1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Clinical Governance Implementation in a Private Health Screening Service
MSc Healthcare Management Dara Owens
Abstract
Context: Clinical governance describes a systematic approach to ensuring the quality and safety of healthcare, has been accepted as one of the foundations of effective healthcare. This project describes the implementation of a clinical governance system in a private health screening service, over a nine month period, in which lack of clinical governance and oversight had been identified as a significant risk.
Aim: The aim of the project was to design and implement an effective, sustainable clinical governance system to ensure the safety and quality of care delivered in a private health screening service.
Methods: The key principles and components of clinical governance, and evidence guiding effective implementation were established through review of the literature. The HSE change model was used as the organisational development framework for the change process, including strategic analysis, stakeholder management, communication, planning and implementation.
Evaluation: The project was evaluated using service data, clinical audit and a stakeholder survey to measure project implementation and project outcomes. Outcome evaluation was limited by the timescale of the project.
Results: 71% of the objectives were fully achieved and 29% partly achieved. A causal link was established between the implementation approach and process change, and between process change and improved outcomes. Before and after evaluation of service data combined with clinical audit confirmed that clinical governance structures and processes were implemented and working as intended. Stakeholders perceived the change as positively affecting service safety, and the system design was seen as being fit for purpose without imposing an excessive workload. The leadership and change management approach were seen as effective, and there was evidence supporting the sustainability of the system.
Conclusions: Use of the HSE change model, with a combined top down and bottom up approach, in the context of a model of engaging leadership and the development of distributed leadership provides an effective approach to clinical governance implementation and healthcare innovation. Culture was an important enabler, while resourcing and information technology support emerged as important barriers.

2. Clinical Governance Implementation in a Private Health Screening Service
MSc Healthcare Management Dara Owens
Introduction & Background
Methodology
Evaluation
Clinical governance describes a systematic approach to ensuring the quality and safety of healthcare.
This project was conducted over nine months in a private health screening service, providing employee health checks in a workplace setting.
Lack of clinical accountability and a dearth of quality data and quality management identified as a weakness in the service.
The project was approached using an organisational development methodology within the framework of the HSE change model 1
Change model: key enablers and barriers
Initiation:
Structured strategic analysis, stakeholder management and planning
High level support, internal strategic alignment, external regulatory alignment
Vision for change based on clinical risk assessment, evidence based best practice and service need
Inadequate resource planning
Failure to recognise importance of IT as a potential enabler
Planning:
Close collaboration with key stakeholders
Valuing resistance
Implementation and Mainstreaming
Leadership based on model of engaging leadership²
Clinician leadership
Existing positive patient safety culture
Combined top-down and bottom-up change
Lack of medical records management
Lack of management data
Approved clinical governance policy document
Quality management structures and processes implemented and generating intended outputs.
Clinical oversight process producing intended outputs
Functioning clinical audit program
Stakeholder survey:
Changes positive: 90% 80% Change approach effective: 80%.
% improvement in service safety (before versus after) 18%
Aims & Objectives
Aim of the project:
To design and implement an effective, sustainable clinical governance system, to ensure the safety and quality of care delivered by the service, by March 2015.
Objectives:
1. Design and implement an overarching clinical governance policy document
2. Design and implement structures and processes to gather and manage quality data and support continuing quality improvement
3. Design and implement clinical oversight structures and processes including clinical audit and doctor on call
4. Evaluate implementation, outputs and user acceptance
Project Outcome
Organisational Impact
Defined clinical governance structures, processes and policy
Functioning quality data gathering and management system
Improved service safety
Positioned for sustainable development and accreditation.
Conclusion
Use of HSE change model, with a combined top down and bottom up approach, in the context of a model of engaging leadership provides an effective approach to clinical governance implementation and healthcare innovation.
References
HSE (2008). Improving Our Services. A Users Guide to Managing Change in the Health Service Executive. HSE: Dublin.
Alimo-Metcalfe, B. & Alban-Metcalfe, J. (2008). Engaging Leadership: Creating organisations that maximise the potential of their people. Chartered Institute of Personnel and Development: London.