Various Elements of Clinical Governance - Essay Example

?Professional Research and Study Skills The National Health Services (NHS) has established various elements of clinical governance, and these elements include: education, clinical audit, clinical effectiveness, risk management, research and development, and openness [1]. The implementation of education as part of clinical governance has been seen in the firm and strict requirements for continuing education after qualification. Various agencies for the different health professions have set up some of these continuing medical education seminars and trainings to comply with the NHS requirements. Clinical audit has also been established as a means of reviewing clinical performance, measuring this performance against the agreed standards. This audit has been carried out among NHS Trust employees, doctors, nurses, and other health professionals. Medical Audit Advisory Groups have been assigned to carry out such audits in primary care [1]. Clinical effectiveness has been implemented by measuring the efficacy of an implementation via evidenced-based practice. This has been apparent through research and patient-centred interventions. Risk management has also been secured through the implementation of statutory rules for the reduction of risk posed on patients. Regulations include the Data Protection Act and the Medicines, Control Agency approval, among others [1]. Research and development has also been made the basis for interventions and clinical practice. Moreover, research and development has found widespread practice through evidence-based care. Finally, openness has been implemented in order to submit to public scrutiny and to justify actions and interventions within the clinical practice [1]. In relation to research governance, the National Health Services, as well as the National Institute for Clinical Excellence has played an important role in ensuring that employment, ethics, information, science, and finance have been linked and coordinated with each other. Since 2001, the NHS has been setting-up an implementation plan for research governance in the UK. In 2001, the NHS checked the different systems for ethical approval and permission from the NHS individual bodies [2]. The NICE and the NSFs have set-up service guidelines in the hope of improving the quality of health care and for the NSFs to “develop national guidelines for organisations and individuals to put into action locally” [3]. In these instances, all individuals who work within the NICE and NSF framework is responsible for securing clinical governance. In 2002, the NHS was concerned with building local implementation plans to govern research. It was followed by a network of research management primary care trusts in April 2003 [2]. In April 2004, the NHS then established that research studies involving patients, including their tissues, organs, or other significant data may be commenced or continued without their sponsor admitting responsibility for the same [2]. Finally, on April 2004, research governance was established as a control assurance standard. It was now incorporated into the NHS risk management and referenced into CHI at the health authority level [2]. The Medicines and Healthcare products regulatory Agency (MHRA) has also established standards for research governance and in recent years have ensured that these standards would be implemented. They have established standards in ensuring that medicines and other medical devices work and that they are also safe [4]. They have recognized the fact that there are always risks involved with each product used, and in order to reduce such risks, fact-based judgments have been required on each product. This agency has therefore reviewed products and devices, including the research behind these products in order to eliminate the negative impact of these products [4]. This agency has also made the information on the research and the medical products available to the general public. These actions have made it possible for the public and health professionals to discuss the problems with the use of the medicines or medical device, carrying out investigations where necessary. The Department of Health discusses that health research is not based on a single discipline and no particular document can define the wide range of laws and guidelines which apply to this range of work [5]. They are based on five areas: ethics, science, information, health, safety and employment, and finance and intellectual property. Ethical standards in research have been established in order to protect the rights, safety, and wellbeing of research participants [5]. The DoH has already made it clear that research involving patients and volunteers, or their organs, tissues, and health data are subject to independent ethical assessment [5]. Informed consent is the main requirement of the ethical processes of research and the DoH has also emphasized that no research can be carried out without it being secured. The particular details of the research, including its impact and implications must be made clear to the participant. It must also be explained in a language understood by the participant [5]. The participant must then give his assent by signing the conditions of the research. The Mental Capacity Act of 2005 indicates the specific details of informed consent, especially those who cannot express their consent on their own behalf [5]. In this case, researchers have to respect a participant’s decision regarding his participation in the research process. Care in the conduct of research among children, and those who are mentally incapacitated are also included in the provisions of the Mental Capacity Act. The next domain secured by the DoH in research governance is on science, whereby all sources of evidence, particularly systematic reviews, must be understood well before actual research is undertaken [5]. Research which is similar to other works are therefore considered unethical, especially if they are unnecessary and do not contribute anything significant to the knowledge in the genera clinical practice. Information is also another domain of research governance and this domain points out that free access to data on research and the findings of the actual research must be made available to the public [5]. The domain of health and safety involves the utilization of dangerous or harmful tools and organisms. In this case, the DoH requires for the safety of the participants in research to be safeguarded based on safety and health standards. Hence, information, containment, shielding, and monitoring elements must be made secure by the researchers [5]. Finally, in relation to the finance domain, the DoH has firmly established that organisations or individuals carrying out the research must be prepared to compensate the research participants who have been harmed in any way by their negligent acts. How the approaches impact on improvement of healthcare in the NHS The different approaches can assist in the improvement in the NHS in the sense that clinical governance provides for the standards of the practice. The standards for clinical governance provide the guidance for the practitioners in their delivery of patient care. The Commission for Health Improvement discusses how clinical audits reviewed the application of antibiotics in the initial treatment of otitis media in children [6]. Clinical practice has revealed that the use of antibiotics among children has revealed that antibiotics did not effectively reduce tympanometry, perforation, or even recurrence and vomiting, diarrhoea and rashes seems to be higher among children taking antibiotics [6]. The audit revealed that there was a need to implement a new policy. The practitioners have more or less reached a compromise on the use of antibiotics among children