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Dr Catherine Chen Jean Ai, KPP(G), Sarawak Kursus “Clinical Governance”, 9 – 11 Nov 2009, Sematan, Kuching

Clinical Governance & Clinical Audit

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Page 1: Clinical Governance & Clinical Audit

Dr Catherine Chen Jean Ai, KPP(G), SarawakKursus “Clinical Governance”, 9 – 11 Nov 2009,

Sematan, Kuching

Page 2: Clinical Governance & Clinical Audit

Why Clinical Governance?Traditional Concept: well trained staff, good

facilities and equipment = high std of healthcare.

In 1980s: Total Quality Management (TQM) concept and continuous improvement concept - viewed as management driven with no clearly defined role for clinical staff.

In 1990s: emphasis on evidence-based medicine and research

Clinical Governance: systematic approach to improving quality of patient care within a health system.

Page 3: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCENHS DEFINITION

A system through which an organization is accountable for continuously improving quality services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish – Scally & Donaldson (NHS 1998)

Page 4: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Effective leadershipPlanning for qualityEducation and trainingRisk managementResearch and developmentTransparencyClinical effectivenessClinical audit

Page 5: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Effective LeadershipA well led organisation will have clear vision,

values, plans, guidelinesThese would be communicated effectively to

all staffGood leadership empowers teamwork,

encourages openness, creates high-trust environment

Page 6: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Planning for qualityPlan based on:- Objective assessment of patients’ needs and views- Assessed exposure to clinical risk- Regulatory requirements- Staff capabilities and training needs- Realistic comparison between present

performance and best practice standardsOwnership of the plan at all levels (not just

management generated)

Page 7: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Education and TrainingContinuing professional development (CPD)Professional duty of clinicians to remain up-

to-date

Page 8: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Risk managementRisks: human error, poor organisation, lack

of clear guidelines Errors and accidents cause patient

discomfort, incur costs, may result in loss of life.

Risk management involves managing and monitoring staff and patient safety – reduce errors and accidents, improve quality.

Page 9: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Risk managementRisk to Patient - compliance to statutory

requirements; regular systems review; audit critical event; learn from complaints

Risk to Practitioner - immunization against infectious diseases; safe work environment; worker safety guidelines; good practice

Risk to Provider/Organization – poor quality is a threat to organisation. Need to ensure high quality employment practice; safe environment; well designed policies.

Page 10: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Research & developmentPromotion of research: - critical appraisal of literature - project management - development of guidelines & protocolsData must be valid, up to date, presented in

useful manner e.g. highlight shortfalls in stds, differences in outcomes, time trends

Timely application of research findings

Page 11: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Transparency – openness in discussion of clinical governance issues

Poor performance and poor practice often thrives behind closed doors

“No blame culture” enables system flaws to be identified.

Any organisation providing high quality care has to show that it is meeting the needs of the population it serves.

Page 12: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Clinical effectiveness - a measure of the extent to which a

particular intervention worksNeed to consider: - appropriateness of intervention - whether it is value for money - safety of patient and care providers

Page 13: Clinical Governance & Clinical Audit

How to provide clinically effective care?

Competence and skill development among personnel

Accreditation/ credentiallingRegular review of proceduresRedesign of services to improve delivery of

care, initiate changes in response to error or complaint

Develop and enhance leadership skillsMentoring

Page 14: Clinical Governance & Clinical Audit

CLINICAL GOVERNANCEKEY ELEMENTS

Clinical auditA Quality Improvement process that seeks to

improve patient care and outcomes through systematic review against explicit criteria and the implementation of change

Aims to ensure patients receive the most effective, up to date, appropriate treatment, delivered by clinicians with the right skills and experience.

Page 15: Clinical Governance & Clinical Audit

CLINICAL AUDITIMPORTANCE & BENEFITS

Identifies & promotes good practiceImprovements in service deliveryImprovements in service outcomesEvidence of service effectiveness & cost-

effectivenessOpportunities for training & educationPromotes efficiency in resource utilizationImproves working relationships &

networking at all levels

Page 16: Clinical Governance & Clinical Audit

ROLE OF CLINICAL AUDIT TEAMHelp specialties develop audit programsAssist clinical staff in carrying out auditsIdentify audit issues linked to risk

management, complaints, health & safety and litigation

Teaching, advice & consultationAudit process: planning; data entry &

analysis; report writing; presentation; implement change; monitoring

Page 17: Clinical Governance & Clinical Audit

CLINICAL AUDITAREAS TO AUDIT

STRUCTURE – The availability & organization of resources and personnel

PROCESS – Activities pertaining to service resources

OUTCOME – Effect of activities on health or well-being of service user, i.e. changes for individual attributed to clinical intervention received

Page 18: Clinical Governance & Clinical Audit

CLINICAL AUDITWHO SHOULD BE INVOLVED

Clinical & non-clinical staffService usersManagersOther key stakeholders

Page 19: Clinical Governance & Clinical Audit

CLINICAL AUDITTHE AUDIT PROCESS

Establishment of audit team: Team leader & members; special expertise

Determination of areas to be audited: critical areas for more in-depth and frequent audit

Preparation of audit checklists: against work processes and best practice

Consultation with auditee managementGround logisticsAudit scheduleOpening meeting

Page 20: Clinical Governance & Clinical Audit

CLINICAL AUDITTHE AUDIT PROCESS

Audit implementation: examination of documents; interviews; site verification

Analysis, report writing & presentation

Ensuring remedial, continuing improvement & preventive measures are implemented

Closure

Page 21: Clinical Governance & Clinical Audit

CLINICAL AUDITHALLMARKS OF SUCCESSFUL AUDIT

Patient-oriented planningPatient-outcome based

Are patients given the best care?Are they better?Do they feel better?

Page 22: Clinical Governance & Clinical Audit

CLINICAL AUDIT VS RESEARCHClinical audit is not research but interrelated

i.e. uses research methodology to assess practice (Black, 1992)Research provides basis for defining good

quality care & best practiceClinical audit generates high-quality data for

non-experimental evaluative researchEffectiveness & cost-effectivenessResearch needs on assessment of high quality

care

Page 23: Clinical Governance & Clinical Audit

EFFECTIVE CLINICAL GOVERNANCE

Culture of trust & honesty; adverse events discussed openly

Organizational commitment to continuous improvement

Clear role delineation & accountabilityRigorous system to identify, monitor &

respond to problems in patient careEvaluating & responding to key aspects of

clinical performance

Page 24: Clinical Governance & Clinical Audit

REFERENCES

“Clinical governance and clinical audit” – Dr Husna Abbas, Pengarah Penggalakan, Kawalan dan Amalan Pergigian, KKM (lecture given during Kursus Pemantapan Pegawai Pergigian, 2009)

Halligan A, Donaldson L. “Implementing clinical governance: turning vision into reality”. BMJ 2001 June 9; 322(7299): 1413-1417.

NHS Scotland Educational Resources. “Clinical Governance” 2007.

Page 25: Clinical Governance & Clinical Audit

Thank You!