Effective Clinical Governance Research Articles

Reduction in the use of seclusion in a high secure hospital: A retrospective analysis

Specific concerns have been raised about seclusion use within mental health services. However, it has been reported that one of the potential consequences of reduced seclusion use is an increase in assaults on either clinical staff or patients. In a high secure hospital a number of measures were implemented as part of a clinical governance programme. These measures will be described. Data on all episodes of seclusion and adverse incidents over a five year period was analysed. The results demonstrate a progressive and sustained reduction in seclusion use with over a sixty percent reduction in the number of seclusion episodes. We found no increase in adverse incidents in conjunction with the reduction in seclusion use. The results of this analysis demonstrate that reductions in seclusion use are achievable, without an increase in assaults on clinical staff or patients, when it is identified as both a managerial and clinical priority, supplemented by robust performance monitoring and effective clinical governance arrangements.

Computer-Aided Psychological Treatments: Evolving Issues

Evidence is growing that several computer-aided psychotherapy (CP) systems can effectively improve a range of common mental health problems. Most clients find CP acceptable because of its convenience, confidentiality, and reduction of stigma. CP can be accessed in a clinic, but recently clients have used CP especially on the Internet at home, with brief support on a telephone helpline and/or by email. Brief and efficient screening and support greatly reduce attrition. CP's efficacy, and encouragement of its dissemination and implementation by some national funding bodies and governmental agencies, has led to its spread as a regular care option and is increasing access to psychological therapies in some countries. Transfer of this new approach from use in tight research studies to use as an integrated part of everyday care under widely varying conditions generates teething problems that are being managed in diverse ways across different centers. Anonymized Internet audit of CP outcomes facilitates effective care and clinical governance. This review examines the current state of the art as well as the science and broad applications of CP.

Human error theory: relevance to nurse management

Describe, discuss and critically appraise human error theory and consider its relevance for nurse managers. Healthcare errors are a persistent threat to patient safety. Effective risk management and clinical governance depends on understanding the nature of error. This paper draws upon a wide literature from published works, largely from the field of cognitive psychology and human factors. Although the content of this paper is pertinent to any healthcare professional; it is written primarily for nurse managers. Error is inevitable. Causation is often attributed to individuals, yet causation in complex environments such as healthcare is predominantly multi-factorial. Individual performance is affected by the tendency to develop prepacked solutions and attention deficits, which can in turn be related to local conditions and systems or latent failures. Blame is often inappropriate. Defences should be constructed in the light of these considerations and to promote error wisdom and organizational resilience. Managing and learning from error is seen as a priority in the British National Health Service (NHS), this can be better achieved with an understanding of the roots, nature and consequences of error. Such an understanding can provide a helpful framework for a range of risk management activities.

Improving patient care and clinical governance through the utilisation of a clinical information system

PurposeThis paper seeks to provide an overview of how the involvement of clinicians in the design and implementation of an electronic clinical information system has contributed towards more effective clinical governance, while improving the care of patients with a diagnosis of psychosis.Design/methodology/approachA data collection form was designed by a consultant in public health and a group of consultant psychiatrists to facilitate and standardise the data to be collected and stored on the information system. Two research nurses conducted a retrospective case note audit to record specified data on all existing patients from an inclusive diagnosis list in contact with CMHTs.FindingsThe establishment of PsyCIS has increased the understanding of the nature and prevalence of psychosis in Greater Glasgow for patients aged 18‐65. As well as giving some insight into how the needs of this patient group are being addressed, it has also provided clinicians with the ability to benefit from their collective experience on the treatment and support of this patient group.Practical implicationsTo ensure excellent data quality and information management systems, it is essential to involve clinicians in their design and validation. The primary goal of information should be to aid clinical practice and patient care. Well designed datasets will also provide information that can inform clinical governance as well as the management of services and resources.Originality/valueThis paper supports the view that clinical audit and electronic clinical information systems are imperative for effective clinical governance.

