Clinical Governance - what does it mean to your practice?-

Transcription

1 + Clinical Governance - what does it mean to your practice?- Presented by Gary Smith JP FAAPM MAICD Chair, Quality Innovation Performance (QIP) Life Member AAPM

2 + What is quality? Quality is; a systemic issue where success or failure is determined by a complex set of interactions between individuals and organisations.

3 + The 6 elements of quality Safety Effectiveness Appropriateness Consumer participation Access Efficiency

4 + What does a quality led organisation look like? You must be the change you wish to see in the world A quality led organisation has leaders who are committed to quality. This commitment is visible in their decisions, behaviours and communication and starts at governance and executive level. Effective leaders: Model desired behaviours and values Inspire a shared vision Challenge the status quo and culture Enable others to act Fuel passion

5 + What does a quality organisation espouse? Committed Leadership Staff Engagement Patient, Family & Carer Engagement Safety/Learning Culture Guidelines & Training Measure & Monitor Quality Allocate Resources to Quality

6 + What are the first steps to quality Develop a high level quality message to encapsulate your quality and safety efforts. Develop a quality improvement and patient safety strategic plan with measurable aims. Agree a manageable set of quality indicators to review at regular intervals, including clinical and patient reported data. Develop an accountability framework for all, making quality central to the organisation

7 + How do you cultivate a quality culture? Setting expectations from the outset Principals/Owners involvement down as far as staff orientation Regular communications with staff promoting importance of quality Encouraging all staff to provide ideas on how to make care safer and of higher quality Reinforcing that all staff play a role in safety & quality

8 + What is Quality Improvement about? 1. Patient-centered & community focused care 2. Leadership or leading 3. Governance - clinical organization 4. Communication 5. Manage change 6. Performance 7. Information & Information Technology APHCRI Centre of Research Excellence

9 + What is clinical governance? A system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. This is achieved by creating an environment in which there is transparent responsibility and accountability for maintaining standards and by allowing excellence in clinical care to flourish. (ACSQHC, 2012; also used by the CEC: from Scally G, Donaldson LJ. Clinical governance and the drive for quality improvement in the new NHS in England BMJ 1998; ) Corporate accountability for clinical performance (NHS Scotland)

10 + The Practice Clinical Governance Role A Threefold responsibility for quality: Ensure that essential standards of quality and safety are met as a minimum Ensure that the organisation is striving for improvement Ensure that every member of staff that has contact with your patient/consumer of health services, or whose actions directly impact on patient care, is motivated and enabled to deliver safe and person centred care.

11 + Monitoring Quality Care Decide on what information you need to know as a practice think about all the dimensions of quality and the key clinical governance questions you want to ask Decide on a reporting schedule to the practice clinical governance group. Focus on safety first risk register, sentinel and other adverse events Ensure other dimensions of quality and the supporting pillars of clinical governance are also covered processes and outcomes to support staff to provide quality care Keep your eye on the prize are we achieving the quality of care we want to provide? Have we set the right goals and are we monitoring these goals in the right way?

12 + The benchmark : Characteristics of organisations achieving high quality health care Dissatisfaction with the current quality of care A shared sense of purpose for the achieving high quality care and a culture of we can do better Relevant strategic/operational plan actions are translated into measurable quality of care objectives Priorities, objectives and measures are centralised, and the strategies for meeting them are decentralised Accountabilities for providing safe care and improving care are clear A focus on both systems redesign and human behaviour to improve care. (Baker, G.R., et al High Performing Healthcare Systems: Delivering Quality by Design Toronto: Longwoods Publishing.)

13 + Summarise the Practices Role Build the Culture Foster organisational commitment to continuous improvement Establish rigorous organisational structures and monitoring systems Evaluate and respond to performance

14 + Elements of Clinical Governance 1. Education and training 2. Clinical audit 3. Clinical effectiveness 4. Research and development 5. Openness 6. Risk management

15 + (1) Education and Training QI CME for clinicians Nursing staff continuing education non mandatory education CPM program for members of PMAANZ Internal and external Documentation of all training

16 + (2) Clinical Audit The review of clinical performance, the refining of clinical practice as a result of and measurement of performance against agreed set of standards a cyclic process of improving the quality of clinical care. In one form or another, audit has been part of good clinical practice for generations.

17 + Methods of Audit Entries made into medical records by; - medical practitioner's (MP) - nursing in the Treatment room (TR) - nursing in chronic disease unit (CDMU) Guidelines to be set by the Practitioners

18 + (3) Clinical effectiveness Is a measure of the extent to which a particular intervention works. The measure on its own is useful, but decisions are enhanced by considering additional factors, such as whether the intervention is appropriate and whether it represents value for money.

19 + (4) Research and development Good professional practice has always sought to change the light of evidence from research. Techniques such as critical appraisal of literature, project management and the development of guidelines, protocols/policies and implementation of strategies are all tools for promoting the implementation of research practice.

20 + (5) Openness Poor performance and poor practice can too often thrive behind closed door. Processes which are open to public scrutiny while respecting individual patient and practitioner confidentiality, and which can be justified openly, are an essential part of quality assurance. A no blame culture needs to be established.

21 + (6) Risk Management Risk management involved consideration of the following components; 1. Risk to patients 2. Risk to practitioners 3. Risks to the organisation

22 + Applying Clinical Governance in your Practice Clinical governance is to identify, develop and improve clinical handover communication. Safe health care delivery for patients defends upon effective communication between health care providers. Developing and implementing more consistent and reliable approaches to clinical handover is a key strategy to reduce communication.

23 + Clinical Handover Clinical handover needs to occur whenever there is a change of care providers. Examples of clinical handover include; A clinician covering for a fellow clinician who is on leave or is unexpectedly absent A clinician covering for a part time clinician A clinician handing over care to another health care professional such as a practice nurse, physiotherapist, podiatrist or psychologist

24 + Clinical Handover A clinician referring a patient to a service outside the practice A shared care arrangement (eg. Team care of a patient with mental health problems)

25 + Clinical Governance Actions Prepare a position description statement for a Director of Medical Services detailing their responsibilities Appoint a Director of Medical Services Construct, approval, implementation and monitoring of the following clinical policies of the practice;

26 + Overview of Clinical Governance and Clinical Handover in General Practice

27 + Overview of Clinical Governance and Clinical Handover in General Practice

28 + In Summary Lead the development of a culture that is supportive of safety and quality in health care. Make improving safety and quality a key strategic direction in the organisation s strategic plan Adopt a safety and quality framework Adopt a safety and quality plan with defined strategic goals for the quality of care you want your organisation to provide and clear accountabilities for achieving this Ensure that the organisation s annual budget contains an appropriate allocation for safety and quality Agree on a regular, systematic reporting schedule against the quality plan Ensure the organisation develops both staff and systems to create high quality care

29 + Questions???? -don t ask me hard ones-