Leadership and Team Working - the Building Blocks of Clinical Governance - Essay Example

Clinical Governance (1500 Words) Word Count: 1575 Words {Introduction to Conclusion} Contents of the Report Introduction Elements of Clinical Governance Leadership and Team Working: The Building Blocks of Clinical Governance Conclusion References Introduction The main aspect that is now taking center stage in providing quality care to patients is 'patient - centric care'. The nursing staff plays a major role in providing care to patients and therefore increasing the influence they have on enhanced patient care is essential. The advent of Clinical Governance provides that opportunity to elevate the nursing staff and consequently improve medical experience for patients. Simply stated, clinical governance is an advanced management system that improves the standard of clinical practice. Van Zwanenberg fro Oxford defines clinical governance as "a powerful, new and comprehensive mechanism for ensuring that high standards of clinical care are maintained throughout the NHS and the quality of service is continuously improved" (Zwanenberg, 2000). Clinical Governance is a practice that was brought about by the United Kingdom National Health Service (NHS), to describe and establish a systematic approach to improve the quality of patient care. The framework of clinical governance aims at establishing the same levels of quality and accountability and management in clinics and hospitals that the framework of corporate governance aims at establishing in an organization. Prior to 1999, ensuring financial management and acceptable levels of patient care quality were the only mandatory responsibilities of the trust boards on NHS. Since 1999, the NHS trust boards accepted the need for improving the quality of service extended to patients; the effect of which was the adoption of clinical governance. Successful implementation of clinical governance mandates continual professional development for the whole primary care team. Each and every team member must be involved. The main challenge that teams may face is the transition shift to a multidisciplinary, team based learning. The tasks of clinical governance are complex and demanding. It needs efforts from all members of a team. The following sections will cover various aspects of clinical governance such as 'elements of clinical governance', 'clinical team management' and 'clinical leadership'. Elements of Clinical Governance Improving patient care means that all the factors that have an impact on the care must be studied and improved, which requires a high level of inter-professional understanding. Representatives from all groups of staff must explore 'care' from patient's point of view (Dickinson et al, 2006). Various elements are needed to be carefully understood in order to establish an effective patient care. Nigel Starey, Director, Center for Primary Care from University of Derby identifies some of the major elements that build effective clinical governance (Starey, 2003). Education: Continual sustained professional education is mandatory for all health care professionals. It is found out that a substantial amount of what is learnt during training is quickly forgotten. Post Registration Education and Practice (PREP) for nurses, Postgraduate Education Allowance (PGEA) for GPs, Continuous Professional Development (CPD) for hospital doctors are some of the various systems that are prevalent to assist health care professionals in their continued professional education. Another essential aspect of continual education is team based learning. Until recently, only the general practitioners attended educational events. The educational requirements of nurses and other staff members were neglected (Pringle, 2000). However the new emphasis on education stresses professional development for all the team members. Clinical Audit: Measurement of the prevalent standards of a clinic against the pre determined standards is a very crucial element of clinical governance. The standards must be pre determined at regular intervals by medical directors and chief executives of the healthcare organization. An important role of the 'clinical governance lead' is manifested in clinical audit. The lead is responsible for the coordination of the governance activity, including clinical audit (Copeland, 2005). Clinical audit is a well thought out activity which affects the service quality of health care organizations. Three stages to clinical audit have been unanimously identified which include 'Preparation for Audit', 'Selecting the Standards' and 'Measuring Performance' (Jones & Cawthorne, 2003). Preparation for audit is essentially readying the organization for an audit. The purpose of audit is made clear to all staff members of the clinic and the skills and people possessing those skills to aid the audit process are recognized. In the selection of standards stage, the medical directors and chief executives formulate criteria about the required outcomes of the health care system. Both structure as well as process is outlined, teams and team leads assigned and expected tangibles during next review is made known to everyone involved. Finally as a part of measurement of performance, the data from various sectors of the organization are collected and contrasted against the pre set standards and key areas of concerns are identified. Risk Management: Apart from quality, safety plays a major role in effective health care. Risk management is identified as "a particular approach to improving the quality of care, which places special emphasis on occasions in which patients are harmed or disturbed by their treatment"(Hands, 1999). For effective risk management, a risk management structure must be established in the clinic. A main group called as the Risk Management Group suggests various processes to mitigate risks and also monitors the application of these parameters by individual departments. Furthermore, each department must have its own Risk Management Group which takes up the