Abstract
BackgroundClinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. Organizational appropriateness is aimed at achieving the best health outcomes and the most appropriate use of resources. The goal of the present study is to verify the likely relationship between Clinical Governance and appropriateness of hospital stay.MethodsA cross-sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV© (Optimizing Health Care Governance) methodology was used to quantify the level of implementation of Clinical Governance globally and in its main dimensions. Organizational appropriateness was measured retrospectively using the Italian version of the Appropriateness Evaluation Protocol to analyze a random sample of medical records for each clinical unit.Pearson-correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels.Results47 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with almost all the main Clinical Governance dimensions. Adjusted multiple regression analysis resulted in a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β = −0.28; p < 0.001; R-squared = 0.8). EBM and Clinical Audit represented the Clinical Governance dimensions which had the strongest association with organizational appropriateness.ConclusionsThis study suggests that the evaluation of both Clinical Governance and organizational appropriateness through standardized and repeatable tools, such as OPTIGOV© and AEP, is a key strategy for healthcare quality. The relationship between the two underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rational improvement of appropriateness levels.
Highlights
Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program
OPTIGOV© The OPTIGOV© methodology is aimed at assessing the Clinical Governance (CG) implementation level within a health care organization by assigning an overall CG score and partial scores referred to the single CG areas
CG and organizational appropriateness were evaluated in 47 hospital wards (24 surgical and 23 medical wards)
Summary
Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. The OPTIGOV© (Optimizing Health Care Governance) methodology was used to quantify the level of implementation of Clinical Governance globally and in its main dimensions. With the aim of assessing and measuring the implementation level of CG within health care organizations, in 2006 the Department of Public Health of the Catholic University of the Sacred Heart developed “OPTIGOV©” (Optimizing Health Care Governance), a methodology consisting of a hospital audit based on a structured and systematic approach and on an improvement operational plan. Specchia et al BMC Health Services Research (2015) 15:142 of them a score; identify the organization strengths and weaknesses; provide suggestions and indications to be implemented by the Hospital management and monitor the health care services quality improvement [4]. The concept of appropriateness in healthcare has progressively become one of the guiding principles of health systems with more and more attention being given to both quality improvement and effectiveness of health care [6]
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