Introduction
The concept of clinical governance and quality care was introduced by the National Health Service (NHS) in the year 1997 by the Health Department. NHS provides a framework that makes NHS organizations continuously accountable for providing proper health care services that is quality health care services. Through the recommendation and control of NHS, various organizations under NHS try to provide excellent health care services and ensure healthcare services by maintaining the safety norms and protocols.
The NHS organizations are accountable to provide good quality health care services (Johansen et al. 2017). The concept of clinical governance is supported by seven pillars such as the effectiveness of risk management, effectiveness of communication, patient experience, clinical effectiveness, learning effectiveness, patient experience, resource effectiveness, and strategic effectiveness. These seven pillars are based on five foundations o teamwork, system awareness, leadership, communication, and ownership. The concept of clinical governance was first introduced in the United Kingdom. The waves of clinical quality revolved all around the globe.
Political and Social Context
LO1: Appraisal of models and policies of improvement practice and clinical governance
Various models and policies o the improvement of clinical governance are the Australian models, NH model. POCK, and OPTIGOV. According to Levett-Jones et al. (2017), the seven areas of focus of clinical governance include the use of information, risk management, clinical effectiveness, service user anticipation, personal and professional development and training, clinical audit, and personnel management. One of the fundamental components of clinical governance is the use of information. Hence, clinical governance requires proper and detailed information for investigation about the performance and the quality of health care services. Management of information is very much linked with the concept of clinical governance. Management of information is like a cycle and follow the following processes such as:
Step 1: Conceptualization
Step 2: Data collection
Step 3: Database designing
Step 4: Transfer of processed data for revision
Step5: Analyzing and processing data
Step 6: Presenting and reporting of results
Step 7: Use of information.
The models on clinical governance are based on three precepts:
- Effective methods of performance changing will bring improvement in quality and accountability. In the absence of these, primary care individuals and groups can’t improve quality and accountability. However, in recent times there is the effectiveness of changing performance and such changing performance helps in guiding arrangements to keep up with the standards of clinical governance (Tajabadi et 2017)
- Clinical governance is mainly involved in both accountability and improvement in quality. Both these parameters need to be improved for receiving quality health care facilities as well as a professional performance.
- Primary are groups are organizations. For making primary care groups effective there is a need that governance complies with the needs of individuals, teams, and organizations. Governance helps in drawing an experience of the systems of quality management of various other organizations under NHS.
The models or practices of clinical governance refers to the activities that are undertaken to define, account for, and improve the quality of clinical governance program at three levels such as in the primary care group, a team of primary healthcare, and the health professional. For improving quality and for accounting for the quality of the primary care group proper steps should be taken. There are various definitions of quality, however; they are too elaborate to be applied practically.
There are a few features of quality that are articulated. These features include the duties of the doctor as set by the General Medical Council, the professional code of conduct of the nurses, midwives, health visitors, the general terms and conditions of the practitioners, and the clauses of the summative assessmen (Gurdogan and Alpar, 2016)t. For ensuring proper quality they should ensure effective care of several of various patient care groups and between patients of various groups. Two factors are important such as quality is a part of improvement and is not an endpoint.
The second factor is the user or the patient and the question lies is that whether a user or a patient is given a predominant role for judging and defining quality. There is no balance between these two factors as both have different perceptions of quality. The primary care group thinks that quality is not a static goal but it is a sequential and continuing improvement. It involves patients defining the quality from a lay perspective.
The quality needs to be defining first by the group and then the group will b accountable for giving healthcare facilities to the primary care group. A recent case in Bristol has proved that transparent and improved accountability is irrefutable. It has been mentioned that corrective actions need to be taken when there will be any kind of unaccepted level of performance. All the groups should establish accountability systems ensuring that any kind of poor performance would be reported and corrective measures would be taken.
The arrangements should be made in such a way that the individual health staff should be made accountable for their performance. Not only that primary care groups and teams are also accountable for improvement as well as their performance. Moreover, primary care groups are accountable and should introduce systems that would account for quality improvements and reporting on various matters.
For ensuring the quality of clinical care clinical audit is the principal tool and that should be used with a variety of methods for getting the maximum level of satisfaction and quality of work. McSherry and Snowden (2019), stated that various methods should be used for identifying obstacles. If the deficiency is detected by clinical audit in their performance then there should be an analysis of the underlying reasons for finding out the most corrective measure that could be taken for the restructuring of healthcare teams, reminder systems, consultation skills, and targeted education. For making clinical governance effective the responsible person should be able to apply all the interventions as and when required.
