PubMed · 1113775
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G A Degenshein, F Ceccarelli. 1975-03-27. Letter: The end-result system.. https://doi.org/10.1056/nejm197503272921324
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Measuring outcomes of care is an essential component of clinical governance. This article describes a pragmatic approach to auditing symptom control outcomes in a community specialist palliative care nursing team. Using a palliative care assessment tool, it demonstrates that the team make a positive difference to the patient's experience of most symptoms and a plan for further development of practice is formulated in response to the results of the audit. Unexpected outcomes reveal some of the realities of community specialist palliative care and demonstrate that audit is worthwhile despite some of the pitfalls in this area of practice.
There is increasing interest in complexity as an explanatory model to help understand how health care organisations operate and change. In this article, we present a brief introduction to some of the basic ideas in complexity and illustrate how these might be relevant to the process of implementing clinical governance. The implementation of clinical governance can be seen as a complex adaptive system: as such, we must accept that uncertainty and unpredictability are inescapable. This makes life uncomfortable for managers, but an understanding of how complex adaptive systems work helps us explore a range or management styles and practices, depending on how the 'system'--in this case the implementation of clinical govenance--is developing.
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