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  • Clinical governance

    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
     
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    Figure: Victorian clinical governance policy framework

    Source: http://www.health.vic.gov.au/clinrisk/publications/clinical_gov_policy.htm  

     

    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.