S ETTING THE SCENE Clinical Governance and Clinical Supervision

W HAT IS CLINICAL GOVERNANCE ? “ A framework through which (health) organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish” Scally& Donaldson (1998, p.62)

T OOLS OF CLINICAL GOVERNANCE incident management risk minimisation through ensuring policy and procedures are used in practice complaints management processes clinical audits quality improvement projects performance reviews against quality plans

C AUSES OF C LINICAL E RRORS Inadequacies in setting (e.g. ward layout, medication labelling) Environmental factors (e.g. stress, workload, skill mix) Cognitive errors of omission or commission precipitated by: Inadequate knowledge Inappropriate processing of information (clinical reasoning) Situational factors (distractions, health care hierarchies etc) Ineffective leadership and teamwork Poor communication (written, verbal, electronic, inter-professional, intra-professional and with patients/carers) Inappropriate or outdated policies (e.g. patient transfer, admission, paediatric) Failure to comply with policies. Bogner(1994)

IMPACT OF CLINICAL SUPERVISION It seems highly likely that supervision has some effect on patient outcomes, junior doctor effectiveness and junior staff wellbeing. However, research still lacks rigorous study design, precision and good patient outcome measures

Clinical supervisors are not meant to perform their role without support. Responsibility for supervision rests with the whole organisation.

B ARRIERS TO SUPERVISION Junior staff’s reluctance to consult with senior staff Seniors’ absenteeism, alternative priorities or workload (Ross et al, 2011)

E XAMPLE : S UPERVISION EFFECTS ON HERNIA RECURRENCE (2004) 4406 Repairs – 90 recurrences – 2.0% over all methods Data collected over 8 years Robson AJ et al., Brit J Surgery, 2004, Total Performed Recurrence Rates (%) in Open Mesh Supervised by Surgeon No-oneSTC Consultant (C) Junior Trainee * Senior Trainee (ST)

W HAT T HEN IS CLINICAL SUPERVISION An organisational process focused toward safety and learning Part of good clinical practice and every doctor’s professional practice Often easier to recognise what is it not than what it is..

P URPOSE OF CLINICAL SUPERVISION Ensure the supervisee is safe to carry out clinical work within their scope Ensure the supervisee progresses through regular appraisals the collation of workplace-based assessment outcomes the provision of career advice and support as required.

M ECHANISMS OF CLINICAL SUPERVISION One to one Group – one supervisor One supervisee – group of supervisors Group of supervisees – group of supervisors

W HO P ROVIDES S UPERVISION

S UMMARY : H OWEVER D EFINED, CLINICAL SUPERVISION IS Purposeful Everybody’s responsibility Frequently distributed among roles and professions Requires an understanding of delegation, accountability and lines of communication