with otitis media, expressing to parents that they may defer the use of the drug after they observe their child and evaluate if they would not improve without the antibiotics [6]. Risk management within the context of clinical governance has been apparent in the practice of understanding and minimizing patient risks. In which case, when things do not go well in the delivery of care, the health professionals must feel proper about admitting such unease and to learn and later share the things they have learned [7]. In the practice clinical context, risk management may be seen in preventive measures including the compliance with hand washing, discard of sharps, as well as appropriate patient identification. As each health professional also learns from near misses in the clinical practice, anticipation for bigger errors may be seen [7]. Clinical governance is therefore important in reducing patient errors and in improving patient safety. As each activity is carried out, appropriate clinical governance by the health professional involves an efficient critical thinking process which ensures that each intervention is within the set standards of care. The above critical thinking process would be seen in the audit of case notes and of interviews with women who have undergone Caesarean section deliveries where pain control has been considered been a major issue. These cases have led to a review of evidence and a new protocol evaluating formal pain assessments, and self-medication options for these women [8]. After the audit, a project team has been formed and a coordinated care pathway has been established. Communication plans and discussions with the trust board, the public and local councillors have been set-up. A new psychological assessment framework has been later implemented with stroke beds ordered and referral processes standardized [8]. Through this audit, the number of stroke patients released to their homes was increased, their hospital stay was shortened, and lesser incidents of hospital-acquired complications became apparent [8]. In relation to research governance, research standards as discussed previously have assisted in ensuring that health organizations carrying out research would comply with the duty of care to all patients [9]. Due to these standards, additional responsibilities have been established for these organizations, to apply the principles of research governance in their large-scale or their small-scale projects. The standards of research governance has not been as applicable for secondary care where research governance already exists; on the other hand, it has been particularly useful for primary care where research governance has not been strictly implemented and their research and development studies have not been fully developed [9]. Research governance has also assisted in improving healthcare implementation within the NHS as the researchers have been mindful of the different ways they can respect the rights of service users, carers, and staff in relation to obtaining personal data from the respondent patients [10]. They have been more conscious in obtaining such data lawfully and fairly and only through the informed consent of the participants. Most practitioners have also taken the time to fulfil the requirements of informed consent, paying particular attention to the consent process for incapacitated to give their consent to the research. Such requirement has called for them to be was accurate and up to date about the data they set out to review. As such, practitioners have also been compelled to use the research data only for the purpose indicated [10]. The anonymous and confidential nature of the research process has also been an essential requirement in research governance. In the practice, many researchers have been required to comply with patient anonymity, and as soon as possible, the researchers have sought to protect their respondents’ identity, keeping safe the identity and personal identifiable data to be shared with other parties. Steps to keep such data safe from loss, theft, and alteration have also been secured by the researchers [10]. Ethics committees have been tasked with ensuring that these confidentiality and safety measures have been imposed on researchers. At times, these processes seem to interfere with the efficient research requirements, however, these standards help prevent the unconscionable management of research subjects, especially human respondents. The negative impact of research governance has been expressed in a study by Jones where she established that research governance has become an over-reaction “to a small, technical infringement of the procedures” [11]. It impacts on the quality of research, wasting the taxpayers’ money and the time of patients and staff. The study also declares that research governance does not consider the kind of transgression in the research process [11]. All in all, her study discovered that in research governance, one size does not fit all. Information governance within the NHS has been expected in a variety of ways, but mostly in relation to how patient records are handled by the health professionals. Information governance requires health professionals to be aware of their responsibility of maintaining the confidentiality of patient records [11]. The simple matter of not discussing patient information and cases in hallways and in other public places is part of efficient information governance, one which is often overlooked by health professionals as they mingle with their colleagues within and outside the clinical setting. Although most health professionals generally comply with the requirements of information management, they often overlook its minor requisites, including discussing patient cases with colleagues. In these instances, patients must still be consulted. References 1. Starey, N. What is clinical governance? Evidence-based Medicine, 2001; 1(12): 1-8. 2. Taylor, M. Research governance—the NHS perspective. National Health Services. 2003. [cited 12 December 2011] Available from http://publicationethics.org/static/2003/2003pdf7.pdf 3. National Health Services. Clinical Governance. 2011. [cited 24 December 2011] available from http://www.wwl.nhs.uk/Internet/About_Us/Clinical_Governance.asp 4. Medicines and Healthcare products Regulatory Agency Research and Development – MHRA. 2011. [cited 12 December 2011] Available from http://www.meht.nhs.uk/our-services/research-and-development-at-mid-essex-hospital-services-nhs-trust/research-and-development-mhra/ 5. Department of Health Research Governance: Framework for Health and Social Care Second edition. 2005. London: National Health Services. 6. Sanders, S., Glasziou, P., del Mar, C., & Rovers, M. Antibiotics for acute otitis media in children (Review). Cochrane database of systematic reviews, 2009; 2: 1-43. [cited 12 December 2011] Available from http://epublications.bond.edu.au/hsm_pubs/159 7. Commission for Health Improvement. Principles for Best Practice in Clinical Audit. UK: Radcliffe Medical Press Ltd. 2002. [cited 12 December 2011] Available from http://www.nice.org.uk/media/796/23/BestPracticeClinicalAudit.pdf 8. Department of Health. NHS Information Governance: Guidance on Legal and Professional Obligations. 2007. [cited 24 December 2011] available from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_079619.pdf 9. Shaw, S., Boynton, P., & Greenhalgh, T. Research governance: where did it come from, what does it mean? J R Soc Med, 2005; 98:496–502. 10. National Health Services. Information Governance in Research: Caldicott Guidance. Avon and Wiltshire. 2006. [cited 12 December 2011] Available from http://www.awp.nhs.uk/FOI%20Documents/AWPCaldicottGuidance-ResearchInformationGovernance.pdf 11. Jones, M. The other face of research governance. BMJ, 2004; 329(7460): 280–281. Read More