An overview of clinical governance policies, practices and initiatives

To map the emergence of, and define, clinical governance; to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services' clinical and corporate governance; the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement; the creation of clinical governance structures to improve safety and quality and manage risk and performance; the development of strategies to ensure the effective exchange of data, knowledge and expertise; and the sponsoring of a patient-centred approach to service delivery. A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.

GUIDELINES FOR SURGICAL AUDIT IN AUSTRALIA AND NEW ZEALAND

Surgical audit is an important part of the process to measure performance, reduce clinical risk and improve quality of care. Recognizing this, the Royal Australasian College of Surgeons established a Surgical Audit Taskforce as a subcommittee of the Board of Continuing Professional Standards. This study aims to review the recommendations of the Taskforce for data collection and peer review. The minimum data for whole-practice, continuing audit have been defined. The method of data collection, devices and databases are personal choices for the individual surgeon. However, there are many benefits of developing an electronic surgical audit, and these include facilitating comparison and sharing of audit data between units. Surgical audits should not only report on work carried out but also ensure that outcomes include key performance indicators such as major complications, readmissions, reoperations, transfers, incident reports, complaints and mortalities. Effective clinical governance demands that issues raised by audit need to be documented and reported together with recommendations for improvement. Surgeons should be proactive in helping to find and implement solutions to the issues arising from surgical audit.

Low back pain: barriers to effective clinical governance

PurposeThe purpose of this article is to investigate acceptability, dissemination and use of a multidisciplinary audit toolkit to monitor evidence‐based care for acute low back pain and to identify barriers to implementation of the RCGP evidence‐based LBP guideline and associated audit process.Design/methodology/approachA survey was carried out of 707 clinical governance leads (CGLs) and 336 clinical audit leads in English/Welsh Health Authorities, NHS Trusts, Primary Care Groups and Primary Care Trusts. Subsequently, structured telephone interviews with 50 CGLs and 22 CALs in 72 Primary Care Trusts were qualitatively analysed.FindingsSubstantive barriers specific to implementation of the RCGP LBP guideline and associated audit toolkit could not be identified. Issues were raised pertaining to the wider healthcare system, which itself may restrain implementation of evidence‐based health care for LBP sufferers. Qualitative analysis revealed six categories responsible for poor clinical governance. Results suggest that LBP is not a priority area and that without National Service Framework status this is unlikely to change.Research limitations/implicationsResponse to the initial survey was only 37 per cent; thus results may not be representative of all relevant UK NHS organisations. It coincided with a particularly busy period of change and ongoing reform, making it difficult to reach relevant personnel. This problem was accentuated by frequent change of persons in the post of clinical governance lead. All of this may have impacted on the response rate. In addition, some organisations/individuals were reluctant to be identified for the purpose of this study.Originality/valueThis study identifies the practical difficulties of delivering the clinical governance agenda, particularly in non‐priority areas, as reported by those responsible for doing so.

Strengthening clinical governance through cultivating the line management role

The implementation of clinical governance in health care services introduces increased responsibility and transparency around safety and quality into all staff roles. Encouraging staff to assume these responsibilities as part of their daily routine is fundamental to achieving effective clinical governance, and requires health care managers at all levels to embrace clinical governance leadership and management. Fostering this role will need to be approached skillfully if managers are to achieve effective leadership of clinical governance activities. This paper reviews the management and quality-related literature to explore how these roles may best be developed to ensure that health care managers are equipped and willing to undertake the critical task of translating clinical governance policy into day-to-day practice.

Clinical Effectiveness in Psychotherapy and Mental Health: Strategies and Resources for the Effective Clinical Governance S. McPherson P. Richardson & P. Leroux (eds) London: Karnac, 2003, £16.99 pb, 154 pp., ISBN: 1-85575-902-0

Clinical Effectiveness in Psychotherapy and Mental Health: Strategies and Resources for the Effective Clinical Governance S. McPherson P. Richardson & P. Leroux (eds) London: Karnac, 2003, £16.99 pb, 154 pp., ISBN: 1-85575-902-0 - Volume 28 Issue 5

Clinical governance in primary dental care--getting started.