responsibility of assessing the performance off staff in their department and reporting the risk parameters to the main clinic wide group. The main group then carries on the mitigation of all identified risks. All the staff members must take responsibility for any mistakes committed, learn from them and apply strict risk management guidelines in the future. Apart from the above mentioned main elements, constant research and development is very essential in providing good patient care. Medical procedures always undergo massive changes due to advancements in technology. The clinical organization must constantly assess medical trends and orchestrate their procedures to reflect the latest prevalent trends. Leadership and Team Working: The Building Blocks of Clinical Governance The requirements of effective clinical governance mandate a sound implementation strategy. The entire workforce of the organization must work with conviction to successfully implement the policies set by the executive board. An important aspect of clinical governance is 'Clinical Leadership'. Clinical leadership has been defined as 'attempting to harness the energies of clinicians and reformers in the quest for improvements in performance that benefit patients" (Wagner, 2004). All health care organizations must assign a clinician as a leader and entrust up on him, the effective implementation of clinical governance. The main responsibility of the clinical lead is to update the directors of the organization on all aspects of clinical quality. The complete set of responsibilities of the clinical lead is not pre defined; it depends on the particular organization. The general duties of a clinical lead are listed (Mortimer et al, 2004). Participating in establishing of policies. Take up the responsibility of implementing the agenda. Acting as champion for improvement. Prioritizing, designing and implementing improved process of care. Clinical leadership is to a large extent voluntary as it requires conviction. Health care organizations must assist clinicians who wish to take up the leadership role. Leads understand the complete picture of health care and they constantly thrive to improve standards or delivery of care. Clinical leaders must not only be on the constant process of improving themselves, but they should also motivate all the staff members to improve themselves. Clinical governance leaders at practice and primary care group level will need to ensure that all the staff members belonging to his/her department are taking part in continuing professional development, assist directors in drafting policies for audit and risk mitigation, ensure that all effective policies are being adopted at the departmental level, listen to the problems of team members and help them resolve them and keep the directors updated on all the happenings of the organization. Clinical leaders alone can not lead an organization. They need effective team members who can assist the team leader in his/her activities. Teams are built to monitor and assist in specific activities. In some cases, the team may need special training in handling certain activities. Teams assist in both clinical as well as non-clinical activities of the organization. The information flows down the organizational hierarchy. At the top, the medical executives and directors of the organization draft the policies which are handed down to the departmental team leaders. The team leaders in turn pass the message to the team members, who actually carry out the policies. The teams should spend time and effort on understanding the agreed goals and consequently develop methods of communicating and working (Moss, 2004). Conclusion The concept of clinical governance brings together the various elements of effective delivery of care. It aims at improving the experience of the patient in a healthcare organization. An organization that provides high quality care needs to constantly meet the requirements of the patient as well as the board. Clinical governance provides the necessary framework with which this can be achieved. However if clinical governance needs to be successful, it must be well supported by all the staff members of the healthcare organization. Clinical leadership is very essential to aid clinical governance and requires highly visible clinicians enacting policies that will improve quality. All the elements of clinical governance must be given equal weightage and carried out at all levels in the organization. If professional support, a group of highly motivated clinicians and well worked out policies are put to place, clinical governance will bring about a definite positive change in the quality of care delivered to the patient by the health care organization. References Van Zwanenberg T, Harrison J (2000), "Clinical Governance in Primary Care", Oxford: Radcliffe Press. Wall Dickinson, Kilbane J & Cummings D (2006), "Developing large group working in clinical governance", Clinical Governance, Volume 11, November 1, 2006. Nigel Starey (2003), "What is Clinical Governance", Hayward Medical Communications Press, Volume 1, Number 12. Mike Pringle (2000), "Clinical Governance in Primary Care: Participating in Clinical Governance", BMJ Publications. Graham Copeland (2005), Clinical Audit Development Director, "A Practical Hand Book for Clinical Audit", Published by Clinical Governance Support Team for NHS. Tracey Jones & Simon Cawthorne (2003), "What is Clinical Audit", Published by Hayward Medical Communications, Volume 4, Number 1. Hands D (1999), "Clinical governance: making it happen", London: Royal Society of Medicine Press. Wagner EH (2004), "Effective Teamwork and Quality of Care", Medical Care Journal, Vol:42, No:11 Mortimer R, Sewell J, Robertson D, Thompson N, Leigh J, Long P (2004), "Lessons from the CSSP: Facilitating better practice through leadership and team building", MJA, Vol: 180 Moss F (2004), "The clinician, the patient and the organization: a crucial three sided relationship", Quality and Safety in Health Care, Vol:13, pp: 406 - 407. Read More