LO2: Differentiating between clinical effectiveness, quality assurance, and evidence-based practices
There is a difference in evidence-based practices, research, and clinical effectiveness. In recent times health care institutions are becoming complex and they focus on the experience of patients. The doctors and nurses are participating and leading to quality improvement, evidence-based practices, and research studies to improve the outcome of the patient. There are subtle differences in research, evidence-based practices and clinical effectiveness and many times overlap each other. Hence, it makes a challenge on the part of nurses to identification the best option for investigation of any kind of clinical problem.
Quality improvement does not require any literature reviews and is usually specific to one facility. The main motto of quality improvement projects is to know about the proper workflow processes, reduction of variations in care, improving efficiencies, addressing educational problems, and clinical administrations. Evidence-based practices integrate the best research evidence with patient values and clinical expertise for the improvement of outcomes. The process entails finding the best evidence for answering it, asking various clinical questions, application of evidence into practice, evaluating evidence-based on clinical outcomes (Porter-O’Grady, 2019).
Research involves finding the gap in the literature review for generating new knowledge and for validating the existing knowledge for answering specific research questions. The approval of human subjects is necessary for conducting a research study. Nurses at every level of care are involved in the task of answering the questions asked and it focuses on basically clinical questions to improve the outcomes of patients. Hence there is a need for becoming familiar with the differences and similarities between evidence-based practices, quality improvement, and research (Stellenberg, 2018).
Research involves a systematic investigation of research evaluation, development, and testing. That is designed to contribute and develop generalized knowledge. The impact of this practice is that it generates new knowledge for doing practice and adds to professional knowledge based on the literature. Evidence-based practices refer to the integration of individual expertise with the best clinical evidence that forms systematic research. It involves systematically utilizing, finding, and appraising for providing the best clinical practice. Evidence-based practice involves a lifelong approach to clinical practice integrating systematic appraisal, systematic search, and clinical expertise, patient values and preferences, and synthesis of various relevant research questions. The impact of evidence-based practice is to translate the knowledge to improve practice. Quality improvement refers to the unceasing and combined efforts of everyone from educators, healthcare professional, their families, planners, payers and researchers, and educators that make changes leading to better outcomes among patients, better development o profession, and better performance of the system. The impact of quality improvement is to improve patient processes, care, and outcomes in specific health settings (Breathnach and Lane, 2017).
Evidence-based practices involve the following seven steps:
Step 1: Cultivating the spirit of inquiry
Step 2: Asking the clinical question
Step 3: Collection of best and relevant advice
Step 4: Appraising the evidence
Step 5: Integrating evidence with patient preference, values, and clinical expertise for making practice changes and decisions.
Step 6: Evaluation of practice change and decision
Step 7: Dissemination of evidence-based practice results
The most important level of evidence comes from the systematic review, established clinical evidence, meta-analysis, and a systematic review
Hence there is a need for every practice that is clinical effectiveness, evidence-based practice, and quality improvement. Another level of evidence is also from randomized controlled trials (RCTs), various other types of qualitative and quantitative studies, and expert analyses and opinion.
Final steps in the evidence-based process include the integration of evidence from providing clinical expertise and keeping track of the patient preferences, evaluation of the effectiveness in the application of evidence. Reporting or disseminating the results may help in applying the best evidence. There are certain examples of potential evidence-based practices that provide a guideline for preventing or reduction of CAUTIs and helps in evaluating performance and quality improvement.
Clinical Governance components
LO3: Examination of various approaches for determination of the quality of health care facilities and advising on ways for improving the practice
The ways of improving clinical governance encompass around a few strategies, multilevel strategies should be implemented combining research, audit, education, and various other things. clinical governance is mainly an NHS quality improvement program and its operation in primary care groups remains unclear. Many activities are coming in the concept of clinical governance and are undertaken however all the activities need to be coordinated. The model of clinical governance addresses the main task of improving quality, accounting for, defining, and incorporating various shreds of evidence that are effective in changing the methods of performance. The model improves the performance of primary care groups, professionals, and practice. It also reveals how various groups develop and introduce clinical governance and the duty of the Commission for Health Improvement and Health authorities to monitor progress.
The primary care groups are responsible for the improvement of the health of their community by providing community and primary health services and providing high-quality secondary care services. Clinical governance is a local system for accountability and quality improvement. There will be an appointed lead clinician who will be responsible for clinical governance and that person will be a leader in the practice of clinical governance.
Moreover, all health professionals are expected to take part in the improvement process of clinical governance. The main components of clinical governance include taking care of poor or bad [performance, professional development, drawing a clear line of accountability for quality care in clinical governance programs. There are several components of clinical governance programs in primary care groups and other related sectors.