Clinical Governance is a contractual requirement of everyone working in the NHS. This article explores the components, standards and key stages in developing effective clinical governance in primary dental care and the issues associated with quality assurance.

Lessons from the inquiry into Obstetrics and Gynaecology services at King Edward Memorial Hospital 1990-2000.

The Douglas Inquiry investigated the Obstetrics and Gynaecological services at King Edward Memorial Hospital from 1990-2000. Performance deficiencies were identified at state, board and hospital level contributing to poor outcomes for women, babies and families. The Inquiry raises important issues about clinical governance, leadership and culture, accountability and responsibility, safety and quality systems, staff support and development, and concern for patients and their families. The King Edward, Bristol and Royal Melbourne Hospital inquiries reveal important similarities and key lessons for governments, health care leaders and providers. The health care industry must ensure effective clinical governance supporting a culture of inquiry and open disclosure, and must build rigorous systems to monitor and improve health care safety and quality.

Quality in Counselling in Primary Care: A Guide for Effective Commissioning and Clinical Governance

Peter Bower, Joan Foster and John Mellor-Clark explain why a new handbook on counselling is essential reading for PCTs

Clinical Governance: A Guide to Implementation for Healthcare Professionals

CHAPTER 1: INTRODUCTION AND BACKGROUND: CLINICAL GOVERNANCE AND THE NATIONAL HEALTH SERVICE. Introduction. Background. Why the need for clinical governance?. Political. Changes in health policy. The impact of organizational change on the provision and delivery of health care. Public. Rising patient and public expectations and involvement. Demographic changes. Lack of public confidence in healthcare provision due to media coverage of poor clinical practices. Trend towards greater access to healthcare information. Professional. Increased patient dependency. Advances in health care technology. Rising numbers of complaints going to litigation. Summary. Key Points. Suggested reading. References. CHAPTER 2: WHAT IS CLINICAL GOVERNANCE?. Introduction. The evolution of clinical governance. Origins of clinical governance. Corporate governance and the NHS. The development of a framework of corporate governance. Improvements in the organisation and staffing of internal audit. The development of controls assurance. Defining clinical governance. The key components of clinical governance. Non-clinical services that support clinical governance. Controls assurance. Standards for Better Health. The need for national healthcare standards. Defining the healthcare standards. Describing the new healthcare standards. The standards vs existing systems. Applying the healthcare standards to an example of practice. Criteria for evaluating the standards. Conclusion. Key points. Suggested reading. Useful websites. References. CHAPTER 3: A GUIDE TO CLINICAL GOVERNANCE. Introduction. The key components of clinical governance. Healthcare organisations and the achievement of quality care. Risk management. Managing performance. Clinical incident reporting. Individual performance review. Complaints and accolades monitoring. Sickness and absence monitoring. Quality improvement. Clinical risk management and clinical audit. Continued practice and professional development. Implementing continuing professional development within an NHS organisation. Research and development (R&D). Evidence-based healthcare. Quality information. Information requirements for effective clinical governance systems. Healthcare organisations. Clinical teams. Individuals (healthcare professionals and patients). Accountability. Conclusion. Key points. Suggested reading. References. CHAPTER 4: APPLYING CLINICAL GOVERNANCE IN DAILY PRACTICE. Introduction. Introducing clinical governance into healthcare organisations. Clinical governance: what is a baseline assessment and development plan?. What does a clinical governance action plan look like and why is it necessary?. Case study 1: Applying the principles of clinical governance to an organisation. Case study 2: Applying the principles of clinical governance to a team. Case study 3: Systems and processes associated with the application of a clinical governance framework at individual level. Conclusion. Key points. Suggested reading. References. Appendix 4.1 an example of a clinical governance action plan. Appendix 4.2 an example of a personal development plan . CHAPTER 5: IDENTIFYING AND EXPLORING THE BARRIERS TO THE IMPLEMENTATION OF CLINICAL GOVERNANCE. Introduction. The potential barriers affecting the implementation of clinical governance. Culture. Management. Management styles and clinical governance. Change management. Reaction to change. Leadership . Communication. Education and training. Informing the organisation, team and individuals about clinical governance. Knowledge. Support. Conclusion. Key points. Suggested reading. References. CHAPTER 6: CLINICAL GOVERNANCE AND THE LAW. Introduction: defining terms. Litigation in the NHS. Setting the scene. Where we are now with clinical governance?. What is competent clinical practice?. How the courts determine competent clinical practice. The law and clinical guidelines. Personal updating: knowledge and clinical guidelines. Good guidelines practice. Conclusion. References . CHAPTER 7: THE IMPACT OF CLINICAL GOVERNANCE IN THE NATIONAL HEALTH SERVICE. Introduction. Clinical governance: friend or foe?. Revealing the impact of clinical governance. Accountability. Organisational structures. Continuous quality improvement. Performance management. Culture. Recipe for successes. Conclusion. Key points. Suggested reading. References. CHAPTER 8: CONCLUSION: THE FUTURE OF CLINICAL GOVERNANCE FOR HEALTHCARE PROFESSIONALS. References

