NHS Clinical Governance Support Team Research Articles

Ensuring that care complies with best practice

The NHS Clinical Governance Support Team service is scheduled to close on 31 March 2008 and, as of 1 April 2008, the Strategic Health Authorities in England will be responsible for clinical governance. It is therefore timely to re-appraise how nurses can champion the rights of children and young people to receive the best standards of care based on current policies. This is important as Coles et al (2007) have, while measuring compliance to one of the standards of the children’s national service framework (Department of Health (DH), 2003) in an English Strategic Health Authority, reported several disquieting elements of less than optimum performance.

Sharing good practice: knowledge in action

PurposeThe purpose of this article is to describe the development of the NHS Clinical Governance Support Team's (CGST) information products, with a focus on good practice “eurekas” and an integrated management system for storing knowledge and learning; an intranet‐based “action points” system.Design/methodology/approachThe process behind development of a set of products and a system to capture and share good practice in health care.FindingsTo ensure that good practice in clinical governance was being disseminated effectively, and to celebrate success, the CGST developed “eurekas” as short, structured accounts of local improvements to health care. To enhance the number of “raw” eurekas turned into finished, online products, the process of production was streamlined through an online “action points” system. This is an effective knowledge management tool for storing, retrieving and monitoring the development of information into a range of products for sharing across the NHS (e.g. stories, case studies). The system was developed in parallel with the team's website and intranet.Originality/valueThe stages in development of CGST information products since 2000 are outlined, along with the principles behind an efficient system for capturing good practice and CGST learning. Tips on information product development and distribution are given.

The role of an NHS Board in assuring the quality of clinically governed care and the duty of trust to patients

PurposeTo provide an overview of the change to NHS Clinical Governance Support Team's Board Development Programme.Design/methodology/approachThe background to the programme, the methods adopted by the Board Team and lessons learned are outlined. Commitment and active support at Board and senior levels are known to be essential for organisational change and, in order to help translate aims into strategic priorities and to implement these into improved services, the Clinical Governance Board Support Team was formed in 2000 as part of the overall NHS Clinical Governance Support Team (CGST). Its members provide advice and support to NHS personnel who are involved in improvements to health care services.FindingsThe team worked initially with Boards of acute NHS Trusts and later with Primary Care, Ambulance and Mental Health Trusts. Among the lessons learned from their own work and the increasing body of research‐based evidence is the importance of the leadership role of the Board in fostering a positive culture of change, enthusing and empowering staff. Other factors are the effectiveness of communication with external organisations, scrutiny of all points of contact with users of the services and involvement of users – patients and carers – at all stages. The Team evolved during the programme, strengthening its clinical base and introducing patients and carers as associates. In order to meet demand and increase capacity of the Team, learning materials have been developed and these and their experiences widely disseminated. An example of success is demonstrated by the progress made by a pilot cohort of Primary Care Trusts.Originality/valueThis review summarises the aims, objectives and progress of the work of the Board Development Programme.

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 Support Team: patients as a virtue

A core objective of the NHS Clinical Governance Support Team (CGST) is to enable the NHS to improve the experience of patients and staff. In its programmes the CGST encourages delegates to work with patients and carers to improve local health services, but does the CGST practice what it preaches in its own activities? This paper examines how patients and carers are involved in the work of the CGST, specifically as patient consultants in the CGST’s Performance Development Team (PDT). In their role as PDT members, patient consultants provide guidance to the PDT and the trusts with which they engage, focussing their activity and their thinking around improvements in the patient’s experience. They are also working with the wider CGST and are involved in mentoring the acting head of the team.

Making an impact: exploring delegates’ perceptions of the clinical governance development programme

Aims to identify the positive and negative impact that the NHS Clinical Governance Support Team’s (CGST) Clinical Governance Development Programme (CGDP) was perceived to have (or failed to have) on delegates, working practices and work relationships. Data were collected with a random sample of 500 delegates who had participated in the CGDP. Indicates that the CGDP was successful in meeting its aims, with participants reporting that their views or behaviours had changed on a number of items. Subjects reported an increase in their skills, knowledge, clarity and structure in their work and improved communication between clinical teams. Participation in the CGDP had a positive impact on the individuals’ professional development. Major benefits were reported as: networking and sharing with other professionals from a diverse range of clinical and geographical areas, taking time to reflect and plan, and development of a new set of skills. Some participants who reported little or no progress attributed the main factors hindering change to shortage of time, resources, workforce migration and the debilitating impact of continuous change in the NHS.

