Fundamentals of Clinical Governance.pptx

A Class-Note on Clinical Governance

1. Clinical Governance Brigadier General Dr Zulfiquer Ahmed Amin, Retd M Phil (Healthcare & Hospital Management), MPH, PGD (Health Economics), Fellow (AIIMS, Delhi), MBBS (DMC)

2. Governance Governance encompasses the system by which an organization is controlled , and the mechanisms by which it, and its people, are held to account .

3. Government vs Governance Government Government is a group of people who rule or run the administration of a country . In other words, it may be said that a government is the body of representatives that governs and controls the state at a given time. Government is the medium through which the power of the state is employed . Governance Governance is the act of governing or ruling . It is the set of rules and laws framed by the government that are to be implemented through the representatives of the state. Simply put, governance is what governments do .

4. Governance vs Administration 1. Governance is formulating the laws, and acts , where as the administration is implementing the laws enacted by the governance. ex : Bangladesh Organ Transplant Act-2018 (Passed by the Parliament) and it is enacted at the local level by DGHS (Done by the Administration). 2 . The governance is done by the elected representatives but administration is done the officials selected through set of exams. 3. Governance is the head and administration is like the body ; where body works, as the head ask to perform . But both has to be to respond correctly to have smooth functioning of the whole system.

5. Difference Between Leadership and Governance The main difference between ‘Leadership’ and ‘Governance’ is that leadership primarily involves guiding and influencing people towards achieving specific goals, often through inspiration, motivation, and setting a vision. In contrast, governance encompasses the policies , and rules that define, guide , and control an organization, focusing on ensuring accountability, fairness, and transparency in the management of resources

6. Health System Governance Health Systems G overnance also known as Clinical Governance refers to the processes, structures and institutions that are in place to oversee and manage a country's healthcare system . It manages the relationships between different actors and stakeholders involved in healthcare, including government agencies, healthcare providers, patients and their families, people and communities, civil society organizations and private sector entities . Clinical governance helps us to deliver safe healthcare .

7. Clinical Governance i s a mechanism through which ‘ health services are held accountable for the safety, quality and effectiveness of clinical care delivered to patients ’. Clinical governance promotes a learning culture , and develops a system to deal with and learn from errors , mistakes, incidents, claims, complaints, and to identify and manage risk in healthcare organizations. The ultimate aim of clinical governance is to deliver high-quality of care by promoting safety, open , and no blame culture.

8. Effective health systems governance is essential for ensuring that healthcare services are accessible, equitable, efficient, affordable and of high quality for all. This requires efficient and equitable allocation of healthcare resources, the presence of policies and regulations guiding healthcare delivery, and mechanisms for monitoring, evaluating and reviewing the healthcare system’s performance. Rather than asking whether a particular health care system has the right inputs or produces the right outputs, questions about governance aim to identify factors that influence the behavior of the system, such as rules or procedures that are expected , in turn, to be associated with better performance and outcomes.

9. Good Governance and Its Pillars Good Governance denotes " proper functioning of institutions and their acceptance by the public " (legitimacy). Good governance aims to minimize corruption , take into account the opinions of minorities , listen to the voices of the oppressed people in the decision-making process, and respond actively to the needs of the community now and in the future. The seven principles (Pillars) of good governance: -Accountability -Transparency -Integrity -Clinical Audit -Risk Management -Clinical Effectiveness -Communication & Coordination

10. Transparency Transparency is the quality of being easily seen through . It means that decisions taken and their enforcement are done in a manner that follows rules and regulations . It also means that information is freely available and directly accessible to those who will be affected by such decisions and their enforcement . It also means that enough information is provided and that it is provided in easily understandable forms and media.

11. Accountability The term “accountability” refers to the acceptance of responsibility for honest and ethical conduct toward others. It includes the existence of mechanisms where there is certainty that public officials and political leaders are responsible for their actions, responsible for the use of public resources and transparency of government and media freedom . Have the competence to make and run the right public policy including the ability to deliver the service to the public efficiently .

12. Integrity   Integrity is acting in a way that is impartial, ethical, and in the public interest . Integrity is reflected in part through compliance with legislation, regulations, and policies , as well as through the instilling of high standards of professionalism at all levels of an organization . Clinical Audits Clinical governance can’t operate successfully without regular audits to review the quality of health care and clinical performance . An audit can analyze things such as procedures for diagnosis, treatment and care, use of resources and the resulting outcomes and quality of life for patients. The aim of the audit process is to ensure that clinical practice is continuously monitored and that deficiencies in relation to set standards of care are remedied .

13. Risk Management Risk Management involves having robust systems in place to understand, monitor and minimize the risks to patients and staff and to learn from mistakes. When things go wrong in the delivery of care, doctors and other clinical staff should feel safe admitting it and be able to learn and share what they have learnt. This includes: • Complying with protocols (hand washing, discarding sharps, identifying patients correctly etc ) • Learning from mistakes • Reporting any significant adverse events via ‘ Critical I ncidents Forms ’, looking closely at complaints etc. • Assessing the risks identified for their probability of occurrence and its impact. • Promoting a blame-free culture to encourage everyone to report mistakes .

