Clinical Governance is a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. Clinical governance encompasses quality assurance, quality improvement and risk and incident management.
You will very often get asked about Clinical Governance in your NHS Interview! This Blog aims to outline how to address each pillar in your interview.
The aim is to ensure that the whole screening pathway, including associated follow-up services, is functional and safe.
The national programme defines standards against which data is collected and reported annually. The programme standards provide a defined set of measures that providers have to meet to ensure local programmes are safe and effective
Quality improvement makes local programmes safe, effective, patient-centred, timely, efficient and equitable.
Self-assessment systems should be embedded alongside external review so that continuous improvement becomes an integral part of service delivery.
1) Risk management. Risk management is about minimising risks to patients by:
2) Clinical audit. Clinical audit is a way that doctors, nurses and other healthcare professionals measure the quality of the care they offer. It allows them to compare their performance against a standard to see how they are doing and identify opportunities for improvement. Changes can then be made, followed by further audits to see if these changes have been successful.
3) Education, training and continuing professional development. It is vital that staff caring for patients have the knowledge and skills they need to do a good job. It is for that reason that they are given opportunities to update their skills to keep up with the latest developments as well as learn new skills.
4) Evidence-based care and effectiveness. Care for patients should be based on good quality evidence from research.
The National Institute for Health and Clinical Excellence (NICE) is responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health
5) Patient and carer experience and involvement. If a Trust is to offer the highest quality care it is important that they work in partnership with patients and carers. This includes gaining a better understanding of the priorities and concerns of those who use our services by involving them in our work, including our policy and planning.
6) Staffing and staff management - Staffing and staff management is vital to a Trusts ability to provide high-quality care. A Trust needs to have highly skilled staff, working in an efficient team and in a well supported environment.
Traditionally, clinical governance has been described using 7 key pillars. Although it has been refined over the past few years, this approach remains the easiest to remember and to describe at a trainee interview level. It is also the approach that your interviewers are most likely to expect from you since this is what they would have learnt too. The 7 pillars are as follows:
1) Clinical Effectiveness & Research
Clinical effectiveness means ensuring that everything you do is designed to provide the best outcomes for patients i.e. that you do "the right thing to the right person at the right time in the right place”.
In practice, it means:
The aim of the audit process is to ensure that clinical practice is continuously monitored and that deficiencies in relation to set standards of care are remedied.
3) Risk Management
Risk Management involves having robust systems in place to understand, monitor and minimise the risks to patients and staff and to learn from mistakes. When things go wrong in the delivery of care, doctors and other clinical staff should feel safe admitting it and be able to learn and share what they have learnt. This includes:
4) Education and Training
This entails providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date. Professional development needs to continue through lifelong learning.
In practice, for doctors, this involves:
5) Patient and Public Involvement (PPI)
PPI is about ensuring that the services provided suit patients, that patient and public feedback is used to improve services into day-to-day practice to ensure an increased level of quality and suitability, and that patients and the public are involved in the development of services and the monitoring of treatment outcomes.
This is being implemented through a number of initiatives and organisations, including:
6) Using Information and IT
This aspect of clinical governance is about ensuring that:
7) Staffing and Staff Management
This relates to need for: