Clinical Governance In Primary Care Research Articles

Top tips for clinical governance in primary care

Top tips for clinical governance in primary care

Identifying leadership for clinical governance in rural and remote primary health care services.

Clinical governance is a system for improving the quality and safety of health care.1 The importance of clinical governance in primary care and the contribution of leadership to implementation of clinical governance have been established, with an expanding evidence base.2 Whilst definitions of leadership vary, the role of leaders in implementation is multifaceted and continues to evolve and expand.3, 4 However, leaders face multiple challenges in effectively engaging clinicians with understanding, conceptualising, improving perceptions and implementing clinical governance.5 Practising leadership with intent to strengthen clinical governance requires those perceived as leaders to be identified and appropriate interventions applied to strengthen and support recognised leaders. This paper aims to identify recognised leaders for clinical governance in rural and remote primary health care, as perceived by clinical service providers, and views related to leadership in this context.

Experimenting clinical pathways in general practice: a focus group investigation with italian general practitioners.

BackgroundClinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008.Design and MethodsTwenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach.ResultsFour major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity.ConclusionsManagerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.Acknowledgmentsthe Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers.

Complexity in practice: understanding primary care as a complex adaptive system

This series summarises new empirical research on quality improvement through case studies of the implementation of clinical governance arrangements in two primary care organisations (PCOs). To describe a new socio-technical model for effective quality improvement and clinical governance. The research strategy included a literature review, survey, in-depth interviews, participant observation and purposively sampled case studies, conducted within a social constructionist ontological perspective. This approach contextualises the origins of clinical governance and the trend towards collaborative partnerships and federated models of practice, enabled by developments in primary care informatics. People operating within multidisciplinary networks communicate with each other to determine actions that govern their most relevant concerns. Quality improvement in two PCOs is enabled through social interactions between individuals and groups with complex relationships; and information technology (IT) systems which make some aspects of the quality of care explicit. The results are real-world exemplars of the emergent properties of complex adaptive systems. Improving clinical governance in primary care requires both complex social interactions and underpinning informatics. The socio-technical lessons learned from this research should inform future management approaches.

Supporting clinical governance in primary care

PurposeTo report on the clinical governance work of the NHS Clinical Governance Support Team's, Primary Care Team.Design/methodology/approachThe review describes the formation of the NHS Clinical Governance Support Team's Primary Care Team and the development of a range of national clinical governance activities, drawing on a case study example.FindingsThe Team have been developing appraisal, and revalidation for general practitioners across the UK, supporting front‐line staff in primary care to improve patient experience by embedding principles of clinical governance into day‐to‐day practice, and are providing an online education and training programme to develop primary care managers. It has established links, and worked collaboratively with a range of partners in its activities.Originality/valueThe article provides a summary of the activities of the Primary Care Team and its activities to date. An example of supporting clinical governance in primary care is given in a case study of facilitating an influenza vaccination campaign.

Clinical governance in primary care. Second edition

Clinical governance in primary care. Second edition

Clinical governance in primary care: a literature review.

A systematic review of the research literature published between 1999-2003 was carried out to review how primary care trust groups and primary care organisations were monitoring the implementation of clinical governance and the effects this may have on nursing. Studies were limited to research papers with explicit methodology applicable to primary care trusts. The selection criteria, search procedures and methods of data extraction and analysis were formed at the outset. A data extraction tool developed by Cormack was adapted as a guide to include nine areas of methodological appraisal in summary forms. Initially 87 articles were identified from the search. When papers were omitted on the exclusion criteria seven studies remained. Clinical governance is a notable example of co-ordinated policy development and the entire concept can be difficult to translate into the integrated and systematic approach to improving quality of care. Clinical governance requires changes at three levels: the individual health care professional, primary care teams need to become multidisciplinary with clear understanding, primary care organisations need to put in place systems and local arrangements to support such teams. Clinical governance is about changing the way people work; demonstrating that leadership, teamwork and communication is as important to high quality care as risk management and clinical effectiveness. Whilst the sharing of information between practices is seen to be increasing with multi-professional study days occurring in some areas this in turn needs commitment for time and funding. The organisational and cultural environment within the trust as well as resource issues needs continuous attention if high quality governance is to become the norm.

The value of visits to non‐involved and single‐handed practices from a primary care audit group

Two series of visits to practices in a district in north west England were undertaken to encourage significant event review. The first was to non‐participants in audit projects who discussed lumbar‐sacral spine X‐rays and deaths with the GP facilitator. The second was to single‐handed GPs who discussed new diagnoses. Levels of participation and completion were high and there was a significant fall in the number of X‐rays requested compared with neighbouring controls. This method of influencing professional performance is compared with others. An evaluation questionnaire suggested that the method was acceptable and useful. It is suggested that academic detailing/practice visiting has a vital place in developing clinical governance in primary care, especially in recruiting those who have seldom been involved in audit activities in the past.

Demystifying health informatics Louise Simpson Demystifying health informaticsandPaulRobinson Radcliffe Medical Press112pp£19.951 85775 595 21857755952

This practical, easy-to-read book covers a range of important issues related to health informatics and clinical governance in primary care. While not all practitioners are convinced of the benefits of informatics in health care, this book will help to change the mindset of sceptics. The introduction asserts that clinical governance and health informatics are mutually supportive partners. It makes clear that the reader will find useful material on teamwork, organisational learning and patient-focused care, and little on the inner workings of computer technology.

Softly, softly, the way forward? A qualitative study of the first year of implementing clinical governance in primary care

The aim of this study was to explore the views of Primary Care Organisation (PCO) clinical governance leads on the implementation and development of clinical governance within primary care in the south west region. A grounded theory study using focus groups, research interviews and negotiated feedback reports was designed for use in the primary care setting. The subjects were a purposeful sample of 16 PCG-level clinical governance leads. Four main categories emerged from the data. These included: (1) defining clinical governance; (2) the process of implementing clinical governance; (3) positive aspects of clinical governance; and (4) concerns about delivering clinical governance. At the time of collecting the data (approximately 1 year after the introduction of clinical governance), there was evidence of a culture in primary care where clinicians valued efforts to improve the quality of patient care and enjoyed their own involvement in decision-making at a grass-roots level. However, whilst the concept of clinical governance was received with enthusiasm, the delivery of clinical governance faced challenges. These challenges included the paucity of ear-marked funding, the speed of implementation, the volume of work, and the impact on the clinical governance lead's relationships at home and at work and on his/her emotional wellbeing.

Clinical governance in primary care: early impressions based on Bradford South and West Primary Care Group’s experience

The experience of implementing clinical governance in Bradford South and West Primary Care Group illustrates how an emphasis on cultural change rather than on target setting, scrutiny and enforcement is both more consistent with the primary care context and more likely to create lasting improvements. The emerging focus on governance is reviewed and its implementation in one PCG via baseline assessment, strategic planning and innovative practice is presented. Linking clinical governance with a reduction in medical autonomy, as some commentators have done, does not allow for the complexity of power and responsibility characteristic of primary care. Alternative analytic models that draw on organizational theory and on sociology are offered.

Progress in clinical governance: findings from the first NPCRDC National Tracker survey of Primary Care Groups/Trusts

In April 1999, 481 English Primary Care Groups (PCGs) were created. The National Primary Care Research and Development Centre is leading a three year longitudinal study, in conjunction with the King’s Fund, to track the development of PCGs. The implementation of clinical governance is an important responsibility of PCGs. This survey aimed to describe initial progress in implementing clinical governance in primary care, and to describe barriers to change. Data were collected in autumn 1999, using a questionnaire to clinical governance leads, in a random sample of 72 PCGs. PCGs have put considerable effort into the development of clinical governance and an extensive range of activities were planned for tracking quality of care. However, PCGs face barriers in implementing clinical governance and they must foster a culture of engaged participation by practices and practice staff. PCGs must also be given the time and resources needed to implement clinical governance.

Clinical governance in primary care: from blind‐eye to no‐blame culture in one short leap?

Recent changes in the National Health Service in the UK have included a drive towards better quality health care through enhanced professional regulation, clinical governance and lifelong learning. It has been stated that the successful adoption of programmes of clinical governance is dependent on the right culture prevailing within the NHS. Progress and problems in the implementation of clinical governance to date are discussed.

Clinical Governance in Primary Care

Clinical Governance in Primary Care

Clinical Governance in Primary Care

This is an up to the minute book on a relevant subject for community nurses. It is well referenced, clearly set out and incorporates headings, boxes and diagrams. The authors set out to examine some of the facets of clinical governance such as quality, accountability, transparency and continuous improvement. After explaining the meaning of clinical governance and placing it squarely within primary care groups and trusts, aspects such as humane care, clinical effectiveness, risk management and personal and professional development are outlined. The book concludes with a critique of possible future developments. Whilst the authors acknowledge that the implications of clinical governance apply equally to all members of the primary care team, this is not borne out in the text, which appears to have been written almost exclusively for general practitioners. In the entire book, only five pages refer to issues relating to nurse members of the primary care team. Although this text would make a useful addition to nursing libraries, it is not one that individual nurses are likely to purchase. They could suggest, however, that each of their GP colleagues buys a copy, as the book contains many useful guidelines for continuously improving the quality of medical services.

Participating in clinical governance

This is the fourth in a series of five articles Earlier papers in this series have highlighted the collective nature of clinical governance in primary care and the central role...

Clinical Governance in Primary Care

Clinical Governance in Primary Care

Clinical governance in primary care

Clinical governance in primary care

New Zealand's independent practitioner associations: a working model of clinical governance in primary care?

Clinical governance has achieved “band wagon” status in recent months in the United Kingdom.1–3 Yet there remains considerable confusion and uncertainty about its scope and purpose. Since 1991-2, the NHS...

New Zealand offers model of clinical governance in primary care

New Zealand offers model of clinical governance in primary care