Introduction to Clinical Governance and Techniques Applicable in Clinical Governance - Assignment Example

1.0 EXECUTIVE SUMMARY   The aim of this study is to carry out a brief introduction to the concept of clinical governance, followed by review of how the various quality and performance objectives are managed within the health care system, which help to improve the clinical governance standards and coordination. In the next section, the paper studies a quality management initiative – GMAS – Grid medical archive based solutions for the purpose of effective information management. In order to improve the quality of clinical governance and health care services offered to patients, how GMAS has been implemented in the health care sector will be of particular interest to the study of the paper. Also a brief about the working of GMAS systems will be given in the paper.                                  2.0 INTRODUCTION TO CLINICAL GOVERNANCE   Clinical governance is a quality management initiative, set up originally by the NHS, facilitates all clinicians to persistently extend better quality of care to patients. Clinical governance targets to integrate all the actions that influence patient care into one single policy. This consists of activities ranging from clinical audits to improving the clinical information quality, promoting teamwork, joint ventures in health care medicine, reducing disparities in the clinical industry and implementing evidence based practise. (Groene & Jorgensen, 2005). Clinical Governance is basically an improvement technique which has been largely applied to the health care industry to encourage a learning and facilitating environment. This form of governance in the health care industry promotes both public as well as patient participation, motivation for embracing leadership qualities in the clinical staff and deploying effective risk management techniques. Clinical governance is capable of balancing both individual and professional clinical regulation standards and makes available a flexible environment for both of them to operate jointly, (Porter, 1997). Clinical governance activities are implemented as per the standards laid down by the Quality Improvement Program.   3.0 TECHNIQUES APPLICABLE IN CLINICAL GOVERNANCE   This Section studies the various techniques that are applied in enhancing the clinical governance and other medical operations in the health care sector. This part of the study makes an assessment of how the Quality and Performance Objectives are managed in the clinical governance of the health care system.            Performance Management     Clinical governance utilizes a range of methods to measure performances which may be both individual and collective in nature. Performance based appraisals are given due significance to maintain quality standards. Performance based audits of clinical providers are regularly made and consequently, changes are made to improve the system performance, (Groene & Jorgensen, 2005). Clinical governance aims upon building quality system into the health care through improvement in employee performance.               Risk management   Risk management is another method of maintaining quality standards in clinical governance form of healthcare system. The method of risk management helps to increase the service quality levels and also maintain safety of medical services that are offered to medical patients. Risk management basically concerns the presence of a safe medical service culture for patients where in every issue / problem and accidents are methodically assessed and revised, thereby leading to discontinuation of insecure clinical procedures. Also risk management in clinical governance refers to learning from erroneous incidents by taking successful corrective action, (Groene & Jorgensen, 2005).            Evidence based research   With the purpose to serve the customers more efficiently, evidence based research has been integrated into clinical governance. Evidence based research is based upon taking the clinical decisions on the basis of best evidence available at that time. The evidence may be arrived at with the help of medical experts, well researched and authenticated studies, patient past familiarity and various incidences and experiences (Groene & Jorgensen, 2005). At the same time, it is important that the clinical staff should be able to assess and review the quality of evidence and make decisions in the best health of the concerned patient.            Quality Management   Reliable and regular enhancement of procedures and techniques used in clinical operations is the essence of quality management, (Porter, 1997). The main aim of quality management in clinical services is to offer best services to patients and optimize the use of resources and expertise. Effective quality management consists of progressive augmentation which is based on measured clinical results and the systematic administration and development of the course of patient care in the course of the quality cycle or feedback procedures, (Groene & Jorgensen, 2005). There have been many initiatives to serve the purpose of quality management in the clinical operations. One of them – GMAS is the subject of study in the subsequent section.   