One most important approach of clinical governance is linking up the activities of clinical management into a unified management committee or structure having representatives from each of the activities. There is a need for a more integrated approach to clinical governance that would bring together various activities or components of clinical governance together for meeting the joint objectives of primary care groups involved in the process and their patients and local health authorities. It determines the relationship between various activities and uses the most appropriate activity.
The main task is to bring all the activities of clinical governance in such a manner such as the impact of the whole is less than the impact of the sum of the parts of the activities (Khraisat et al. 2020)
Clinical governance serves as the main framework for supporting the delivery of quality service of primary care groups. Some several national mechanisms and structures help in developing and reinforcing clinical governance. For a set of quality standards, there is a need for frameworks on national service.
The national institute of clinical excellence serves as a key component for developing new technology to improve clinical governance programs and provide treatment against several ailments. The National Institute of Clinical Governance provides proper guidance for the appropriate use of medicines, treatment, procedures, and interventions for the development of proper clinical guidelines in the management of several types of disease and their treatment.
The National Institute of Clinical Governance conducts audits for proper implementation of clinical governance programs in various primary health care centers. Mohalli, Wagharseyedin and Mahmmodirad, (2017) stated that these approaches of clinical governance help in the proper application of clinical governance programs in primary health care groups, big hospitals, and several other local health care centers. These approaches should be coordinated properly along with the various components of clinical governance for getting proper service on the clinical governance program.
The medical staff is well trained for providing patients with proper care, assistant, and treatment of various diseases. There should be proper coordination amount all the components of clinical governance and all the medical staff to bring about a change and massive improvement in the clinical governance program. However, a committee or team is constructed for monitoring the activities and the protocol of the clinical governance program and also to look after the execution o clinical governance in primary care groups and various other health centers.
The key components or elements of a clinical governance program are the local duty of quality, learning mechanism, underlying strategies, standards, scrutiny, patient empowerment, the local duty of control, and quality. There are sufficient policies in clinical governance programs to deal with the poor performance of practitioners.
These practitioners need to learn about the adverse errors and events that have added to the structure of the clinical governance program. The NHS plan has improved in several ways where there is the participation of both citizens as well as patients influencing the quality of health care services. Liaison service and patient advocacy is established ad there are several patient teams available for patient families and other health care professionals. The NHS planning committee plans to improve the information of patients, their participation, and consent.
The NHS planning committee conducts patient forums and lays contribution through the activities of the trust boards to work on the National Institute of Clinical Excellence. There are other trust boards, committees, and groups such as various regulatory professional bodies, Commission of Health improvement that works o modernization of NHS and to bring about improvement and to built-in better practices among the medical staff and the practitioners.
The clinical governance program is being updated and improved continuously to bring about new changes and incorporating newer ideas for proper planning, execution, and implementation of planning activities.
The updated charter on NHS will formalize various commitments on the same. In the clinical governance program there should be proper planning for quality, effective leadership, truly being patient-centered, proper insight, information, and analysis, good designing of service, extraordinary activities is done by ordinary people, demonstration of success (White and Evans, 2019).
Hence, various approaches and improvement measures are taken by the NHS for the proper implementation of clinical governance programs at every level of medical care services. Moreover, the ability to measurement health care and quality services is essential for the proper implementation of a culture that supports clinical governance. The measurement of effectiveness includes turnaround time and waiting time, reduction of waste, reduction in repeat tests, the effectiveness of strategies for innovation, the time needed for the introduction of new services.
LO4: Analyzing the importance of the team in the delivery of person-centered quality care
Person-centered care refers to one of those 13 fundamental standard cares according to Cae Quality Commission that is required to be met by the health care providers. The delivery of person-centered care involves the delivery of care to patients beyond the tailoring and their condition of the service that suits the individual needs and wants of individual patients under the umbrella of healthcare services.
It involves respecting the patients that they have their priorities, values, and views on monitoring what is best for them. Enabling person-centered care requires knowing the patients well and should be involved actively in providing care-related problems and providing solutions and decisions. Everybody wants to make their input when decisions are made about them otherwise they feel like a task or object if their inputs are not taken rather than human beings with feelings and thoughts (Cleary and Duke 2019).
The main principles of patient care services are that patients should be treated with respect, compassion, and dignity, they should be provided coordinated treatment, care, and support, they should be offered personalized treatment, care, and support. The service users should be able to develop and recognize the abilities and strengths that enable them to lead fulfilling and independent life. There is a role of teamwork in providing patient care services.
A team refers to a set of people that interacts adaptively, dynamically, and interdependently for reaching a valued and common goal, mission, and objective. Snowden (2017) opined that the team is assigned with specific functions and roles for performing a limited lifespan of membership. It enables providing healthcare services to various communities, individuals, and families. It requires two caregivers and health providers that work collaboratively with the caregivers and the patient. Moreover, it requires the need to provide coordinated high health care services.
