Clinical Governance Activities Research Articles

Lived experiences of women with spontaneous abortion at a district hospital, South Africa.

Spontaneous abortions occur in 12.5% of pregnancies and have a significant impact on the well-being of women. Dissatisfaction with health services is well-documented, but no studies have been conducted in district health services of the Western Cape. The aim was to explore the lived experiences of women presenting with spontaneous abortions to the emergency department at Helderberg Hospital. A descriptive phenomenological qualitative study used criterion-based purposive sampling to identify suitable participants. Data were collected through semi-structured individual interviews. Atlas-ti (version 22) software assisted with data analysis using the framework method. A total of nine participants were interviewed. There were four main themes: a supportive environment, staff attitudes and behaviour, the impact of time, and sharing of information. The comfort, cleanliness and privacy of the environment were important. COVID-19 had also impacted on this. Showing interest, demonstrating empathy and being nonjudgemental were important, as well as the waiting time for definitive treatment and the time needed to assimilate and accept the diagnosis. In addition, the ability to give relevant information, explain the diagnosis and help patients share in decision-making were key issues. This study highlighted the need for a more person-centred approach and managers should focus on changes to organisational culture through training and clinical governance activities. Attention should be paid to the physical environment, availability of patient information materials and sequential coordination of care with primary care services.Contribution:This study identifies issues that can improve person-centredness and women's satisfaction with care for spontaneous abortion.

Knowledge, attitudes and health choices among non-diabetic patients regarding diabetes mellitus

Background: Healthcare workers require better understanding of the current knowledge and behaviours of the local community towards diabetes mellitus (DM) and its prevention before appropriate interventions can be developed to address the gaps. There is currently a paucity of scientific papers on knowledge, attitudes and health choices among the non-diabetic population in a facility setting in South Africa.Methods: In this cross-sectional study, a self-reported questionnaire was administered to 165 adult participants attending the Chiawelo Community Practice from 02 March 2020 to 17 April 2020. The study utilised descriptive statistics, Chi-square testing, univariate logistic regression, and multivariate analysis for variable assessment.Results: Almost half of the participants (49%) had good knowledge of DM, with 60% indicating good attitudes and 52% making good health choices to prevent DM. Participants having received education from clinicians were 5.61 times more likely to develop better attitudes and 3.92 times more likely to adopt better health choices towards DM compared to those who obtained information from media or other sources.Conclusion: The study found that poor knowledge of DM does not necessarily translate into poor attitude towards the disease, which is noteworthy. The study also highlighted the important role of healthcare workers in influencing behaviour change.Contribution: Information from this study can be used to strengthen health services through several clinical governance activities including quality improvement, capacity building, health education and community-oriented promotion, and prevention strategies.

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

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.

Barriers and facilitators to integrating antimicrobial stewardship into clinical governance and practice: A Thai case study

Thailand is currently facing the emergence of antimicrobial resistance. To address this issue the Thai government has supported the introduction of antimicrobial stewardship (AMS) programs. Little is known about the perceptions of key-stakeholders regarding the current clinical governance of AMS and the barriers and facilitators to embedding AMS into clinical care. The aim of this study was to explore organizational leaders’ and clinical nurses’ perceptions of the AMS clinical governance structure and activities at a tertiary referral centre in Thailand. Semi-structured interviews and focus group discussions were conducted with 15 organizational leader interviews and three focus groups involving 18 nurses. Four themes emerged from the data: (1) executive seemed to endorse but not support AMS activities; (2) lack of AMS policy and resources to optimize antibiotic prescribing, tracking and reporting; (3) lack of multidisciplinary engagement in the AMS team; and (4) lack of clinician expertise and education about AMS is a major hurdle. Key issues identified included: the need to develop and embed formal AMS policies; the need for organizational investment in personnel, information management systems, and staff education; and the need to establish a multidisciplinary approach to AMS with identifiable roles and responsibilities for each member of the team.

