Clinical Governance In Hospitals Research Articles

ANALYSIS OF IMPLEMENTATION OF ACUTE APPENDICITIS CLINICAL PATHWAY WITH ICPAT (INTEGRATED CLINICAL PATHWAY APPRAISAL TOOL) AT FAISAL ISLAMIC HOSPITAL MAKASSAR YEAR 2022

Background: Clinical Pathways are crucial for implementing Good Clinical Governance in hospitals to reduce variations, ultimately decreasing the risk of medical errors. A Clinical Pathway must create a diagnosis with high volume, risk, cost, and problem-proneness standards. Appendicitis is an essential public health problem; the prevalence and incidence have increased globally. The clinical pathway implementation at our institution has yet to be evaluated. Objective: This study aims to analyze the implementation of the Acute Appendicitis Clinical Pathway using ICPAT. Methods: This study is a mixed methods study with a case study approach. Quantitative samples were collected from medical records of patients with acute appendicitis through proportional random sampling based on the inclusion and exclusion criteria. Qualitative participants were chosen according to appropriateness and adequacy principles. The validation method used was data triangulation. Result: The outcomes demonstrated a 0% compliance rate in implementing the clinical pathway for acute appendicitis. ICPAT results (content and quality); D1 (90%, 100%), D2 (39.13%, 25%), D3 (30.77%, 35.29%), D4 (60%, 100%), D5 (50%, 30.77%), D6 (66.67%, 75%). Conclusion: There was never a comprehensive review, especially using standard tools. This study helps Faisal Islamic Hospital conclude points to improve, especially the bad categories, namely the documentation, development, and maintenance dimensions.

Implementasi Clinical Pathway dengan Analisa Penggunaan Antibiotika, Pasien Anak dengan Demam Tifoid Rawat Inap

Clinical Pathway (CP) is an important part of the documents and tools to realize good clinical governance in hospitals. In Indonesia, this document is also one of the requirements that must be met in the Hospital Accreditation Standard version of the Hospital Accreditation Commission (KARS). The aim of this study was to determine the effectiveness of implementing CP in pediatric patients with typhoid fever on clinical outcomes, length of stay, use of antibiotics at Permata Bekasi Hospital. Providing information and scientific data regarding the implementation of CP on clinical outcomes and can be used as a reference material in making programs and regulation of antibiotics used for pediatric patients with typhoid fever in a rational manner. The research used is a quantitative method with a pre and post approach after the implementation of CP using secondary data, namely medical records of patients with typhoid fever hospitalized at Permata Bekasi Hospital retrospectively. The age group before CP was the most aged 5 - <10 years (29.8%), as well as the group after CP the most aged 5 - <10 years (34.7%), it can be concluded that the age range was diagnosed with typhoid fever more than the age of the other patients. The effectiveness of CP implementation after CP can reduce the average length of stay according to CP recommendations compared to before CP implementation.

1324 DEVELOPMENT OF A M&M MEETING INTEGRATING THE SITUATIONAL JUDGEMENT REVIEW (SJR) FRAMEWORK IN A GERIATRIC DEPARTMENT

Abstract Introduction The National Mortality Case Record Review Programme commissioned in 2016 aimed to improve the learning from deaths process. As part of this aim, several reports were published, which identified barriers in implementing the mortality review process. Mortality and Morbidity (M&M) meetings can be an important mechanism for removing these barriers, and while have been in place for a long time in surgical specialties, are only recently becoming more common in medical specialties. We have developed an innovative M&M meeting in our geriatric department to integrate Mortality case reviews with teaching and QI development. Methods We created a standardised mortality data collection proforma, using the (SJR) framework as a template. During the development, feedback was obtained from consultants and juniors. Data was then collected using the proforma by trainees, and all mortality cases were then reviewed with consultant supervision, and specific cases were chosen for their educational benefit or requiring areas of improvement. Cases were then presented at the meeting. At the end of the meetings, an action plan was then created in collaboration with the consultant and juniors in the meeting to create a teaching plan or develop a QI project to help improve service. Results From feedback gained, the M&M was well received, and has already helped improve training and delivery of end of life care and recognising the dying patient. There were several difficulties identified during the process such as incomplete medical records, time and lack of engagement from other team members due to work pressures. Conclusion Mortality meetings are an essential part of junior doctor training and hospital clinical governance, often times underutilised. They can support quality improvement and professional learning, especially when facilitated by a standardised mortality review process.

