How Clinical Governance and Research Governance Can Help a Clinical Scientist - Case Study Example

How Clinical Governance and Research Governance Can Help and Hinder A Clinical Scientist- Rehab Engineering Table of Contents 1. Introduction: Definition and Concepts of Clinical Governance, Research Governance and Rehabilitation Engineering 2. Clinical Governance and Rehabilitation Engineering 2.1 Benefits of Clinical Governance and Research Governance 2.1.1 Standardization 2.1.2 Monitoring 2.1.3 Organization and Structure 2.1.4 Research Integration 2.1.5 Cooperation among different teams of Rehabilitation Engineers 2.2 Problems Faced by Rehabilitation Engineers due to Clinical Governance and Research Governance 2.2.1 Excessive Documentation and Record Keeping 2.2.2 Accountability and Management 2.2.3 Lack of Organizational 3. Conclusions 4. References Topic: Explain how clinical governance and research governance can help and hinder a clinical scientist- Rehab Engineering 1. Introduction: Definition and Concepts of Clinical Governance, Research Governance and Rehabilitation Engineering Adequate and high quality health care is very crucial in the modern day world. A series of failures in the health care system to provide effective solution led to major health care reforms in the United Kingdom in 1998. Clinical Governance can be defined as ‘A framework through which NHS (National Health Service) organisations are accountable for continually improving the quality of their services and safeguarding high standards of health care by creating an environment in which excellence in clinical care will flourish’ (Donaldson and Scally, 1998). Clinical Governance is an umbrella term and its purview is not limited to providing high quality health care service. It also involves working towards improving the quality of medical information, reducing the variations in practice, involving the patients and the public and improving teamwork in health care facilities. Overall, Clinical Governance aims at providing top quality ‘integrated care’ where any possible risks are mitigated. To support the strategy of Clinical Governance, it is also very important to have top quality research. It is a given fact that research is crucial to the successful promotion of health and well-being. As with any unregulated research, health care research has fair chance of risk – in terms of the results as well as in terms of the safety of the researchers as well as the patients. Hence, proper governance of research is essential to ensure that the public can have confidence in, and benefit from, quality research in health and social care (Department of Health, 2001). Research Governance can be defined as the set of framework, regulations and standards that are set to continuously improve the quality of research in the field of health care. Both Clinical Governance and Research Governance are critical projects that NHS has been focusing upon. To have an effective Clinical Governance policy and Research Governance framework, it is important to have good clinical scientists too. Clinical scientists are healthcare experts who facilitate efficient implementation of Clinical Governance as well as Research Governance. Typically, these scientists work with patients or aid the clinical staff either by providing clinical and laboratory support or by assisting in rehabilitation and research work. Clinical Scientists specialize in one area of expertise. Some of them specialize in conducting tests and interpreting results so that they can aid the treatment. There are others who are involved in coming up with scientific solutions that help the patients. Some clinical scientists are also involved in research to develop and test new methods of treatments. One crucial role that the clinical scientists play is that of rehabilitation engineer. Rehabilitation engineering can be defined as the systematic application of engineering sciences to design, develop, adapt, test, evaluate, apply, and distribute technological solutions to problems confronted by individuals with disabilities in functional areas, such as mobility, communications, hearing, vision, and cognition, and in activities associated with employment, independent living, education, and integration into the community (Rehabilitation Act, 1973). Therefore, rehabilitation engineering also involves the attempts to reduce any environmental barriers and efforts to restore the physical and mental function of any disabled individual. For any form of Clinical Governance or Research Governance to be effective, it is necessary that the clinical scientists working in rehabilitation engineering to work in tandem and by providing the right support to each other. While there are many benefits that support a clinical scientist, there are also certain hindrances that they face when they are involved in rehabilitation engineering. This article aims to explore how clinical governance and research governance can help and hinder a clinical scientist (engineering) working in a rehabilitation engineering setting. 2. Clinical Governance and Rehabilitation Engineering Research governance ensures that proper protocols and procedures are used during the research and the development of the products or aids that made by the rehabilitation engineers and other researchers who are involved in developing solutions for healthcare. Clinical governance on the other hand is involved with the management and implementation of health care solutions in a manner that makes them most effective and beneficial for the end-users. Rehabilitation engineers too have to ensure that the products or equipment that they develop are actually beneficial and cost effective for the patients and these standards are again guided by the concepts provided by clinical governance. Clinical and research governance is therefore useful for the rehabilitation engineers as it helps them in standardization of their processes and products, ensures monitoring and assessment of their work, provides better framework for organization and structuring of their work, enables information and knowledge integration and leads to better coordination and cooperation among the engineers. However, there are also some problems that the rehabilitation engineers may face due to clinical governance, like the need to record and report, the excessive scrutiny that their work is subjected to... 2.1 Benefits of Clinical Governance and Research Governance 2.1.1 Standardization Rehabilitation is a process that involves the contribution of an entire team of professionals including the doctors and the nurses that are working directly with the patient, the medico-legal professionals who guide the availability and use of the rehabilitation methods and the rehabilitation engineers who are involved