clinical governance a framework for high quality care marian balm sir charles gairdner hospital

CLINICAL GOVERNANCECLINICAL GOVERNANCE

A Framework for High Quality A Framework for High Quality CareCare

Marian Balm

Sir Charles Gairdner HospitalSir Charles Gairdner Hospital

HIMMA June 03 Clinical Governance

BackgroundBackground

• Bristol Inquiry

• KEMH - Douglas Inquiry


In AustraliaIn Australia

1995 - 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.


Findings...King Edward and Findings...King Edward and BristolBristol

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


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 Findings...King Edward and Bristol cont...cont...


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 Clincial Governance


CULTURE

COMMUNICATION

ACCOUNTABILITY

SUPPORT

CLINICAL PERFORMANCE & EVALUATION

CLINICAL RISK MANAGEMENT

CONSUMER VALUE

PROFESSIONAL DEVELOPMENT

OPTIMAL PATIENTOUTCOMES

Framework for CG in WAFramework for CG in WA


Guiding PrinciplesGuiding 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


Aim of Clinical Governance Unit at SCGHAim 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


• 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 safetySurrogate measures of health care safety


• 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 The safety message


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 SafetyPatient Safety


• 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 governanceBarriers to good governance


Examine your processes

• Define your key services

• Define indicators of quality

• Define best practice protocols

• Implement an audit process

Your taskYour task


Structured ACCOUNTABILITY

forSafetyQuality

toSelf

PeersCommunity

So what then is CG So what then is CG


• 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 CG is in essence an issue of safety and your role is to ... your role is to ...

clinical governance a framework for high quality care marian balm sir charles gairdner hospital

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