Reviving clinical governance? A qualitative study of the impact of professional regulatory reform on clinical governance in healthcare organisations in England

BackgroundUntil recently, processes of professional regulation and organisational clinical governance in the UK have been largely separate. However, the introduction of medical revalidation in 2012 means that all doctors have to demonstrate periodically to the regulator that they are up to date and fit to practise, and as part of this process doctors must engage with clinical governance activities in the organisations in which they work. ObjectiveTo explore how the recent implementation of medical revalidation has affected the arrangements for clinical governance in healthcare organisations in England. DesignThematic analysis of interviews with 62 senior clinicians and non-clinicians in management or senior administrative roles, from a range of healthcare organisations in England. ResultsRevalidation has engendered changes to clinical governance systems, resulting in: increased doctor engagement with clinical governance activities; new or improved systems for access to clinical governance data for doctors and leaders within healthcare organisations; and more leverage - through the Responsible Officer role – to enforce engagement with clinical governance. Organisational context has been an important mediator of the impact of revalidation on clinical governance. ConclusionRevalidation has increased alignment between systems for organisational and professional oversight and accountability, resulting in increased scrutiny of clinical practice. However, it is still a matter of conjecture whether this will in turn lead to improvements in medical performance.

The bird’s-eye perspective: how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study

Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems.
 
 Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes. 
 
 Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities.
 
 Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems’ performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2018; DOI: 10.1080/20786190.2017.1348047

A reflection on the practical implementation of the clinical governance framework in the Cape Winelands District of the Western Cape

Primary health care is seen as the ‘linchpin of effective health care delivery’ by the Western Cape Government Health services and improving the quality of primary care, through clinical governance, is a key aspect of realising this vision. This article aims to provide an outline of the provincial clinical governance framework and to reflect on the experience and lessons learnt within the semi-rural Cape Winelands District in implementing this framework.Strategies that were used included the establishment of district clinical governance meetings; leadership development of both managers and family physicians, defining clinical governance activities and using routine monitoring and evaluation meetings as part of quality improvement cycles; developing clinicians competent to address the burden of disease; and focusing on establishing a primary health care approach in the district.Lessons learnt included that activities should take place within a supportive organisational culture with a focus on continuous quality improvement at all levels of the health system. A systematic approach to planning clinical governance at the district level should be balanced with a localised approach to encourage reflection, engagement and change. Recommendations for further implementation of clinical governance in the district are listed.

Healthcare professionals’ perceptions of clinical governance implementation: a qualitative New Zealand study of 3205 open-ended survey comments

ObjectivesTo investigate healthcare professional perceptions of local implementation of a national clinical governance policy in New Zealand.DesignRespondent comments written at the end of a national healthcare professional survey designed to...

CR0301 British Society for Oral Medicine and clinical effectiveness

It is reasonable for patients to expect similar minimum standards of care irrespective of which specialist center care is provided in. Robust clinical governance and effectiveness activities are fundamental to high-quality, safe, patient-centered care. It identifies how care may be improved further. Over time, its importance within health care has increased, as expectations among patients, service providers, and regulators change. Governance and effectiveness activities are most typically undertaken within individual centers and often use different approaches for the same issue.

Funnel plots and spine surgery: unit level and surgeon level outcome data

Funnel plots and spine surgery: unit level and surgeon level outcome data

The Computerized Medical Record as a Tool for Clinical Governance in Australian Primary Care

BackgroundComputerized medical records (CMR) are used in most Australian general practices. Although CMRs have the capacity to amalgamate and provide data to the clinician about their standard of care, there is little research on the way in which they may be used to support clinical governance: the process of ensuring quality and accountability that incorporates the obligation that patients are treated according to best evidence.ObjectiveThe objective of this study was to explore the capability, capacity, and acceptability of CMRs to support clinical governance.MethodsWe conducted a realist review of the role of seven CMR systems in implementing clinical governance, developing a four-level maturity model for the CMR. We took Australian primary care as the context, CMR to be the mechanism, and looked at outcomes for individual patients, localities, and for the population in terms of known evidence-based surrogates or true outcome measures.ResultsThe lack of standardization of CMRs makes national and international benchmarking challenging. The use of the CMR was largely at level two of our maturity model, indicating a relatively simple system in which most of the process takes place outside of the CMR, and which has little capacity to support benchmarking, practice comparisons, and population-level activities. Although national standards for coding and projects for record access are proposed, they are not operationalized.ConclusionsThe current CMR systems can support clinical governance activities; however, unless the standardization and data quality issues are addressed, it will not be possible for current systems to work at higher levels.