with developing solutions for such patients. Clinical governance ensures that the team works in accordance to the pre-set standards and that the members are aware of their responsibilities and liabilities. This includes the duties and accountabilities of the rehabilitation engineer who is tasked with the objective of researching and designing the products that facilitates the rehabilitation of the patient’s disabled faculties (Halligan, 2001). However, as the specific task of the rehabilitation engineers requires that they focus on developing products that may be of ultimate utility to a very small section of the population, the concept of research governance and clinical governance has to be made rather flexible. The engineers come up with a design that they base on their own understanding of the treatment needed as well as on the feedback of the doctors and other researchers. However, they may have no set criteria or standards laid out for them at the onset, but as their design is developed and evaluated by others like the doctors and the patients and researchers, the standards and specifications of the products/aids are fine tuned. It is also difficult for the rehabilitation engineers to find a trial sample – simply due to the fact that there may not be enough people with the disability and drawing a sample of any credible size may be difficult or impossible. This means, that much of the work that the rehabilitation engineers may not fall in the structured approach provided by the clinical or the research governance dictates. But, this does not imply that the rehabilitation engineers are not concentitious or that they do not use the standard protocols as desired by the NHS research standards (Foort, 1985). The engineers too are guided with the principles of cost-effectiveness or the projects that they undertake, and are continuously required to be self-evaluative and critical of their own work in order to remain on track. 2.1.2 Monitoring and Evaluation Research governance has set a protocol for the conduction of research, though the process evaluation is not well defined in case of new product development for rehabilitation. However, there are standards and evaluation systems in place in case of innovation and repairing the equipment, and also for evaluation of the final end products once they are ready. The initial evaluation of the product is conducted by the rehabilitation engineers using a limited sample, while there are several other stages of evaluation that ensure that the product is actually useful. These stages of evaluation and monitoring are conducted with the help of third party researchers and the psychotherapists or the doctors who are going to be involved with the practical use of the product on the patient. The provision for continuous evaluation and monitoring helps the rehabilitation engineers in streamlining their work and excelling in their fields. 2.1.3 Organization One key benefit of being a clinical scientist after clinical governance was implemented is that there it has brought an organized set up which was hitherto lacking. Traditionally, the scientists and the engineers used to work in isolation and have little interaction with the end users or understanding of their specific needs (Smith and Leslie, 1990). With clinical governance, scientists and engineers are able to better organize their own work and are able to keep a track of what the end-customers want and need. This helps them to give consideration to the actual needs of the people who are going to use their products while they are looking for an area of research or when they are developing the product . This in turn translates into the production of aids and products that are more targeted and more cost effective for the end users. 2.1.4 Research Integration The rehabilitation engineers have traditionally worked in isolation, without concerning themselves with what the other researchers are doing or what other engineers may be developing. This lack of communication was due to the fact that the rehabilitation engineers or engineering teams worked in close circles in order to safeguarded their research as there was no provision to establish ownership of an idea or a concept or a product prior to clinical governance (Lugon and Secker-Walker, 2006). It also ensures that the team of the rehabilitation process is working in tandem and cooperates with each other in terms of knowledge sharing and skills development. With the implementation of clinical and research governance at the NHS, it is now possible to integrate research conducted by individual teams and hence ensure that there is better utilization of resources and more information sharing. As clinical governance provides that there is better dissemination of information about existing and current research projects that are being undertaken (Lugon and Secker-Walker, 2006), the rehabilitation engineers are saved from unknowingly duplicating projects and assignments and this leads to saving time, energy and other resources that can be utilised for furthering fresh research. In addition, as some of the engineers may be working on keystone problems or problems the solution to which may provide insights needed to solve several other problems. If information is easily available and openly communicated between different teams of engineers, there is a better chance of making quick breakthroughs and speeding up the rate of innovation. Further, the integration of databases of all the previous research and the availability of information and the understanding of the work that is undertaken by practitioners with the patients is made possible with the new clinical governance facilities. The rehabilitation engineers now have access to vast amount of data and knowledge relevant to their subject, past and current research and about the lifestyle and economic backgrounds of the patients that they want to serve (Cooper, Ohnabe and Douglas, 2006). 2.1.5 Cooperation among different teams of Rehabilitation Engineers Research integration is one way of ensuring that the different rehabilitation engineers and teams are aware of each others works and are also able to benefit from it. However, it is also essential that the engineers that are working on the same project are able to do so in a non-competitive and cooperative environment. Clinical governance ensures that that due credit is given to the rehabilitation engineers for their ideas and work and the scope of losing their data and ideas to others is minimized. This in turn leads to a more enthusiastic sharing of work and cooperation among researchers and engineers and leads to more efficiencies and effectiveness of the efforts. 