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At least 19 recordsLinked to original sources
PubMed2000

Principles to govern clinical governance.

Clinical governance--a new NHS concept that seeks, through clinical guidelines and national service frameworks, to encourage and enforce compliance with nationally-devised evidence based clinical policies--has manifold and complex implications. This paper reasons that clinical governance is actually a means to promote excellent practice of a particular kind and that non-compliance does not necessarily equate to bad practice. Therefore, separate means must be utilized to address bad practice. The paper proposes and supports in turn a series of principles to ensure that the potential benefits of clinical governance are maximized and the potential harms are diminished. A similar set of principles is proposed to help govern the management of bad practice. The complementary conclusions of the reasoning are that a) doctors should willingly embrace clinical governance and b) the NHS should not rigidly enforce it. However, as clinical governance restricts clinical freedom and patient choice it is important that ethical principles, such as those proposed, are followed in order to avoid or manage some unhappy conflicts.

Evidence-Based Medicine↗
PubMedDate not supplied

Clinical governance.

Clinical governance has marked a significant shift towards involving clinicians in the assurances of both quality and accountability in healthcare delivery. The White Paper (Department of Health (DoH), 1997) stated that: 'The Government will require every NHS trust to embrace the concept of clinical governance, so that quality is at the core, both of their responsibilities as organizations, and of each of their staff as individual professionals.' In order to achieve this the Government will bring forward legislation to give NHS trusts a new duty for maintaining quality care. Under these arrangements, chief executives will carry ultimate responsibility for assuring the quality of the services provided by their NHS trust, just as they are already accountable for the proper use of resources. In 'A First Class Service Quality in the NHS' (DoH, 1998), clinical governance is defined as 'a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish'. The principles of clinical governance apply to all those who provide or manage patient care services in the NHS. It requires staff to work in partnerships, breaking down boundaries by providing integrated care within health and social care teams (Wilson, 1996), and between practitioners and managers and between the NHS, patients and the public.

Decision Making, Organizational↗
PubMed2006

Point-of-care-testing and Clinical Governance.

Clinical Governance is a quality framework encompassing risk management, clinical and cost effectiveness, and patient outcomes. These principles apply to point-of-care testing (POCT), which is becoming widely used within hospitals and the community. Formal regulation of POCT is variable throughout the world, but it is vital that the principles of clinical governance are followed in the implementation and management of POCT and laboratory professionals have a responsibility to advise users of POCT accordingly.

Cost-Benefit Analysis↗
PubMed2005

What do specialist registrars know about clinical governance?

Clinical governance is an essential part of quality assurance for everyday clinical practice. It is part of the generic curriculum for all specialist registrars (SpRs) training in medical specialities. The authors of this update undertook a survey of SpRs training in geriatric medicine to determine their perceived knowledge of clinical governance and whether they had received training in this area.

Clinical Competence↗
PubMed2006

Involvement of patients in Clinical Governance.

Clinical Governance is a framework through which the National Health Service (NHS) organisations in the UK are accountable for continuously improving the quality of their services and safeguarding high standards by creating an environment in which excellence in clinical care will flourish. The NHS has moved on from being an organisation that simply delivered services to people, to being a service that is totally patient-led and responds to their needs and wishes. There are numerous national drivers and initiatives for patient involvement, including the NHS Plan 2000, Involving Patients and public in healthcare 2001 and, more recently, Creating a patient-led NHS 2005 and Patient choice 2005. There is also an independent public body funded by the Department of Health, the Commission for Patient and Public Involvement in Health (CPPIH), which supports and enables patient involvement in local decisions about delivery of healthcare. At Luton & Dunstable Hospital NHS Trust, patients and carers are seen as a valuable resource and there are formal mechanisms for recruiting patient representatives to sit on hospital committees and to be involved in service provision, including Clinical Governance arrangements.

Clinical Medicine↗
PubMed1998

Educating towards clinical governance.

Clinical governance represents a culture change in the NHS, making managers of health care institutions responsible for clinical standards as well as the financial bottom line. Doctors and managers will need to be educated to play their full part in this new culture.