People will support what they help to create: clinical governance large group work

The NHS Clinical Governance Support Team (CGST) has completed a pilot “protected‐time programme”, supported by a small team of national facilitators and delivered locally in 19 NHS pilot sites across England. The programme worked on the premise that health professionals can successfully lead service developments when given time and space to do so. The paper describes the methodology behind this initiative, how local events were organised to “get the whole system into the room” and what was learned by applying tried and tested methodologies such as accelerated service improvement. Some of the changes being implemented in participating NHS Trusts are presented in brief, along with a more detailed case study of work undertaken at Royal Cornwall Hospitals Trust. Having completed the pilot programme, the team is supporting other CGST activities and applying the learning from working with large groups to improve locally delivered care in NHS organisations.

Team resource management: a programme for troubled teams

The necessity for effective multidisciplinary team working within increasingly complex health and social care environments has been emphasised in The NHS Plan. Good teamwork makes a critical contribution to effectiveness and innovation in health‐care delivery and it is through such teams that the agenda of quality improvement through clinical governance can be delivered at local level. The NHS Clinical Governance Support Team’s Team Resource Management Programme supports individuals who work directly with poorly performing NHS teams. A case study example illustrates how a team coach has used her experiences on the Programme to facilitate effective change in a “troubled” team in her health‐care organisation.

Learning by doing: training general practitioners to be appraisers

Effective appraisal is one of the key underpinning systems to allow the practical implementation of clinical governance. Between March and July 2002, over 800 GPs have attended the national GP “Training the Appraisers” Programme, funded by the Department of Health, and run by the NHS Clinical Governance Support Team (CGST) in partnership with Edgecumbe Consulting Ltd. The one day programme, which includes practical “real life” appraisal sessions for GPs, is well on the way to meeting its remit of training 900 GP appraisers (an average of three appraisers per PCT) in 2002. Once they have completed the course, trained appraisers can begin the process of conducting the first round of appraisals in their local primary care organisations. The GP Appraisal Programme recognises the potential of an effective system of appraisal to develop over time, so that patients can be confident that their family doctor is supported in taking regular, structured steps to ensure they are identifying and fulfilling their professional development needs and thereby enhancing the delivery of high quality care.

Developing strategic leadership of clinical governance through a programme for NHS boards

National Health Service trust boards are constantly challenged to achieve a balance between their resources and meeting the needs of the communities they serve. In addition, the scientific, technological, political and economic factors, which influence health and social care, are driving change more rapidly than ever before in the Health Service. As part of its function to support NHS organisations with the implementation of clinical governance, the NHS Clinical Governance Support Team (CGST) has developed a strategic development programme for trust boards. The aim of the programme is to develop the board’s capability to meet its responsibilities for governance and the delivery of safe, high quality patient care.

Team skills

David Johnson, a senior route check 747 Captain with British Airways, gives a personal account of team resource management. Captain Johnson's involvement with clinical governance began after an article he had written, describing similarities between aviation and medicine particularly in the area of team skills, attracted the attention of Professor Aidan Halligan and the NHS Clinical Governance Support Team. But why clinical governance and what has this to do with diabetes and vascular disease?

Clinical governance … after the review – what next? Agreement and implementation

The NHS Clinical Governance Support Team (NCGST) is working with multidisciplinary teams as they begin the cultural shift in their sponsoring organisations towards the development of excellence in health care provision. Describes show how delegate teams move from an awareness of the problems, through gaining a commitment and agreement to change, to implementation of new ways of working.

Clinical governance: its origins and its foundations

This article from the NHS Clinical Governance Support Team (NCGST) outlines the development of quality concerns since the NHS was founded in 1948. It traces the development of clinical governance as a means of achieving continuous quality improvement and describes what the implementation of clinical governance means for patients and professionals. It analyses features of the cultural shift necessary to underpin quality improvement initiatives and describes with practical examples the constituents of the culture necessary for successful clinical governance. Future articles in this series will address other issues around clinical governance and will explain the model being followed by delegates to the NCGST's Clinical Governance Development Programme as they implement clinical governance "on the ground".