2.2 Problems Faced by Rehabilitation Engineers due to Clinical Governance and Research Governance 2.2.1 Excessive Documentation and Record Keeping One of the most common drawbacks that have been associated with the implementation of clinical governance is the need for excessive record keeping and documentations. It has been argued that the scientists and the engineers have to spend time on non-core activities – which are related to their research – and have to indulge in record keeping, making reports and sharing information and opening up their research to speculation and external evaluation (McSherry, Pearce and Tingle, 2007). 2.2.2 Excessive Supervision The clinical government initiative has led to the establishment of various committees and evaluation and monitoring bodies that operate are responsible for ensuring clinical governance is followed. There is the Commission for Health Improvement (CHI) that oversees the monitoring process for the effective clinical governance. The National Service Frameworks provides the broad framework for assessing the clinical services as well and this forms the basis of the performance appraisal criteria for different professionals associated with healthcare (Zahir, 2001). However, the opening to scrutiny of the work of the rehabilitation engineers and other scientists is often viewed as undue interference in their work. The supervision and control of research and quality of products and services related to healthcare is aimed towards ensuring that the best services are made available to the customers (Specchia et al, 2010). However, it can be viewed as intrusive and debilitating to the initiative and effort of the engineers. 2.2.3 Lack of Organizational Orientation In addition to the organizational structure and supporting facilities, it is also the organizational culture and attitude of the top management that comprise an essential part of the effort that is needed to make clinical governance a success (McSherry, Pearce and Tingle, 2007). In the case of rehabilitation engineering, while there are detailed protocols and monitoring processes, the engineers often feel the lack of basic support in terms of the culture and attitude of the management. This means that that there is a discordant culture that goes against the basic objectives and concepts of clinical governance. While clinical governance was initiated to encourage a culture that leads to maximum voluntary contribution of the professionals, the ground realities reflect that the culture is actually restrictive and inhibitory (McSherry, Pearce and Tingle, 2007). The healthcare professionals like the rehabilitation engineers are not given an environment that encourages them to work freely and cooperate or to interact with the end customers or even with the doctors involved with the rehabilitation process. The lack of proper culture change and orientation therefore acts as a hindrance for the rehabilitation engineers to utilize their full potential. 3. Conclusion The above paper discussed the meaning and concepts related to the terms clinical governance, research governance and rehabilitation engineering. It also critically analysed the benefits and disadvantages of clinical and research governance that the rehabilitation engineers have to face. It is seen that clinical governance goes a long way in helping the rehabilitation engineers to standardize their work, use monitoring and self-evaluation, organizing their work, work in a cooperative environment and take advantage of better organized and integrated research and knowledge databases. However, clinical governance and research governance has also brought about a mechanism for monitoring, controlling and supervision of the wok of all the professionals related to health care work, including those involved in rehabilitation engineering. However, in addition to the various advantages that the rehabilitation engineers can get from clinical governance, there are often issues related to supervision, monitoring and dissemination of their work that are perceived as unduly intrusive by the community. In addition, the professionals are also tasked with record keeping and reporting in order to be able to furnish information to monitoring communities or the public, and as such, they end up committing time and energy to activities that are seen as wasteful by them. Further, it is seen that despite the tremendous efforts put by the NHS into the clinical governance initiative, there is little effort made to actually change the culture of the organizations that could encourage better contribution from the professionals like the rehabilitation scientists and engineers. Clinical governance has tremendous scope for making the work of rehabilitation engineers better and more effective, but there is also a need apparent to educate and train the engineers about the need and importance of making their work transparent. There is also a need for ensuring that there is a balance between autonomy and initiative on the one hand and monitoring and supervision on the other. For this, it is recommended that focus be placed on bringing about a cultural change to inculcate the appropriate orientation and attitude among the healthcare practicing and research organizations. References Cooper, R. A., Ohnabe, H. and Douglas, A. H. (2006). An Introduction to Rehabilitation Engineering (Series in Medical Physics and Biomedical Engineering. NJ: Taylor & Francis Donaldson L.J and Scally G (1998), Clinical governance and the drive for quality improvement in the new NHS in England p 61-65 Department of Health. (2001). Research Governance Framework for Health and Social Care. Retrieved on November 11, 2010 from http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4014757.pdf. Retrived on Nov 15, 2010 Foort, J. (1985).Comments for A New Generation of Rehabilitation Engineersa. Journal of Rehabilitation Research and Development, 22(1), 2-8. Halligan, A. (2001). Implementing clinical governance: turning vision into reality. BMJ, 322(1413), 22-23 Lugon, M. and Secker-Walker, J. (2006). Clinical governance in a changing NHS. London: The Royal Society of Medicine Press Ltd. McSherry, R., Pearce, P. and Tingle, J. (2007).Clinical governance: a guide to implementation for healthcare professionals. London: Wiley-Blackwell Rehabilitation Act. (1978).What is Rehabilitation Engineering? Retrieved on November 11, 2010 from: http://rehabengineer.homestead.com/. Smith, R. V. and Leslie Jr., J. H. (1990). Rehabilitation Engineering. UK: CRC Press Specchia, M. L., Torre , G. L., Siliquini, R., Capizzi, S., Valerio, L., Nardella, N., Campana, A. and Ricciardi, W. (2010). OPTIGOV - A new methodology for evaluating Clinical Governance implementation by health providers. BMC Health Services Research, 10, 174. Zahir, K. (2001).Clinical Governance in the UK NHS.UK: DFID’s Health Systems Resource Centre Read More