness looks at the whole process as well as the parts, of healthcare delivery, and the relationship between them
It is about looking outside of your own sphere of influence or team / department

17. Teamwork
“Without teamwork, the potential of clinical governance is not achievable. Cooperation across and between organizations, between the NHS and the public it services is fundamental to building better structures and safer, high quality care.” “If teamwork is performed successfully teams can reap benefits for them selves, patents and patients’ families. However, if done badly, the organization will struggle to meet its objectives, quality of care and the service being delivered will diminish, self morale and satisfaction will be lowered and patients will have on unsatisfactory and possibly negative experience of care.”

18. Communication Being greeted warmly Being respected
Being listened to
Clear Explanations
Reassurance
Having confidence in the ability of staff
Being able to express fear & concern
Being respected
Being given enough time
Having personal circumstances considered when advice or treatment is offered
Being treated as a person & not as a disease

19. Ownership Clinical Governance as a whole.
Doctors of their chore, responsibilities and working areas
AMO of their duties and working areas
Nurses of their working areas.
AHP of their tasks and working areas
Patients of their care & treatment
Local community of their health services

20. Leadership
Leadership is critical to the quality of care, treatment and outcomes to staff morale and to the learning climate and opportunities available to all level of staffs
Traditionally, position of the top of the hierarchical structure.
Modern approach, recognizes effective leadership at all levels

21. Clinical Effectiveness
“Applying the best available knowledge, derived from research, clinical expertise and patient preferences, to achieve optimum processes and outcomes of care for patients.”

22. Clinical Effectiveness
Finding and assessing evidence
Implementing the evidence
Monitoring and evaluating the impact, readjusting practice as necessary, usually through clinical audit and patient feedback

23. Risk Management Effectiveness

24. Risk Management Effectiveness
“The identification, evaluation and control of potential adverse outcomes that threaten the delivery of appropriate care to patients.”
Clear risk Management policies in place
Incident reporting and acting upon

25. Adverse Events
Adverse event is defined as “An event or omission arising during clinical care and causing physical or psychological injury to the patient.”
Occur in around 10 % admissions or at a rate of an estimated 850,000 adverse event a year
Cost approx. £2billion a year in additional hospital stays alone
400 people die or are seriously injured in adverse events involving medical services every year

26. Near-misses
Near-miss can be defined as “a situation where probability have become an incident.”

27. Patient Experience National Patient Survey Interview Patient Diaries
Patient Groups / Patient Forums
Patient Tracing
Consultation with voluntary Groups

28. Learning from & Dealing with Complaints
Provide an opportunity for AMO /Nurses to see themselves and their service as others see them and to identify the issues, which concern users.
Reality a past mistake and enable services to be put right for the future.
Well handled it can increase a patients trust in the service.
Identify adverse event and near misses which otherwise might have gone undetected

29. AMO Roles Take complaint seriously Local resolution Good communication
Fully involve patients / care in decisions

30. Communication Effectiveness
Staff to Patient
Written
Verbal
In just about every complaint there will have been and breakdown in communication
Staff to the organization as a whole

31. Resource Effectiveness
How are resources used , and for what benefits?
Is there waste in time,
I best use being made at all available resources money, equipment?

32. Strategic Effectiveness
Make sure that Clinical Governance is written into all organizational planning
That the direction on the organization is to continually deliver a quality service that is continuously looking to improve.

33. Learning Effectiveness
Making sure that the lessons really are being learnt and acted upon, from:-
Complaints
Adverse Incidents
Research
Patient & Staff feedback
Becoming a Learning Organization

34. Learning Organization
Where people continually expand their capacity to create the results they truly desire,
where new and expansive patterns of thinking are nurtured,
where collective aspiration is set free and
where people are continually learning how to learn together.

35. Key Features Of A Learning Organization
Open System Thinking
Improving Individual Capabilities
Team Learning
Updating Mental Models
Sharing A Cohesive Vision

36. What is Clinical Governance?
It’s about quality. How I can ensure and constantly improve the quality of care I deliver, through on going training, following policies and procedures, through teamwork and communication, complaints management, leadership and improving and listening to the patients experience.
Achieving Excellence in Clinical Governance

37. THANK Q