Implementation Analysis Of Clinical Pathway At Royal Prima Hospital

Clinical pathways are an important part of documents and tools in realizing good clinical governance in hospitals. In Indonesia, this document is also one of the requirements that must be met in the KARS version of the Hospital Accreditation Standard. However, the process of implementing this Clinical Pathway itself also has various problems. Things that might hinder the implementation of this clinical pathway could come from the staff and hospital members themselves because they have not adapted to this Clinical Pathway. This study aims to analyze the implementation of the Clinical Pathway at the Royal Prima Hospital in Medan. This study uses a quantitative design with a cross sectional approach. The research sample was all doctors, nurses, nutritionists, pharmacists at the Royal Prima Hospital Medan who filled the Clinical Pathway as many as 83 people. The results of the Fisher's Exact test showed that there was a significant effect between regulation (p=0.000), compliance (p=0.004), supporting factors (p=0.025), and inhibiting factors (p=0.002). By using the t-test at a significance level of 0.05, the results obtained that regulation is the variable that has the main influence on the implementation of the Clinical Pathway at Royal Prima Hospital Medan (Sig.0.001). Suggestions to hospitals are expected to strengthen policies regarding the implementation of Clinical Pathway to improve health services in hospitals. Caregivers are expected to maintain compliance with the implementation of the Clinical Pathway to improve health services in hospitals.

Non-collagen pathogenic variants resulting in the osteogenesis imperfecta phenotype in children: a single-country observational cohort study

Background/ObjectivesIn England, children (0–18 years) with severe, complex and atypical osteogenesis imperfecta (OI) are managed by four centres (Birmingham, Bristol, London, Sheffield) in a ‘Highly Specialised Service’ (HSS OI); affected...

Proposed training pathway with initial experience to set up robotic hepatobiliary and pancreatic service.

Although robot-assisted hepatobiliary and pancreatic (HPB) surgery has gained momentum over the last 2decades, only a handful of units in the world perform major robotic resections. Adaptation of robotic surgery in the UK lags behind its European counterparts and this is mainly because of cost implications in a publicly funded National Health Service (NHS). We describe our experience of setting up a robotic HPB programme with clinical outcomes and propose a training pathway that would help prospective centres in setting up their own robotic HPB service with robust clinical governance oversight. After gaining colleagues' and departmental support, approval from the hospital clinical governance, finance department and new intervention procedure committee was sought. A team of two consultant surgeons, three assistants and three theatre staff went through a structured training programme sponsored mainly by the industry. Surgeon training consisted of online modules, simulation, wet lab, cadaveric training, case observations, proctored procedures followed by independent practice. All major cases were recorded and videos reviewed to improve performance. A total of 111 procedures were successfully completed with robotic assistance between April 2018 and March 2020. The programme started with robot-assisted cholecystectomy as index procedure and progressed on to more complex liver and pancreatic resections including major hepatectomy and Whipple's procedure. The training pathway followed by our team has been effective in setting up a safe robotic HPB programme and could be considered as a roadmap to start new Robotic HPB services.

Pengaruh Audit Operasional, Pengendalian Internal, Dan Good Clinical Governance Terhadap Efektivitas Pelayanan Kesehatan Pasien Bpjs Di Rumah Sakit

This study aims to prove that the effect of operational audits, good internal and clinical governance in hospitals has an effect on the health services of goverment of public health patients in hospitals. The sample selection in this research used purposive sampling method with various criteria according to the research objectives. The total sample used as the object of research in this study is the desire of 15 hospitals in Padang city with the category of government-owned or private hospitals. The data analysis technique used in this study was a questionnaire that was designed according to the variables used in this study. The results of this study can prove that the audit has a positive effect on the health of goverment of public health patients in the hospital. With the results of the sig value 0.001 <0.05, and the t-count value of 3.366> t-t table 1.992, it can be concluded that the hypothesis H1 is accepted. In addition, this study can also prove empirically that good clinical governance has a positive effect on the health of goverment of public health patients in the hospital with a sig value of 0.002 <0.05 with a value of t-count 3.162> t-t table 1.992. So it can be concluded that the hypothesis H3 is accepted, while the internal control variable has no effect on the influence of goverment of public health patient health services in the hospital. it can be concluded that the hypothesis H2 is rejected. Suggestions for further research are expected to increase the number of research samples and also the year of observation. Can also use other variables that are used to measure the effectiveness of BPJS patient health services in the hospital.

