Clinical Governance
Clinical Governance
Safety and quality in the delivery of health services is underpinned by an effective system of clinical governance at all levels of the health system. The Australian Council on Healthcare Standards defines clinical governance as:
"..the system by which the governing body, managers, clinicians and staff share responsibility and accountability for the quality of care, continuously improving, minimising risks, and fostering an environment of excellence in care for consumers .."
The Victorian Government has recently released a policy framework for clinical governance that provides the structure for this plan. This framework has the consumer experience as a central part of the approach, reflecting the significance of the consumer in the identification of and solution to many safety and quality issues.
The framework principles provide a basis for supporting excellence and good governance of clinical care. These are:
- The focus is on the consumer experience throughout the continuum of care
- Priorities and strategic direction are communicated clearly to support quality and safety systems
- Planning and resource allocation supports achievement of goals
- Strong clinical leadership and ownership
- Organizational culture supports patient safety and quality improvement initiatives and is supported through committee structures, systems and processes
- Compliance with legislative and departmental policy requirements, including hospital accreditation
- Rigorous measurement of performance and progress, including reporting and review
- Continuous improvement of quality and safety
- Clearly defined roles and responsibilities are understood by all participants in the system
Domains of Quality and Safety
As per the Victorian clinical governance policy framework, there are 4 domains supporting safe and quality care
1. Consumer Participation
Consumer participation needs to occur at many levels of the organization, through activities such as community consultation and partnership on governance and management committees, and within improvement initiatives or clinical risk management activities. Consumer participation should be sought in planning, policy development, health service management, clinical research, training programs and guideline development. Consumer feedback should be used to inform improvement and consumer input used to assist development of information and resources for patients and families. At RCH our commitment to consumer participation is a significant component of our key strategic goal of achieving Patient and Family Centred care.
2. Clinical Effectiveness
Clinical effectiveness refers to ensuring the right care is delivered to the right patient who is informed and involved in their care at the right time by the right clinicians with the right skills in the right way. Strategies such as clinician empowerment, active involvement of consumers in their care, fostering clinical innovation, streamlining clinical processes, evidence based care, measurement of clinical care processes (particularly clinical outcomes), peer review, clinical audit and other performance measures, external review of quality improvement activities and safe introduction of new procedures and therapies are key components of this domain.
3. Effective Workforce
All staff within the health service must have the appropriate skills and knowledge required to fulfill their role and responsibilities. Support is required to ensure that clinicians and managers have the skills, knowledge and training to perform the tasks that are required of them and that they understand the concept of governance. Processes need to be in place to support the appropriate recruitment, retention, credentialing and annual review of practice, and maintenance of professional standards. Workforce development and maintenance of competence are key components of this.
4. Risk Management
Clinical risk management is part of a broader organisational risk management system which integrates the management of organisational, financial, occupational health and safety, plant and equipment and patient safety risk
Minimising clinical risk and improving safety of care requires a systems approach. This is achieved by developing a system level response to issues that sustain an environment that allows adverse events to occur. Clinical risk management and improvement strategies are integrated within improvement and performance monitoring functions.
Clinical Governance at RCH
The governance and reporting structure at RCH is described in the document Clinical Governance Structure which is found in the Risk Management procedure. The peak clinical governance body is the Board Quality Committee. This is underpinned by the RCH Clinical Quality and Safety Committee.
Divisional Quality Committees
The Executive has endorsed the establishment of divisional quality committees (DQCs) across all clinical divisions to commence in February 2010, supporting the new divisional structure for quality. The purpose of these committees is to strengthen clinical governance at RCH and provide staff at a divisional level with the support and structure within which to fulfil their clinical governance responsibilities. Minimum standard Terms of Reference have been endorsed by the Executive and RCH Quality Committees.
The membership of these committees will be based on nature of the clinical areas subsumed by the Division, and will be chaired by a member of the Divisional leadership, and supported by the Divisional Quality Manager. It will be important that the committee is informed of quality and safety issues relating to the Division, and that the outcomes of these meetings are communicated comprehensively to all departments within the division. The RCH Quality Committee with continue to have oversight of clinical governance across the organisation.
