Marcus Stephen Hospital Keningau 16 March 2016 SANDAKAN CLINICAL GOVERNANCE Marcus Stephen Hospital Keningau 16 March 2016 SANDAKAN

Learning Outcome Staff will be able to:- Explore Idea of Quality in Health Care Examine the Model of Clinical Governance Recognize own responsibilities with regards to Clinical Governance. Briefly explore concept of a Learning Organization

Definition “A system 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 clinical excellence will flourish.” Sir Liam Donaldson, CMO 2002

Other Definition Clinical Governance is about quality and how it can be achieved and guaranteed through our service to our patients. It is an umbrella team for everything that helps to maintain and improve high standards of patient care

Clinical Governance is about…. ………Everyone knowing what is supposed to happen, and then making sure it does

CLINICAL GOVERNANCE Suggest to be answerable for your clinical action and performance Responsibility for learning and Improving quality at every level Reduce harm and improves patient safety Reduce variations of clinical outcome Evidence of the best practice Promotes transparency and openness Bridge the gap Promotes and encourages good practice Minimizes and mitigates the healthcare and clinical risks Is a way of learning and sharing Improves quality of care

Clinical Governance Framework Accountability Clinical Governance Risk Management Clinical Audit Clinical Effectiveness Complaint & Complement Service User & Staff Experience Compliance & Standard Stakeholder Involvement Learning & Sharing Improving Quality of Care System & Process Excellent Outcome CPD Transparency

“Whoa! Watch where that think lands, we’ll probably need it.’

Framework for Integrated Quality, safety and Risk Management Assurance 6 4 Policies Capacity & Capability 3 Monitoring & Review 5 Communication 1 Accountability 2 Patient / Services Users

Six Core Processes and Programmes (Donabedian’s Process”) Clinical Effectiveness and audit. QA or HAS studies and evidence-base practice Patient Centred – Multi- professional working and collaboration. Involvement of patients / service users and the public / community Risk management and patient safety The risk management process according to ISO 31000 Risk management Principles and guidelines on implementation Knowing high priority risk Patient Safety Occupational safety, health and welfare Environmental and fire Safety Incidents and complaints reporting/recording, analysis and learning Staffing and Staff Management Service Improvement Learning and sharing Information

Placing Quality At The Heart of NHS Without it, there is unfairness. Every patient wants to know that they can rely on receiving high-quality care when they need it. Every part of the NHS & everyone who works in it should take responsibility for working to improve quality

Duty of Quality Legal Obligation Clear lines of responsibility & accountability for quality of clinical care Chief Executives are accountable Clinical Governance Board / Committee (Reports to Trusts Main Board) Annual Report Must Be Produced All staff are responsible for the quality of care they deliver

Culture For Clinical Governance To Flourish No-blame Questioning Learning Culture Excellent Leadership An ethos where staff are valued & supported as they form partnership with patients

Other Culture Qualities Celebrate success as well as learning from what is done badly Overcoming tribalism by improving understanding of the roles of all professions Develop effective team working Communication with all stakeholders Commitment to sharing of information Outward looking approach

The Foundation Stones Patient – Professional Partnership Clinical Effectiveness Risk Management Effectiveness Effectiveness Patient Communication Effectiveness Resource Strategic Learning System Awareness Teamwork Communication Ownership Leadership Patient – Professional Partnership

System Awareness A set of interdependent elements interacting to achieve a common aim. These elements may be both human and non-human System awareness looks at the whole process as well as the parts, of healthcare delivery, and the relationship between them It is about looking outside of your own sphere of influence or team / department

Teamwork “Without teamwork, the potential of clinical governance is not achievable. Cooperation across and between organizations, between the NHS and the public it services is fundamental to building better structures and safer, high quality care.” “If teamwork is performed successfully teams can reap benefits for them selves, patents and patients’ families. However, if done badly, the organization will struggle to meet its objectives, quality of care and the service being delivered will diminish, self morale and satisfaction will be lowered and patients will have on unsatisfactory and possibly negative experience of care.”

Communication Being greeted warmly Being respected Being listened to Clear Explanations Reassurance Having confidence in the ability of staff Being able to express fear & concern Being respected Being given enough time Having personal circumstances considered when advice or treatment is offered Being treated as a person & not as a disease

Ownership Clinical Governance as a whole. Doctors of their chore, responsibilities and working areas AMO of their duties and working areas Nurses of their working areas. AHP of their tasks and working areas Patients of their care & treatment Local community of their health services

Leadership Leadership is critical to the quality of care, treatment and outcomes to staff morale and to the learning climate and opportunities available to all level of staffs Traditionally, position of the top of the hierarchical structure. Modern approach, recognizes effective leadership at all levels

Clinical Effectiveness “Applying the best available knowledge, derived from research, clinical expertise and patient preferences, to achieve optimum processes and outcomes of care for patients.”

Clinical Effectiveness Finding and assessing evidence Implementing the evidence Monitoring and evaluating the impact, readjusting practice as necessary, usually through clinical audit and patient feedback

Risk Management Effectiveness

Risk Management Effectiveness “The identification, evaluation and control of potential adverse outcomes that threaten the delivery of appropriate care to patients.” Clear risk Management policies in place Incident reporting and acting upon

Adverse Events Adverse event is defined as “An event or omission arising during clinical care and causing physical or psychological injury to the patient.” Occur in around 10 % admissions or at a rate of an estimated 850,000 adverse event a year Cost approx. £2billion a year in additional hospital stays alone 400 people die or are seriously injured in adverse events involving medical services every year

Near-misses Near-miss can be defined as “a situation where probability have become an incident.”

Patient Experience National Patient Survey Interview Patient Diaries Patient Groups / Patient Forums Patient Tracing Consultation with voluntary Groups

Learning from & Dealing with Complaints Provide an opportunity for AMO /Nurses to see themselves and their service as others see them and to identify the issues, which concern users. Reality a past mistake and enable services to be put right for the future. Well handled it can increase a patients trust in the service. Identify adverse event and near misses which otherwise might have gone undetected

AMO Roles Take complaint seriously Local resolution Good communication Fully involve patients / care in decisions

Communication Effectiveness Staff to Patient Written Verbal In just about every complaint there will have been and breakdown in communication Staff to the organization as a whole

Resource Effectiveness How are resources used , and for what benefits? Is there waste in time, I best use being made at all available resources money, equipment?

Strategic Effectiveness Make sure that Clinical Governance is written into all organizational planning That the direction on the organization is to continually deliver a quality service that is continuously looking to improve.

Learning Effectiveness Making sure that the lessons really are being learnt and acted upon, from:- Complaints Adverse Incidents Research Patient & Staff feedback Becoming a Learning Organization

Learning Organization Where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free and where people are continually learning how to learn together.

Key Features Of A Learning Organization Open System Thinking Improving Individual Capabilities Team Learning Updating Mental Models Sharing A Cohesive Vision

What is Clinical Governance? It’s about quality. How I can ensure and constantly improve the quality of care I deliver, through on going training, following policies and procedures, through teamwork and communication, complaints management, leadership and improving and listening to the patients experience. Achieving Excellence in Clinical Governance

THANK Q