It involves the sharing of responsibilities among various team members for offering benefits. Moreover, sharing responsibility without high-quality work can be risky to patients (Mosadeghrad and Ghorbani, 2017). The main reason for patients taking legal action against health providers is the lack of communication between caregivers, patients, and health care providers. Lack of communication also leads to near misses, medical errors, and adverse and unwanted impact among the team members. Moreover, if there is a lack of team case then it can lead to unnecessary wastage. It requires the identification of good practices that could help in avoiding dangers and help in controlling the costs (Bishop, 2017).
In an effective team, the team members have good communication with one another. They also need to merge their expertise, decision-making responsibilities, and observations to provide patients with high-quality health care. A team member needs to understand the dynamics of the team and its functioning as it helps in understanding the culture of a workplace and helps in reducing costs.
There is a role of an effective team in providing proper and high-quality health care services. Now a day’s patients are looked at by several health professionals. In the complexity of the health system, there is a need for effective teamwork for ensuring the safety of patients and to minimize the adverse impact caused by miscommunication with the caregivers of the patients. Effective teamwork helps in the reduction of misunderstandings about the responsibilities and the roles of team members.
Patients are only concerned about their health care and they are also a part of the communication process, it requires the involvement of the patients in the communication process for minimizing errors and for reducing the potential impact of adverse events. In the early days, a doctor or nurse staying in a locality used to be approached quite easily for any kind of medical or health assistance (Shin, 2017). However, health care practices have changed a lot in recent times and at a very rapid pace in the last 20 years. It is now not desirable to put patients in isolation or under one doctor. Patients are now dealt with by a team of doctors. Due to the rise in complexity of the health care services that is evolving rapidly and is acting as a driving force for the transition of health care practitioners to team members rather than soloists sharing a common aim.
Doctors also nowadays’ work in a team to discuss the problems of the patients and are not taking a decision solely. Any decision regarding the patient is taken by a team of doctors and also with the consent of the patient and the caregivers of the patient. Such a change in the practice has brought due to the growing complexities of the health care professionals and the way doctors are misjudged by patients (Garattini and Padula, 2017).
In recent times both patients and clinicians try to integrate new technologies into their process of management. The rapidity of change in health care services will continue and it will lead to a better and more professional approach to providing health care services. One practitioner is not allowed to absorb, handle, and use every information and hence requires specific knowledge in certain specialized areas for high care by various team members.
Every clinician relies and depends on the action and information of other team members. There requires a team of health professionals for dealing with patients. There is a need to strive for perfection in the science and practice of interprofessional health care services. Every clinician is dependent on the action and information of other clinicians. There is a need for purposeful cultivation and explicit acknowledgment, and systematic error inefficiencies otherwise problems cannot be prevented or addressed (Northrop, 2019.).
There are various types of teams identified in systems of health care such as core teams, ancillary teams, contingency teams, coordinating teams, and support administration and services. Each team should be effective to face challenges and generally passes through various phases such as:
Step 1: Forming – this step is characterized by confusion and ambiguity. The team members are not very clear about the tasks that need to be performed at this stage. The team members’ are not working together and are communicating in an impersonal and superficial manner.
Step 2: Storming – this stage is difficult and there can be a conflict among the team members and there is a rebellion against the task assigned. Team members may get frustrated when there is not enough progress in the tasks.
Step 3: Norming – in this stage there is open communication between team members and the team members try to confront the task handled by them. Accepted communication and procedures are established (Macfarlane, 2019).
Step 4: Performing – The focus of the team is to achieve goals. The members of the team have now come close and are supportive, trusting, effective, resourceful, and open.
Conclusion
When the first investigation on clinical governance was conducted it showed that organizations are very poorly led. It was later discovered factions and cliques among the management and staff. The management and the staff were ineffective and very not concerned about the standards and the quality of health care services offered were very poor and hence the staff was concerned about the ineffectiveness, worse and marginalized health care services provided to them.
Various dysfunctional organizations were involved with poor quality health care services and the standards of quality were worse or marginalized and proper services were not undertaken. The NHS was late to understand the fact that healthy organizations are crucial for the patient. The main challenge of the clinical governance program was that it transformed the service delivery and culture of various NHS organizations all through the United Kingdom. The revolution for proper implementation and execution of clinical governance began and hence all inefficient medical staff and practitioners should be careful about their move because each of their activities is monitored.
Moreover, there is a need for proper planning before execution of any task regarding the level of health care facilities that will be provided to the patients, the cost of treatment, the procedure of treatment, and the availability of various other services.
References
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