The Implementation Analysis of Clinical Governance by the Medical Committee at Deli Serdang Hospital

Clinical governance aims to maintain and improve the quality of medical services for patients and protect patients from the risk of unexpected events as regulated in Law Number 44 of 2009 concerning Hospitals and Minister of Health Regulation Number 755 / MENKES / PER / IV / 2011 regarding the implementation medical committee at the hospital. The medical committee is one of the hospital's instruments that has an important role in implementing clinical governance so that the medical staff at the hospital is maintained professionally. In implementing clinical governance in hospitals, it is done by carrying out credentials, monitoring the quality of the medical profession, and maintaining the ethics and discipline of the medical profession. This type of research is qualitative in-depth interviews. Informants were selected using a purposive technique. The subjects in this study were informants relating to the medical committee. The results showed that the implementation of clinical governance in Deli Serdang Hospital was not going well. This can be seen from the implementation of medical committee activities that are not in accordance with the Minister of Health Regulation No. 755 / MENKES / PER / IV / 2011 concerning the implementation of medical committees in hospitals. The work program carried out by the medical committee at Deli Serdang Hospital is deemed not in accordance with the expected target. This is due to the lack of planning and budget that supports the implementation of clinical governance in Deli Serdang Hospital. The implementation of clinical governance by the medical committee in medical services at Deli Serdang Hospital has not been running well. Thus, good planning and budgeting is needed to strengthen the activities of the medical committee in achieving good clinical governance in Deli Serdang Hospital.

The role of the medical committee in hospital clinical governance in Jambi province

Latar Belakang: Tata kelola klinis bertujuan untuk memastikan bahwa layanan kesehatan berjalan sesuai dengan standar keamanan yang tinggi dan kualitas berkelanjutan. Komite Medis bertanggung jawab untuk pelaksanaan tata kelola klinis yang baik di rumah sakit. Penelitian ini bertujuan untuk mengetahui peran Komite Medik dalam tata kelola klinis rumah sakit di era Jaminan Kesehatan Nasional (JKN) pada RS Umum Daerah (RSUD) di Provinsi Jambi. 
 Metode: Desain penelitian bersifat kualitatif. Pengumpulan data dari Agustus hingga Desember 2016 di tiga RSUD kelas C di Provinsi Jambi dan mencakup 23 informan yang diambil melalui wawancara mendalam dan Focus Group Discussion. 
 Hasil: Hasil penelitian menunjukkan bahwa Komite Medik belum berperan optimal dalam proses kredensialing, pemeliharaan mutu profesi dan penjagaan disiplin/etika profesi. Tugas dan fungsi kredensialing di beberapa rumah sakit belum berjalan sebagaimana mestinya (karena digunakan untuk persyaratan penerimaan dokter baru, tetapi tidak untuk menyaring kompetensi dokter), terkesan formalitas, serta sulit dilakukan karena belum memiliki Mitra Bestari. Kebijakan Jaminan Kesehatan Nasional memberi pengaruh baik terhadap peran komite medik dalam tata kelola klinis RS, karena terdapat beberapa regulasi atau peraturan pelaksana tentang JKN yang terintegrasi dengan peran komite medik, khususnya pada aspek kendali mutu kendali biaya. 
 Kesimpulan: Dapat disimpulkan Komite Medik secara umum belum berperan optimal dalam tata kelola klinis pada RSUD Kelas C di Provinsi Jambi. Oleh karena itu, rumah sakit perlu meningkatkan kompetensi, etika dan disiplin profesi medik, serta penyempurnaan regulasi terpadu terkait tata kelola klinis di rumah sakit. 
 Kata kunci: komite medik, tata kelola klinis, RS, Jaminan Kesehatan Nasional.
 Abstract
 Background: Clinical governance aims to ensure that health services run according to high safety standards and ongoing quality. The medical committee is responsible for the implementation of good clinical governance of the hospital. This study aims to analyze the role of the medical committee in the clinical governance of hospitals in the era of National Health Insurance (JKN). 
 Methods: The research design is qualitative. Data collection spans from August to December 2016 in three hospitals in Jambi Province and includes 23 informants who were observed throughout in-depth interviews and focus group discussions. 
 Results: The results show that the medical committee has not played an optimal role in the process of credentialing, maintaining professional quality, and guarding the discipline/professional ethics of the hospital. The duties and functions of credentials in some hospitals are not working properly (because used to apply to new doctor admission requirements, but not as to screen the competence of doctors), seem excessively formal and difficult to implement because they do not have Mitra Bestari yet. JKN policy has a good influence on the role of the medical committee in the clinical governance of the hospital, as there are several regulations that are integrated with the role of the medical committee, especially in the areas of quality control and cost control. 
 Conclusion: It can be concluded that the medical committee in general has not played an optimal role in the clinical governance of hospitals in Jambi Province. Therefore, it is necessary to improve the competence, ethics, and discipline of the medical profession in addition to integrating regulations related to clinical governance in hospitals. 
 Keywords : Medical committee, clinical governance

Conceptual Model of Clinical Governance Information System for Statistical Indicators by Using UML in Two Sample Hospitals.

