CLINICAL GOVERNANCE A Framework for High Quality Care Marian Balm Sir Charles Gairdner Hospital

HIMMA June 03 Clinical Governance Background Bristol Inquiry KEMH - Douglas Inquiry

HIMMA June 03 Clinical Governance In Australia The Quality in Australian Health Care Study (QAHCS) Wilson RM, Runciman WB, Harrison B et al reported an adverse event rate of 16.6% Re-analysis in keeping with the US study - about 2% of serious adverse events. 1.7% to serious disability and 0.3% to death Overall, about 10% of hospital admissions in Australia are associated with an adverse event.

HIMMA June 03 Clinical Governance Findings...King Edward and Bristol Environment unsupportive of openly disclosing errors and adverse events Failure of management to respond effectively to clinical problems raised by staff Non-existent or ineffective systems to monitor, report and respond to performance problems Non-existent or ineffective systems to identify, report and respond to errors and adverse events

HIMMA June 03 Clinical Governance Poor communication with patients and families, particularly when things went wrong Poor management of complaints and potential medical negligence cases Inadequate training and credentialling to ensure clinicians were sufficiently skilled Inadequate state level morbidity & mortality monitoring & review systems Findings...King Edward and Bristol cont...

HIMMA June 03 Clinical Governance Means: Individuals doing the right thing as part of a safe & high quality system with appropriate accountability to individual patients, management and the community Demonstrated by: Best practice, teamwork, credentialing & supervision, risk management, audit & reporting, open disclosure when things go wrong Clincial Governance

HIMMA June 03 Clinical Governance CULTURE COMMUNICATION ACCOUNTABILITY SUPPORT CLINICAL PERFORMANCE & EVALUATION CLINICAL RISK MANAGEMENT CONSUMER VALUE PROFESSIONAL DEVELOPMENT OPTIMAL PATIENT OUTCOMES Framework for CG in WA

HIMMA June 03 Clinical Governance Guiding Principles Clinician led Needs to be ‘enabled’ Is based on professional accountability Is open to external audit Multi-disciplinary approach Shared Values - ‘no blame’ culture Transportable to Secondary & Rural Setting Needs to be in a form that has ‘sign-off’ by Chief Executive A standard reporting system across the institution

HIMMA June 03 Clinical Governance Aim of Clinical Governance Unit at SCGH To embed in hospital culture a AAAA cycle of quality focusing on: Anticipate (incident monitoring, risk assessment) Analysis (clinical audit, practice review, linked databases) Assess (best practice and benchmarking) Act (improve performance) to achieve: continuous review and improvement in clinical practice

HIMMA June 03 Clinical Governance Unplanned return to operating room within 7 days Unplanned re-admission within 28 days Cardiac arrest and M.E.T calls Unplanned return to E.D. Unplanned use of blood Surrogate measures of health care safety

HIMMA June 03 Clinical Governance Safety is the most important dimension of quality for patients and their families The health system delivers safe care for the majority of patients The challenge is to move from 90% reliability to 100% Everyone can focus on safety The safety message

HIMMA June 03 Clinical Governance Context Highly valued Expected Needs Patient centred values Leadership – identified and nurtured System redesign (use technology better) Improvement tools (guidelines) Measures of improvement (feedback) Patient Safety

HIMMA June 03 Clinical Governance Culture of blame drives problems underground Low investment in system redesign - means outdated, unsafe systems Limited use of information technology - high costs, privacy concerns Safe and effective staffing - health lags behind other industries Lack of useful measurement and feedback for health professionals Barriers to good governance

HIMMA June 03 Clinical Governance Examine your processes Define your key services Define indicators of quality Define best practice protocols Implement an audit process Your task

HIMMA June 03 Clinical Governance Structured ACCOUNTABILITY for Safety Quality to Self Peers Community So what then is CG

HIMMA June 03 Clinical Governance Spot the Hazard Assess the Risk Make the Changes Evaluate the Outcome Spot the Hazard Assess the Risk Make the Changes Evaluate the Outcome Spot the Hazard Assess the Risk Make the Changes Evaluate the Outcome Spot the Hazard Assess the Risk Make the Changes Evaluate the Outcome CG is in essence an issue of safety and your role is to...