Clinical governance is defined by the Australian Council on Healthcare Standards
as "The system by which the governing body, managers, clinicians and staff share
responsibility and accountability for the quality of care, continuously improving,
minimising risks and fostering an environment of excellence in care for consumers".
The Victorian Clinical Governance Policy Framework defines four domains to support
safe and quality care. These are consumer participation, clinical effectiveness,
effective workforce and risk management.
This domain is concerned with ensuring that your patients are empowered to participate
in their care. This includes:
- Clear and open communication between your practice team and patients
- The services you provide respond to the needs of your patients
- Consumers are able to provide feedback on services you provide
Consumer participation
This domain is concerned with ensuring that your patients are empowered to participate
in their care. This includes:
- clear and open communication between your practice team and patients
- the services you provide respond to the needs of your patients
- consumers are able to provide feedback on services you provide.
Clinical effectiveness
This domain is designed to ensure that the right care is provided to the right patient
by the right clinician with the right skills and in the right way, whilst involving
the patient at all times. Strategies include:
- consumers are actively involved in their treatment
- clinical care is based on evidence
- performance of clinical processes and outcomes are measured
- quality improvement activities are carried out at least annually.
Effective workforce
Ensuring that the staff you employ have the appropriate skills and knowledge to
perform their duties and fulfil their roles within your practice is paramount. Processes
should be in place to support recruitment, training credentialing and maintenance
of clinical standards. Strategies include:
- the health workforce has appropriate qualifications
- quality and continuous development activities are planned and scheduled
- expectations for clinical standards are clearly identified and communicated to all
staff.
Risk management
Clinical risk management is part of the broader enterprise risk management system
that includes strategic, financial and operational risk management. The key aspects
of clinical risk management include:
- investigation and root cause analysis of incidents
- development of a culture that supports open communication of, and a system of learning
from incidents
- implementation of a system to manage complaints or concerns of a clinical nature
in the practice
Other states have slightly different guidelines on clinical governance (see links),
however all are designed to encourage accountability in clinical standards and patient
safety.
It is important to provide a framework for a clinical risk management approach to
improving safety and quality in health care that places special emphasis upon identifying
circumstances that put patients at risk of harm and then acts to prevent or control
those risks.
Clinical risk management has a dual aim - to improve the quality of care for patients
and to reduce the cost of business risk for health care providers. These are complementary
processes to the activities that ensure the quality of health care provision.
A well-defined process should be available within the practice to identify, analyse,
evaluate, manage, monitor and review risks. This will include key policies, guidelines
and practices to ensure optimal outcomes for patients and staff.
Improving your practice
Key components of the clinical risk management process should include a data collection
system, integration of data, clinical risk reviews and regular meetings.
The development of a data collection system
The first step in any risk management process is risk identification. The practice
should regularly review adverse events or near misses using a system such as an
adverse event form or other process of reporting.
The objective should be to streamline the reporting processes in order to generate
meaningful information from which trends can be identified.
Integration of data
The collection and integration of data is pivotal to the development of risk management
programs. It is important to share the data gathered on trends and patient care
with selected personnel in the practice.
The practice should ensure that mechanisms are established to ensure the regular
review of data from the areas of incident reporting (e.g. patient complaints, quality
activities and safety audits). This review should occur every six months as a minimum.
Clinical risk reviews
The practice should identify principal areas of high risk. The aim of the process
should be to identify clinical risks within the practice by using a range of data
sources to ascertain what adverse events are happening or could potentially occur.
The practice should then develop a risk register and action plan to ensure that
risks identified are managed. The risk register should be based on those described
in AS NZS ISO 31000:2009 (Risk Management standard).
Quality improvement, risk and safety committee
At least every six months, the integrated risk and quality data should be reviewed
by your practice's management committee or team. Actions taken as a result should
be reviewed. In addition, a review of the risk register and action plan should take
place annually.
The following information should be reviewed as a minimum:
- all incidents
- all complaints
- clinical issues or actions of concern to any staff.