Clinical Governance - a Definition Clinical Governance - a - - PDF document

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Anil Kumar Mulpur M.B.B.S, M.S, M.Ch, F.R.C.S (Edinburgh), F.R.C.S (Glasgow) F.R.C.S Cardiothoracic (Edinburgh), FETCS

“A framework through which NHS “A framework through which NHS

• rganisations are accountable for
• rganisations are accountable for

continually improving the quality continually improving the quality f th i i d f di f th i i d f di

Clinical Governance - a Definition Clinical Governance - a Definition

• f their services and safeguarding
• f their services and safeguarding

high standards of care by creating high standards of care by creating an environment in which excellence an environment in which excellence in clinical care will flourish” in clinical care will flourish”

Donaldson and Scally Donaldson and Scally

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DOCTORS PATIENTS

MANAGEMENT /ADMINISTRATION DOCTORS AND PATIENTS DOCTORS PATIENTS

MEDIA NATIONAL / INTERNATIONAL COMPARISON

COST QUALITY

QUALITY

INFRASTRUCTURE QUALITY PROFESSIONAL QUALITY MEDICAL PROFESSIONAL QUALITY NURSING PROFESSIONAL QUALITY ADMINISTRATION PROFESSIONAL QUALITY

• I AM PAYING TAX / I AM TOO POOR
• SPEND LEAST MONEY /

GET THE BEST POSSIBLE CARE NO HEALTH CARE WITHOUT MONEY

• NO HEALTH CARE WITHOUT MONEY
• SOMEBODY ELSE TO SPEND
• VOLUNTARY HEALTH ORGANIZATION
• GOVERNMENT
• INSURANCE
• EMPLOYER
• CANNOT WAIT TO BE SEEN
• NO DELAY IN OUT PATIENT DEPARTMENT
• DOCTORS / NURSES TO BE COURTEOUS

DOCTORS / NURSES TO BE COURTEOUS

• NO DELAY IN INVESTIGATION
• NO DELAY IN INTERVENTION
• SHORT / SWEET STAY

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• GOOD FOOD / GOOD TOILETS

/ GOOD ENTERTAINMENT

• NO COMPLICATIONS
• PATIENT FORUM / ATTENDERS FORUM

PARENTS FORUM / EXPRESS UNHAPPINESS

• MEDIA WANT MASALA !!!

“A framework through which NHS “A framework through which NHS

• rganisations are accountable for
• rganisations are accountable for

continually improving the quality continually improving the quality f th i i d f di f th i i d f di

Clinical Governance - a Definition Clinical Governance - a Definition

• f their services and safeguarding
• f their services and safeguarding

high standards of care by creating high standards of care by creating an environment in which excellence an environment in which excellence in clinical care will flourish” in clinical care will flourish”

Donaldson and Scally Donaldson and Scally

“CREATING AN ENVIRONMENT IN WHICH EXCELLENCE IN CLINICAL CARE WILL FLOURISH”

CLINICIANS ADMINISTRATION OR OR MANAGEMENT INTER RELATIONSHIP

“NO HOSPITAL / DEPARTMENT CAN “EXCEL” WITHOUT A HEALTHY INTERACTION

CLINICIANS ADMINISTRATION INTERACTION

POSITIVE ATTITUDE NEGATIVE ATTITUDE

• HEALTHY
• PRODUCTIVE
• MUTUAL SUSPICION
• BACK STABBING /

BACK BITING

• TRANSPARENT
• WITH A VIEW TO EXCEL

BACK BITING

• UNHEALTHY

UNPRODUCTIVE OPAQUE

• DETERIORATION IS DEFINITE

INTERACTION CREATING AN ENVIRONMENT CLINICIANS ADMINISTRATION INTERACTION CLINICIANS = DOCTORS

• PROFESSIONALLY QUALIFIED

O SS O CO

ROLE OF CLINICIANS

• PROFESSIONALLY COMPETENT
• CONTINUING MEDICAL EDUCATION
• CONTINUE TO IMPROVE SKILLS

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ROLE OF CLINICIANS

IF YOU THINK YOU REACHED THE TOP…

THERE IS ONLY ONE WAY TO GO…

TUMBLING DOWN !!!

• REVIEW THE PERFORMANCE PERIODICALLY
• AUDIT / RESEARCH
• INTER PERSONAL RELATIONSHIPS

ROLE OF CLINICIANS

• INTRA DEPARTMENTAL RELATIONSHIPS
• INTER DEPARTMENTAL RELATIONSHIPS

ROLE OF MANAGEMENT OR ADMINISTRATION

MAN POWER MATERIAL

• RECRUITMENT POLICY
• RETENTION POLICY
• EMPLOYEE SATISFACTION
• PROMOTE EXCELLENCE
• REWARD EXCELLENCE
• BALANCE BETWEEN COST

AND QUALITY

• “ IF YOU DON’T GIVE
• REWARD EXCELLENCE
• “BLACK SHEEP”
• DEAL WITH TACT
• ENFORCE DISCIPLINE
• IF YOU DON T GIVE

EXCELLENT MATERIAL YOU CANNOT EXPECT EXCELLENT RESULTS” KEY GROUPS OF PEOPLE MISERABLE DOUBTERS Pour cold water on everything Everybody listens to them… OPINION LEADERS

Accountable Accountable Safe & high quality Safe & high quality Open & questioning Open & questioning Safe & high quality Safe & high quality

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Teamwork Teamwork Leadership Leadership

Ownership

“What went wrong?” “Blame and train”

Systems Awareness

Root cause analysis Environment

• f fear

Communication Communication

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RAID M d l

Review/ think through

A R D D

Day 1: It’s possible! Day 2: Day 3: Day 5:

RAID Model

Document Demonstrate Data generation Implement/ deliver Agree/ consensus

A D D I

Day 4:

Patient - Professional Partnership

Systems Awareness Teamwork Communi- cation Ownership Leadership

• Try to contact a doctor through the main switchboard.
• Try to contact an ICU late in the night to enquire about a patient.
• Go to out patients and ask for a wheelchair

MANAGEMENT OR ADMINISTRATION

Go to out patients and ask for a wheelchair.