Administrative Personnel↗
PubMed2000

Information requirements for clinical governance.

Clinical governance requires three main types of information--guidelines, policies and treatment options for clinicians and patients; information about the care given; and information about how the systems work. There are other key issues which impact on the above--legal issues, national standards, sophisticated analytical tools and packages and the requisite training and development of staff.

Evidence-Based Medicine↗
PubMed2006

Clinical Governance: from clinical risk management to continuous quality improvement.

Reducing medical errors has become an international concern. Population-based studies from a number of nations around the world have consistently demonstrated unacceptably high rates of medical injury and preventable deaths. The introduction of effective reporting systems is a cornerstone of safe practice within hospitals and other healthcare organisations. Reporting can help to identify hazards and risks. However, reporting in itself does not improve safety. It is the response to reports that leads to change. Clinical teams must feel empowered to change the way in which they deliver their services, promoting effective clinical risk management. Process analysis, implementation of evidence-based practices, and a clear accountability system are effective tools not only for decreasing error rates, but also for improving effectiveness. Clinical Governance represents the context in which effective clinical risk management should be promoted and continuously improved. It should not be regarded as a separate activity, but should form part of the everyday practice of all healthcare professionals. It requires good multidisciplinary working and a willingness to reflect on and learn from errors to achieve a patient-centred and safer system.

Clinical Medicine↗
PubMed2002

How are primary care groups approaching clinical governance? A review of clinical governance plans from primary care groups in London.

BACKGROUND: The aim of this study was to investigate how primary care groups (PCGs) were implementing clinical governance in their first year. METHODS: A structured review was carried out of clinical governance plans of 57 PCGs in London. RESULTS: There was considerable variation in content of the plans. Priority areas were generally based on national service frameworks and local health improvement plans. The most commonly included clinical topic was coronary heart disease. Plans tended to focus on quality improvement rather than on dealing with poor performance. There was generally little information on how quality would be monitored, the data required and methods to change clinical practice. CONCLUSION: Clinical governance plans provide the main public record of PCGs' attempts to improve quality but there is considerable variation in the content of these reports. Plans should provide reliable and comparable data on progress in implementing quality improvement strategies and dealing with poor performance.

Group Practice↗
PubMed2000

Clinical governance and clinical documentation: still a long way to go?

Maintaining good standards of clinical documentation remains a problem in the health service despite continued and consistent advice from protection organisations and professional bodies over many years. This article discusses some of the issues that arise from poor quality note keeping and the need for improvement and the establishment of basic minimum standards for all health records. Requirements are now being placed on NHS bodies to ensure that effective and robust systems are in place to ensure that record management meets Controls Assurance Standards and CNST standards. This article stresses the need to put the current house in order before we lose any opportunities to influence those aspects of electronic systems where appropriate risk management should help reduce the potential for documentation error.

Documentation↗
PubMed2003

Measuring progress in clinical governance: assessing the reliability and validity of the Clinical Governance Climate Questionnaire.

Despite a lack of conceptual clarity, the importance of cultural change to clinical governance is widely accepted. While generic measures of organizational performance, culture and climate are available, their relationship to clinical governance is unclear. Consequently, there is currently no valid and reliable measure of clinical governance climate. This study aimed to address the deficiency by reducing a pool of clinical governance climate indicators developed via previous qualitative research, describing a latent factor structure and assessing the internal consistency and external validity of the factor model. The resultant instrument, the Clinical Governance Climate Questionnaire (CGCQ), attained high internal consistency and external (discriminant and construct) validity in a study population of healthcare Trust staff. It consists of 60 items distributed across six sub-scales of clinical governance: planned and integrated quality improvement; proactive risk management; absence of unjust blame and punishment; working with colleagues; training and development; and organizational learning. The measure enables those charged with leading the clinical governance agenda in UK healthcare organizations to assess the progress of organizational development initiatives, highlighting areas requiring particular attention. They might also be of interest to those concerned about the negative unintended consequences of performance management.