14. Clinical Effectiveness Clinical effectiveness is centred on providing evidence-based care with positive outcomes. It entails applying best practices , tracking treatment results, and continuously evaluating clinical processes. By incorporating the latest research and medical advancements into daily practices, healthcare organizations can ensure that their services are not only up to date but also effective in improving patient health .

15. Education and Training Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values , problem-solving approaches , and language/jargon of each profession . Risk management, change management, team dynamics , clinical audit , professional development and training are the major areas for development in implementing clinical governance agendas.

16. Better Communication, Co-ordination and Interaction ( Information Management ) Communication is ‘an integral ingredient for the success or failure of healthcare governance ’. It helps to communicate goals , purposes and outcomes; shares important and useful information; supports the negotiation between different groups of healthcare professionals; and helps to build mutual respect and trust . Poor communication and relationships among and between healthcare professionals can be harmful to service users and result in increased rates of clinical incidents and errors. Lack of communication and co-ordination between healthcare professionals is seen to be a potentially serious factor in compromising good care.

17. Measuring Governance P erformance WHO, provides a list of ‘Governance P erformance Measures’ for public health care provision : - Health worker absenteeism in public health facilities - Proportion of government funds reaching district-level facilities - Stock-out rates for essential drugs in health facilities - Proportion of informal payments within the public health care system - Proportion of pharmaceutical sales that consist of counterfeit drugs These five indicators measure the gap between expected and actual performance of the public health care services and highlight critical aspects – human resource management, financial management, supply management, drug regulations and enforcement – that affect the outputs and impact of public health care services.

18. Quality Enablers & Standard for Good governance ‘Person- centred ’ means focusing care on the needs of individual . Ensuring that people's preferences, needs and values guide clinical decisions

19. Quality Enabler Enabler is one that enables another to achieve an end . An enabler is something that makes it possible to happen — may be, something negative or positive . The quality enablers ensure a system-wide approach to improving quality . The six quality enablers below complement the implementation of good clinical governance: -Leadership -Culture -Workforce -Information -Learning, and improvement -Research and development -Whole system approach

20. Leadership ( Collaborative) C ollaborative leadership is about bringing together diverse individuals to work towards common goals in a manner that leverages their collective strengths and insights. Unlike traditional leadership models that rely on a top-down approach, collaborative leadership is participative, open, and horizontal . The leaders of inter-professional working team are guided by policies , protocols, guidance, and standards . Maximizing nurse-physician-allied professionals’ collaboration holds promise for improving patient care and creating satisfying work roles.

21. Culture Quality Culture (or Culture of Quality) can be defined as “the opinions, beliefs, traditions and practices concerning quality ”. It represents the environment in which the employees follow guidelines , take quality-focused actions, talk about quality, but also see other employees do the same thing.

22. Workforce An effective workforce is essential for the delivery of high quality care. Workforce development includes ensuring that staff have the right skills and knowledge to do their jobs, and that they are supported to continuously develop and improve their practice. Clinical governance is about the delivery of high-quality care which is not achievable without teamwork . The successful development and implementation of inter-professional care in healthcare organizations are dependent on many professionals, people and organizations such as healthcare regulatory bodies, healthcare professional organizations , academic institutions, hospitals , community and support agencies, healthcare staff and professionals , researchers, service users, government , health caregivers, educators, and administrators etc.

23. Whole System Approach Whole Systems Thinking is a method to understand how things (elements and systems) are related, and how they influence one another within a whole. Using a whole systems approach means bringing together representative stakeholders or the entire community to co-create solutions that will work best for their unique challenges. The premise of the whole system model is that nothing in the organization is truly isolated , and that all actions taken in the organization exert influence on all of the organization's sub-systems .

24. Information K eeping patients’ information updated and correct at all times is an essential part of pursuing excellence in clinical governance. All systems used should reflect accurate, consistent patient data . Confidentiality and security around information is key too to safeguard people’s personal details and medical records. Information that needs to be shared among relevant healthcare professionals must be carefully protected and clearly presented to avoid unnecessary delays in treatments or diagnoses . Key Elements: Data Accuracy : Ensuring patient records are accurate and up-to-date. Data Security : Implementing measures to protect sensitive information. Information Sharing : Facilitating the appropriate sharing of information within the healthcare team and with patients .

25. Research and Development Research and development is essential for ensuring that healthcare organizations are keeping up with the latest advances in healthcare. It is important that new treatments and technologies are developed and that existing ones are continually improved.

26. Learning and Improvement Continuous Professional Development (CPD) One of the important aspects of clinical governance is learning from complaints and adverse incidents . Continuous professional and skill development for healthcare professionals in areas such as communication, change management, teamwork and leadership is important to the successful operation of inter-professional care team. Strong support from management, and adequate resources are required for improving quality of care , patient safety , and patient experience.

27. Quality Standard Good Governance should maintain following quality standards in relation to services and functions which are: -Safe , -Timely , -Effective, -Efficient , -Equitable , and -Person- centred . These quality dimensions provide a framework to assess quality and guide improvement .

28. Interaction Between Clinical Governance, Quality Enablers, and Quality Standards