A structured process for reviewing the operation of the Mental Health Act 2001 in an Irish mental health service.

This paper provides a description of a structured template which allows review of the operation of the Mental Health Act 2001 at St Patrick's Mental Health Services (incorporating St Patrick's University Hospital, St Edmundsbury Hospital and Willow Grove Adolescent Unit). These structured processes were implemented to ensure rigorous monitoring of all clinical governance activities associated with adherence to the Mental Health Act (MHA) 2001. The paper describes in detail the information contained in the St Patrick's Mental Health Services dashboard for 2012. The dashboard displays the key performance indicators that are monitored and the paper describes how these were reviewed by the Hospital's Clinical Governance Committee on a weekly basis for the three approved centres. The dashboard has also been used by the Clinical Governance Committee to provide ongoing education and engagement with staff in order to improve the operation of the MHA 2001. The use of this structured monitoring process has allowed the hospital to measure adherence to the MHA 2001 and also to measure activities that impact directly on the care and treatment of patients detained under the Act. The use of structured monitoring tools (i.e. the dashboard) to review the operation of the MHA 2001 allows for coherent observation of key events and issues which can cause concern in terms of the operation of the Act.

Preparation and priority setting of clinical governance performance indicators in dimensions of risk management and clinical effectiveness from the healthcare staff viewpoints

Background: Evaluating the performance in clinical governance activities requires specific and appropriate national indicators. The aim of this study was to develop clinical governance performance indicators in dimensions of risk management and clinical effectiveness using viewpoints of healthcare staff who were working in various hospitals in East Azerbaijan, Iran. Materials and Methods: Through an extensive literature review, 135 indicators were selected for assessment by using comments of the staff working in all 41 hospitals of East Azerbaijan. Two hundred and eighty-eight people participated in four sessions in National Public Health Management Center (NPMC). Participants evaluated the indicators through 36 Focus Group Discussions. Through their discussions they completed predesigned forms with respect to title of indicators, methods of calculating the indicators, total score of importance and its feasibility, data collection method, data sources, and the level of indicator's evaluation. Results: Patients' safety and cardiovascular care unit (CCU) each by 16 indicators had the highest number of indicators. Pathology, ophthalmology, and radiology each by three indicators had the lowest number of indicators. The median score of the importance and the feasibility were both calculated in eight. Only 36.3% of the indicators were collected from hospitals. Most of the suggestions for gathering the indicators were from medical records and hospital information system (HIS), supervisors, statisticians, and admissions department. Sixty-nine indicators were designed by the participants that patient's safety had the highest number of them. Conclusion: A total of 204 indicators were evaluated and proposed by hospitals staff and stakeholders in clinical governance that can be useful in the quality of hospitals services promotion.

The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria

To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area. This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond. Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service's quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board's level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be 'moderately useful' or 'very useful'. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service. Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful.

The United Kingdom's Experience With and Future Plans for Revalidation

Assuring fitness to practice for doctors internationally is increasingly complex. In the United Kingdom, the General Medical Council (GMC) has recently launched revalidation, which has been designed to bring all doctors into a governed environment. Since December 2012, all doctors who wish to practice are required to submit and reflect on supporting documentation against a framework of best practice, Good Medical Practice. These documents are brought together in an annual appraisal. Evidence of practice includes clinical governance activities such as significant events, complaints and audits, continuing professional development and feedback from colleagues and patients. Revalidation has been designed to support professionalism and identify early doctors in difficulty to support their remediation and so assure patient safety. The appraiser decides annually if the doctor has met the standard which is shared with the most senior doctor in the area, the responsible officer (RO). The RO's role is to make a recommendation for revalidation every 5 years for each doctor to the GMC. Revalidation is unique in that it is national, compulsory, involves all doctors regardless of position or training, and is linked to the potentially performance moderating process of appraisal. However, it has a long and troubled history that is shaped by high-profile medical scandals and delays from the profession, the GMC, and the government. Revalidation has been complicated further by rhetoric around patient care and driving up standards but at the same time identifying poor performance. The GMC have responded by commissioning a national evaluation which is currently under development.