• Sit in an out patient clinic and see what happens to the person

next to you, stay till he leaves. Would you like to be treated the same way?

• Spend a night on a ward bed. Use the toilets in the out patient

clinic/ ward. Are you happy with the conditions?

• Get close - where you stand affects what you see.
• Help your people grow - many individuals have hidden talents.
• Involve everyone - it is not only clinicians

SUCCESS TIPS

who impact on the efficiency of services.

• Mistakes are opportunities - staff want to do a good job,

help them learn from mistakes.

• Provide the tools - people need modern tools

to do a modern job.

• Focus your efforts - give clinical governance meetings a

practical purpose.

• Make progress visible - the simple ideas are often the

best.

SUCCESS TIPS

• Manage upwards - learn how senior people like to be

kept in touch

• Moving together - good teams don't just happen.
• Prove it will work - find volunteers to help you test new

procedures.

• Use time carefully - think carefully about your calls on

people's time.

• Use proven techniques - to seek patients' views.

SUCCESS TIPS

• Help people help themselves - developing the skills of

PHCTs.

• Encourage initiative - to allow staff to redesign their

department.

• Talk to the right people - if you want to make things

happen

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• Encourage volunteers - to share the development load.
• Use terms carefully - if you want to create a common

approach.

SUCCESS TIPS

• Getting the message - use IT equipment sensibly.
• Do your homework - to get the resources you need.
• Use resources flexibly - don't let traditional boundaries

stop development.

• Get issues in the open - to make separate departments

work well together.

• Hear what patients say - help patients make their point.

SUCCESS TIPS

• Use proven techniques - mind maps can help manage

complex issues.

• Small groups work - you don't need large groups of

patients.

• Get known - give your project a catchy title.
• Prove it will work - by testing a new IT system.
• Seek support, make space - finds ways for a time-out to

tackle big tasks.

SUCCESS TIPS

• Help staff keep in touch - communications are an essential

'life-blood' of a good service.

• Show how it works - consider using experts in role-play.
• Mistakes are opportunities - building on complaints.
• Understand others - don't make assumptions about them and

their roles.

• Find the right way - don't assume that you need a working group.

SUCCESS TIPS

• Getting through the maze - meetings can be the best form of

information sharing.

• Keep focused - consider carefully how to manage discussion

groups.

• Keep on track - busy people can lose direction.
• Careful preparation assures success - don't overlook the

administrative tasks involved.

• Make training relevant - don't assume that

generic courses are relevant to everyone.

SUCCESS TIPS

• Learn as you go - new skills are an essential part of personal

development.

• Make training visible - look for innovative ways

to give messages tofrontline staff.

• Encourage initiative - most staff can point

to ways to improve their services.

• Get the right focus - with patients as key stakeholders.
• Don’t duplicate effort - when seeking the views of service users.
• Be opportunistic - when seeking the views of service users.

SUCCESS TIPS

• Don't make assumptions - about what matters to patients.
• Make meal times happier - and a better social experience.

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• Never on a Sunday - can be difficult for service users.
• That’s too much information - providing what is needed at the

right time

SUCCESS TIPS

• What am I doing today? - better information for patients.
• Use language carefully - to avoid giving the wrong message.
• Use their language - to talk to young people.
• Mistakes are opportunities - to improve systems.
• Keep your finger on the pulse - and spot trends early.
• Stick to the rules - helps better team working.

SUCCESS TIPS

• Help us through the day - by sharing information.
• Use hidden talents - to enable staff to improve services.
• Helping people grow - find ways to extend their skills.
• Find the right time - to get staff together.
• Catch as you can - to hear stakeholder views.

SUCCESS TIPS

• Manage upwards - to keep your project on the management

agenda.

• Seek expert help - with tasks new to you.

IMITATE

PLAGIARISE

ADAPT

UPON

GOOD IDEAS

IMPROVE ADAPT

UPON

OF OTHERS

SUMMARY

• Step into patients shoes.
• People are STUCK in their COMFORT ZONE, they are

reluctant to change.

• Be ready to listen.
• Change people before you change system.
• Do the right thing and do it right.

SUMMARY

• Talk to staff – involve them.
• Start small and keep it simple. Don’t be too ambitious.
• Give people credit where they deserve.
• Ask staff and patients, what is good about current services,

what are the things that frustrate them – ACT ON THEM.

• KEEP GOING: SUSTAIN YOUR INTEREST

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DON’T REGARD CLINICAL GOVERNANCE AS JUST ANOTHER PROJECT OR A SUPERFICIAL MAKE OVER. IT IS A ROOT AND BRANCH TRANSFORMATION OF THE WAY CLINICAL CARE IS PROVIDED

• S

IR LIAM DONALDS ON IR LIAM DONALDS ON

“Here is Edward Bear, coming downstairs now, bump, bump, bump,

• n the back of his head, behind

Christopher Robin. It is, as far as he knows, the only way of coming d t i b t ti h f l downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it”

A.A. Milne 1926 Illustration E.H.Shepard 192614