Objective:The purpose of this study was investigating situation and presenting a conceptual model for clinical governance information system by using UML in two sample hospitals.Background:However, use of information is one of the fundamental components of clinical governance; but unfortunately, it does not pay much attention to information management.Material and Methods:A cross sectional study was conducted in October 2012- May 2013. Data were gathered through questionnaires and interviews in two sample hospitals. Face and content validity of the questionnaire has been confirmed by experts. Data were collected from a pilot hospital and reforms were carried out and Final questionnaire was prepared. Data were analyzed by descriptive statistics and SPSS 16 software.Results:With the scenario derived from questionnaires, UML diagrams are presented by using Rational Rose 7 software. The results showed that 32.14 percent Indicators of the hospitals were calculated. Database was not designed and 100 percent of the hospital’s clinical governance was required to create a database.Conclusion:Clinical governance unit of hospitals to perform its mission, do not have access to all the needed indicators. Defining of Processes and drawing of models and creating of database are essential for designing of information systems.

Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam

It is accepted by hospital clinical governance that every clinician's "duty of care" includes hand hygiene, yet globally, health care workers (HCWs) continue to struggle with compliance. Focus group discussions were conducted to explore HCWs' barriers to hand hygiene in Vietnam. Twelve focus group discussions were conducted with HCWs from 6 public hospitals across Hanoi, Vietnam. Discussions included participants' experiences with and perceptions concerning hand hygiene. Tape recordings were transcribed verbatim and then translated into English. Thematic analysis was conducted by 2 investigators. Expressed frustration with high workload, limited access to hand hygiene solutions, and complicated guidelines that are difficult to interpret in overcrowded settings were considered by participants to be bona fide reasons for noncompliance. No participant acknowledged hand hygiene as a duty of care practice for her or his patients. Justification for noncompliance was the observation that visitors did not perform hand hygiene. HCWs did acknowledge a personal duty of care when hand hygiene was perceived to benefit her or his own health, and then neither workload or environmental challenges influenced compliance. Limited resources in Vietnam are amplified by overcrowded conditions and dual bed occupancy. Yet without a systematic systemic duty of care to patient safety, changes to guidelines and resources might not immediately improve compliance. Thus, introducing routine hand hygiene must start with education programs focusing on duty of care.

Clinical Governance; How Been Understood, What Is Needed? Nurses' Perspective

A B S T R A C T Introduction: Clinical Governance (CG) is an overarching concept, using organizational capacity, safeguards high standards of the health services and provides a safe care for patients. The aim of this research was to study nurses' perception about Clinical Governance. Materials and Methods: A qualitative study was done with Focus Group Discussions (FGD). Purposeful Sampling was used to select the objectives including 65 participants. Actually 7 FGD's were held. Content analysis was used to extract the meaningful themes. Results: Nurses believed that patient centeredness and evidence based practice is the core of the CG concept. Also they mentioned that cultural change, staffs training, adequate financial and human resources are required to successfully implementation of CG in hospitals. Conclusion: Spreading up a shared vision about CG and providing the required infrastructures in hospitals would be facilitate CG initiatives. Proper commitment of the managers and staff participation could lead an effective CG implementation. Please cite this paper as:

The Relationship between Matrons' Knowledge, Attitude, and Performance in Clinical Governance Domain and Mashhad Hospitals Fulfillment of Clinical Governance: 2013

Introduction: Clinical Governance (CG) is a systematic approach to the maintaining and improving the quality of provided services for patients in the health system. With regards to the implementation of clinical governance in hospitals affiliated to Mashhad University of Medical Sciences and the role of matrons in ensuring quality care, little is known about the relationship between matrons’ participation in this plan and hospital success in clinical governance fulfillment. Materials and Methods:This cross-sectional, analytic-descriptive study was conducted to investigate the relationship between matrons’ knowledge, attitude, and performance in clinical governance and Mashhad hospitals' fulfillment of clinical governance. A researcher-made questionnaire was used for data collection on matrons’ knowledge, attitude, and performance. The standard checklist of the health ministry and observation were used to assess hospital clinical governance fulfillment. Data was analyzed at the hospital level by SPSS16. Results: The mean scores of matrons' knowledge, attitude, and performance were above average. Matrons' attitude towards clinical governance achieved the highest mark (4.46). There was no significant correlation between matrons' knowledge/attitude/performance and hospital scores for clinical governance fulfillment (P>0.05). Conclusion: While the levels of matrons' knowledge, attitude, and performance were satisfactory, there is still a need for improving matrons' knowledge. Absence of any statistically significant relationship between matrons' knowledge, attitude, performance and hospitals scores for clinical governance fulfillment may be due to the study small sample size.