Improving quality in the changing world of primary care

This is the first in a series of five articles Series editor: Rebecca Rosen Publication of A First Class Service placed quality improvement at the centre of the health policy...

Report of the Coding Committee of the Association for European Paediatric Cardiology

For many years, paediatric cardiologists and paediatric cardiac surgeons have felt the need for a common diagnostic and therapeutic coding system with which to classify patients of all ages with congenital and acquired heart disease. This desire has been highlighted by the recent, and ongoing, enquiry into the outcome of paediatric cardiac surgery at the unit in Bristol, in the United Kingdom, and the resulting obligation to provide national and international comparisons of surgical results between centres caring for these patients. In order to incorporate effective clinical governance and best practice into our speciality, a method is required to gather accurate and validated data on the diagnosis, therapy and outcome of patients with heart disease from prenatal life through to adulthood. This would facilitate comparisons between individual units which fully take into account the mix of cases involved, and thus attempt to focus on the relevant and genuine factors underlying the differing outcomes in terms of both mortality and morbidity. For this to be achieved, it is essential to have a comprehensive system of coding and classification, using mutually exclusive and unambivalent terms. The system must be both easy to use, and fulfil the needs and expectations of widely different cultures of practice. Although many centres have developed their own system of internal audit, with their own coding system, and some co-operation has taken place between centres nationally and across international boundaries within Europe by the European Congenital Heart Surgeons Federation (see below), a cohesive, and comprehensive system suitable for setting standards has yet to emerge. Historically, this has partly been due to the lack of recognition by governments of the importance of such a process, with underfunding of initiatives aimed at addressing these issues, both technologically and in terms of human resources.

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...

Effective practice in the NHS and the contribution from public health: a qualitative study

Reports on a study which explored the views of key stakeholders regarding the meaning and implementation of effective health care and clinical governance in NHS Trusts, and the role for public health professionals. The authors used a national questionnaire survey to derive a sample for qualitative telephone interviews and two area case studies. The authors found that the meaning of effective health care and the means employed for implementation varied. Mergers were seen as hindrances to gaining organisational engagement whilst others, such as the White Paper on quality and the notion of clinical governance, were seen as facilitating. A widespread aspiration was a more integrated and corporate quality culture where quality was central, not marginal. The authors conclude that there is widespread concern among Trusts to change their culture and assert effective health care as a central value. Public health skills, rather than the discipline itself, are seen as important for such culture change.

Clinical governance and record keeping: legal issues issues

This article examines the recent NHS White Paper (Department of Health, 1997). The author argues that it is essential to acknowledge the key legal issues and principles of clinical risk management in order to effectively implement clinical governance provisions. Good record keeping is identified as an area which needs to be addressed and improved in order to develop effective clinical governance.