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Clinician’s Impression of Clinical Governance Dr Emma Glanville Consultant Psychiatrist Mental Health ACT.

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Presentation on theme: "Clinician’s Impression of Clinical Governance Dr Emma Glanville Consultant Psychiatrist Mental Health ACT."— Presentation transcript:

1 Clinician’s Impression of Clinical Governance Dr Emma Glanville Consultant Psychiatrist Mental Health ACT.

2 Clinical governance background  High profile problems in health.  Increasing emphasis.  Structures evolving.  Evidence base evolving.  Local context.

3 Barriers 1. Health is different.  Business as usual after a major incident.  Person injured is patient rather than staff.  Death and disease is normal.  Negative consequences (eg coroner’s case, litigation) occur sporadically, inconsistently & a long time after the event.  Lack of perceived benefits.

4 Barriers: 2. Psychiatry is different?  Not as different as we like to think.  Clear differences between wrong site surgery.  But many parallels with other problems eg type II diabetes.

5 Barriers 3. ‘No blame culture’?  Our culture is a blame culture. ‘In the aftermath of such a disaster there must be an assignment of blame’. Runciman 2003  Medicine is a blame culture.  Finding a balance between fatalism & persecuting scapegoats.

6 Barriers 4. Issue of evidence ‘No sound evidence currently exists to support the claim that clinical governance will improve service quality’ (Thomas M 2002)

7 Barriers 4. The issue of evidence ‘…audit and feedback can be effective in improving clinical practice. When it is effective the effects are generally small to moderate. The relative effectiveness… is likely to be greater when baseline adherence to recommended practice is low and when feedback is delivered more intensively.’ Cochrane Collaboration 2008.

8 Barriers 4. The issue of evidence As the natural heterogeneity of an intervention increases, experimental methods become progressively less helpful in understanding its effectiveness. Walshe  Heterogeneous & evolving activities in heterogeneous organisations in heterogeneous populations – there will never be the definitive study.

9 Barriers 5. Managers vs clinicians? “clinical governance committees provide a ‘theatrical’ function, reassuring the board that all is well while allowing business as usual at lower levels within the organisation”. Freeman 2004

10 My project - Aims  Focuses on clinicians and their opinions of our clinical review process for serious adverse incidents – eg suicides, serious self harm, serious assaults (incl sexual assaults).  Clinical review process aims to identify systems issues (rather than performance management issues).

11 Report Rating CRC discussion Investigation Findings & Recommendations Feedback Incident

12 My project: aims  My aim is to investigate what clinicians feel about this process: -is it worth putting in an incident report? -how do they experience the investigation? -what do they think of our findings & recommendations? -do they think we make a difference? -how could they be more involved?

13 My project: further aims  Better understanding of evidence around governance.  Better understanding of research process – particularly qualitative research.  Better understanding of staff responses when things go wrong.  Learning to provide leadership in clinical governance.

14 Methods  Interview with CATT clinicians.  Questions around: -their knowledge of CRC. -their experience of CRC processes. -their thoughts on our recommendations. -suggestions re learning about adverse events.  Taped.

15 Data Analysis  Themes analysis conducted independently by two researchers.  Key words and concepts.

16 Where am I up to?  Support from clinical director of service.  Support from team leader and psychiatrist on CATT.  Literature review.  Questions designed.  Ethics approval.

17 Questions?


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