Unscheduled re-attendances to a paediatric Emergency Department: an audit

IntroductionUnscheduled re-attendances (UR) continue to pose a problem to the Paediatric Emergency Department (PED) and there is paucity of research on this topic. 5% of PED attendances are UR.1 Although...

Assessing organisational culture for quality and safety improvement: a national survey of tools and tool use

Background:There is growing international interest in managing organisational culture as a lever for healthcare improvement. This has prompted a practical need to understand what instruments and tools exist for assessing...

A study of the attitudes and perceived barriers to undertaking clinical governance activities of dietitians in a Welsh National Health Service trust

Previous studies of National Health Service (NHS) employees have identified barriers to undertaking clinical governance activities. Little of this research has investigated dietitians; however, where dietitians were included, generally positive attitudes towards research and evidence-based practice were reported alongside the identified barriers. A quantitative, whole population census was undertaken via a questionnaire distributed to 54 dietitians employed by Gwent Healthcare NHS Trust. Dietitians reported positive attitudes towards clinical governance; however, barriers to undertaking clinical governance activities were identified. The main barriers included lack of time, inadequate funding, the view that direct patient care should always be prioritised over clinical governance activities and inadequate research and critical evaluation skills. Findings were similar to those reported in previous studies of NHS staff. Where comparison was possible, all of the barriers identified were reported at lower levels than in previous studies. As the study was purely quantitative in nature, no understanding was gained regarding the nature of identified barriers or what factors influenced the dietitians' attitudes and perceptions. For further in-depth analysis of these factors, a qualitative study is recommended. As the study comprised a whole population census, the findings cannot be generalized to the dietetic profession as a whole, or to other staff groups within or outside of the study Trust.

The incidence and cost of adverse events in Victorian hospitals 2003–04

To determine the incidence of adverse events in patients admitted in the year 2003-04 to selected Victorian hospitals; to identify the main hospital-acquired diagnoses; and to estimate the cost of these complications to the Victorian and Australian health system. The patient-level costing dataset for major Victorian public hospitals, 1 July 2003-30 June 2004, was analysed for adverse events by identifying C-prefixed diagnosis codes denoting complications, preventable or otherwise, arising during the course of hospital treatment. The in-hospital cost of adverse events was estimated using linear regression modelling, adjusting for age and comorbidity. Cost of each patient admission ("admitted episode"), length of stay and mortality. During the designated timeframe, 979,834 admitted episodes were in the sample, of which 67,435 (6.88%) had at least one adverse event. Patients with adverse events stayed about 10 days longer and had over seven times the risk of in-hospital death than those without complications. After adjusting for age and comorbidity, the presence of an adverse event adds dollar 6826 to the cost of each admitted episode. The total cost of adverse events in this dataset in 2003-04 was dollar 460.311 million, representing 15.7% of the total expenditure on direct hospital costs, or an additional 18.6% of the total inpatient hospital budget. Adverse events are associated with significant costs. Administrative datasets are a cost-effective source of information that can be used for a range of clinical governance activities to prevent adverse events.

Childbirth delivery options in the UK in 2001-2: Midwife care and governance

This paper reports on a study conducted in 2001 and 2002 to establish the range of labour related procedures that UK midwives undertake and the supporting training and governance mechanisms. Two postal questionnaires were sent to maternity services managers at UK maternity units, requesting information on the number and type of midwifery procedures undertaken and the clinical governance and training activities in place. The study concluded that despite government policy promoting greater parental choice there is a wide variation in the range of labour related tasks that midwives undertake in the UK. If more midwife led units are to be established as a way of promoting parental choice, then adequate governance and training mechanisms must be in place to enhance continuity of care and reduce transfers.