Assessing clinical governance activities in secondary curative health care institutes in the Kandy District, Sri Lanka

Abstract

Background and objective: Clinical governance is a framework through which organisations are held accountable for continuously improving the quality of their services. Therefore, implementing clinical governance is a timely requirement for the Sri Lankan health system. This research assessed the status of clinical governance activities in secondary healthcare institutes in the Kandy District.Methods: A descriptive, cross-sectional study including all the secondary curative health care institutes in the Kandy District; the District General Hospital, Nawalapitiya, the Base Hospital, Gampola and the Base Hospital, Theldeniya, was conducted in 2019. The principal investigator explored activities related to eight key areas of clinical governance, namely, patient and public involvement, clinical audit, risk management, education, training and continuing personal and professional development, clinical effectiveness programme, staffing and staff management, usage of clinical information supporting and quality improvement, by non-participatory observation and by interviewing Institutional Heads, Special Grade Nursing Officers, Medical Officers and Nursing Officers attached to the Planning and Quality Management Unit using a consensually validated and pretested checklist.Results: The studied hospitals had 73.68% of clinical governance activities. The Base Hospital, Theldeneiya showed the highest percentage (76.79%); however, it had the lowest bed capacity (227 beds), received the lowest financial allocation, spent the highest proportion of funds for training and had a qualified medical administrator continuously over the past six years. Gampola and Nawalapitiya Hospitals showed 69.49 percent and 74.76 percent overall clinical governance activities, respectively. Percentages of clinical governance activities did not show a statistically significant difference between hospitals (F_(w.g=21)^(b.g=2) = 0.254, p=0.778). Activities related to clinical audits (57.14%), clinical effectiveness programmes (49.20%), and staffing management (54.55%) were unsatisfactory in all hospitals.Conclusion: The hospital with the highest clinical governance activities had the service of a qualified administrator for more than five years and utilised the highest proportion of funds for training. A similar approach may be helpful for similar organisations. However, clinical audits, clinical effectiveness and staffing management activities are unsatisfactory in the studied hospitals and require prompt attention.