Conceptual Model of Clinical Governance Information System for Statistical Indicators by Using UML in Two Sample Hospitals.

Objective:The purpose of this study was investigating situation and presenting a conceptual model for clinical governance information system by using UML in two sample hospitals.Background:However, use of information is one of the fundamental components of clinical governance; but unfortunately, it does not pay much attention to information management.Material and Methods:A cross sectional study was conducted in October 2012- May 2013. Data were gathered through questionnaires and interviews in two sample hospitals. Face and content validity of the questionnaire has been confirmed by experts. Data were collected from a pilot hospital and reforms were carried out and Final questionnaire was prepared. Data were analyzed by descriptive statistics and SPSS 16 software.Results:With the scenario derived from questionnaires, UML diagrams are presented by using Rational Rose 7 software. The results showed that 32.14 percent Indicators of the hospitals were calculated. Database was not designed and 100 percent of the hospital’s clinical governance was required to create a database.Conclusion:Clinical governance unit of hospitals to perform its mission, do not have access to all the needed indicators. Defining of Processes and drawing of models and creating of database are essential for designing of information systems.

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.

Calidad de vida de los profesionales en el modelo de gestión clínica de Asturias

ObjectiveTo evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care). MethodsA cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of «management support», «workload» and «intrinsic motivation» were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables. ResultsOf the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39±1.42) and that with the lowest was conflicts with peers (3.23±2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life. ConclusionsA longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care.

The learning curve in the use of trans-oral laser microsurgery for cancer treatment

The authors from the University of Barcelona present their experience of using trans-oral laser micro-surgery (TOLMS) in the management of laryngeal and hypopharyngeal cancers over a 14-year period and extrapolate from analysis of the data [1], with surgeons graded by levels of experience addressing early and locally advanced tumours, as well as stage of disease and comment on patient outcome using analysis of number of surgeries per patient, rate of complications, rates of positive and negative tumour margins, rate if tumour relapse, type of surgical salvage procedure employed and disease-specific survival. The difference between the mean of surgical interventions was statistically significant, and the number of total laryngectomy employed as a salvage procedure was lower in the group of patients operated upon by more experienced surgeons. Tumour-free margins and tumour relapse were not influenced by experience. The number of overall complications and the disease-specific survival rates was significantly lower in the ‘‘expert’’ group. The authors do agree that the learning curve of TOLMS for glottis, supraglottic and hypopharyngeal lesions may be different, and suggest that further analysis with larger numbers in each sub-site is necessary. They also suggest that for TOLMS ‘‘beginners’’ that early teaching, confidence and analysis of competency should be gained with early tumours. Based on their results it is suggested that experience in the use of TOLMS should be gained in a levelled approach graduating from early tumours to intermediate and then advanced T stage disease. This paper is a first attempt to review a large series of treated patients and analyse the involvement of surgeons of differing experiences against a number of outcome measures. However, of the 5 surgeons work reported, all were ‘‘experienced’’ head and neck surgeons. The majority (80 %) had more than 15 years of surgical experience before commencing TOLMS, and the other surgeon was less than 7 years experienced. Thus, the surgeons in this report, while ‘‘new’’ to TOLMS had already got experience of micro-laryngoscopy and bimanual surgical excisions, identification of tumours and their margins prior to being introduced to TOLMS. This may not be universally equivalent when starting up a practice employing TOLMS for the management of laryngeal and hypopharyngeal cancers. The most important steps when considering introducing ‘‘new technologies’’ into surgery is to ensure that a ‘‘team approach’’ is agreed and developed—this naturally in cancer surgery will involve the surgeon, the anaesthetist and the histopathologist. The introduction of such new clinical interventions and surgical techniques may need to be approved by the local hospital clinical governance board, and comply with clinicians being able to demonstrate that they can meet externally set of standards on appropriate training, as in the UK NHS [2]. It is also important not to ignore that the data need to be collected prospectively, documentation of duration of surgery, hospital stay, complications, tumour status of resection margins achieved, ability to salvage close or positive margins, functional outcome—objective and subjective evaluation of voice and swallowing outcomes, as well as disease-specific survival. The ability of residents (training grade) to achieve TOLMS expertise is strongly influenced by the personal skills and P. Bradley (&) Department of Otorhinolaryngology Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK e-mail: pjbradley@zoo.co.uk