Adult↗
PubMed2002

Clinical governance--bridging management and clinical approaches to quality in the UK.

Clinical governance has, for the first time, placed the quality of healthcare as a direct responsibility of the Chief Executive and therefore the board of all NHS Trusts (Hospital), community providers and primary care trusts (general practitioners). The foundation for clinical governance was set out in the Department of Health Publication 'A first class service-quality in the new NHS' [Department Of Health, A First Class Service: Quality in the New NHS, London, HMSO, 1998]. Much of this had been precipitated by the Bristol cardiac surgery case and other series of medical disasters in the UK relating to cervical screening, breast screening, psychiatric care and pathological misdiagnoses. This new responsibility of clinical governance involves guaranteeing quality through a number of processes, many of which are currently in use and should be familiar to any clinician or manager. They include clinical effectiveness and optimisation of clinical care, clinical risk management, learning from complaints, professional development, good quality clinical data systems and involvement of patients and carers. This duty is equal to the other statutory responsibilities of NHS organisations, which are of financial probity, accountability and ensuring value for public money on behalf of the taxpayer.

Clinical Competence↗
PubMed2006

Exploring the human resource implications of clinical governance.

In 1998, clinical governance was introduced in the National Health Service, UK (NHS) as a major policy initiative to improve the quality of clinical care. The implementation of clinical governance is crucially dependent on the skills, competencies and willingness of the NHS staff. In turn, clinical governance influences the way people work in health care organisations. Therefore, it is no surprise that the introduction of clinical governance has thrown-up new challenges for human resource management. However, what are these human resource management challenges under the clinical governance framework? The current literature on the subject provides no answer. This article attempts to fill this gap in the literature. A qualitative approach influenced by phenomenological case study approach has been adopted. A heterogeneous group of 33 persons identified through a purposive sampling procedure were interviewed using a semi-structured format. The results indicate that the staff members appreciate the crucial role of human resources management in the implementation of clinical governance. However, there is little evidence to suggest that senior management is paying attention to develop the human resources function around the clinical governance agenda. The seven major human resource implications of clinical governance that emerged from the data analysis are discussed. The author argues that a more proactive HR approach is needed to make clinical governance everyone's business in the NHS organisations.

Evidence-Based Medicine↗
PubMed1999

Clinical governance: bridging the gap between managerial and clinical approaches to quality of care.

Clinical governance has been introduced as a new approach to quality improvement in the UK national health service. This article maps clinical governance against a discussion of the four main approaches to measuring and improving quality of care: quality assessment, quality assurance, clinical audit, and quality improvement (including continuous quality improvement). Quality assessment underpins each approach. Whereas clinical audit has, in general, been professionally led, managers have driven quality improvement initiatives. Quality assurance approaches have been perceived to be externally driven by managers or to involve professional inspection. It is discussed how clinical governance seeks to bridge these approaches. Clinical governance allows clinicians in the UK to lead a comprehensive strategy to improve quality within provider organisations, although with an expectation of greatly increased external accountability. Clinical governance aims to bring together managerial, organisational, and clinical approaches to improving quality of care. If successful, it will define a new type of professionalism for the next century. Failure by the professions to seize the opportunity is likely to result in increasingly detailed external control of clinical activity in the UK, as has occurred in some other countries.

Health Care Reform↗
PubMed2006

Realising the developmental potential of Clinical Governance.

To be effective, Clinical Governance should reach all levels of a healthcare organisation. It requires structures and processes that integrate financial control, service performance, and clinical quality in ways that will engage clinicians and generate service improvements. The Clinical Governance arrangements of many Trusts, however, present several flaws. In particular, the "silos" organisational structure of Clinical Governance is based on generic issues such as risk management, clinical audit, clinical effectiveness and staff development, and it tends to treat clinical work as an undifferentiated aggregate. An alternative model focused on clinical pathways and on a balance between professional autonomy and accountability (responsible autonomy) should be promoted to make Clinical Governance work.

Clinical Medicine↗