4.0 RECOMMENDATIONS FOR QUALITY MANAGEMENT IN CLINICAL SERVICES   With a wide ranging operations involved in the healthcare sector, to initiate and sustain effective quality management it requires a plethora of recommendations that are required to be fulfilled. There are a number of common quality management requirements, but this section will study only a few, which are vital and necessary for competitive advantages. Here are some of them.    1. High Speed Information Exchange - It has been noted that many helathcare organizations still lack an efficient information management systems.A competent and dependable information exchange system is the backbone of any successful organization. Similarly, in the health care management, maximum utilization of available resources requires an effective information management system as it assists in integrating all the operations in an intelligent manner, (Cabena, Hadjinian, Stadler, & Zanasi, 1998). Use of modern technologies like SCM, ERP, SRM, CRM, and TPS within the health care management systems will help proficient integration of various departmental activities into one system, so that information can flow effortlessly.  2.  Safety Strategies and Supervision – Clinical operations consist of a number of sensitive customer information and data that needs to the safely managed.  For effective quality management, safety measures should be implemented to safeguard this information and they should be regularly imposed and effectively monitored with the help of encryption of real time information deliverance systems, Porter, 1997).  automatic procedures, standardization, exception monitoring, and reporting is critical to properly disposition significant data. Computerized procedures for timed supervision can reduce the enforced human intervention which is normally the source of inaccuracy and faults.   3.  Complex Event Processing- Solo events when reviewed single handedly (independent of other actions in the chain), might pose some risks of inaccuracy. However, when these solo events are integrated along in their chain of actions (dependent on each other) it may reduce a great number of anomalies. In the case of the health care sector, there are a number of clinical operations that are related to each other. Client data, case history etc need to be integrated in real time with the help of Complex Event Processing (CEP). This expertise offers the clinical operators to perform practical, real time, faster and accurate judgments with the help of an integrated data case history of the patients. They do not have to wait for long scheduling data generation. This synchronization of events is called complex event processing.   5.0 GMAS DATA MANAGEMENT SOFTWARE SYSTEMS Health care is an imperative ingredient of contemporary society, which amounts to a huge percentage of GDP of any economy, and sustains a strong community interest. In this relation to health care facilities, storage of information and medical images holds increasing importance for clinical community. Earlier, the medical archives and images were stored on a film, but with the advancements in modern imaging modalities and data archiving, they can be easily stored in electronic form. Given the fact that digital medical images and data represent a huge amount of data for clinical staff of a facility, electronic assets for processing and smart indexing are in immense necessity, (Groene & Jorgensen, 2005). There are a number of aims behind introducing the electronic form of data storage and management at health care facilities were:   • Storage and archival of massive medical data and clinical images both for present and future data access and research work   • Maintaining storage standards for the sharing of medical information and images of clinical patients and consulting them in future or in case of any second opinion   • Performing multifaceted calculation and analysis over huge data sets of a definite type of medical images (e.g. all the mammograms of patients aged between 45-65 years)   • Safe and protected exchange of patient’s medical data between various departments and locations   • Competent and fast recovery of medical data as required by the patients or clinical staff queries   Grid Computing has been one of the most recent forms of database management innovations that have greatly helped to accelerate performances and enhance productivity across every sector. Grid computing has evolved from a scientific and technical computing  into a complete business oriented solutions for information management. With a steep rise in the commercial adoption of the Grid technology, the health care sector has also implemented various forms of the Grid technology for faster and efficient clinical data management.   This section of the paper will focus on the mounting requirements of huge health care facilities for information management and will suggest some technological initiatives for storage and its effective maintenance to increase quality of the health care services. The utility of the Grid Medical Archive Solution (GMAS) software system for the purpose of effective information management will be studied in this section. In order to increase the scalability and resiliency of the information technology departments of these vast health care facilities, it became evident that integration of technology was necessary for a fast transformation of health care services from a slow and disorganized form into a completely digitalized automated facility. With the recent technology innovations, information storage systems can prove to be much more resilient than before. The main advantages of employing GMAS system at helathcare facilities will be to enhance the access to the archived information databases at the hospitals, which can prove beneficial with regards to obtaining a patient history, helps to improve the flexibility and protection of data, automate the administration and migration of data. Moreover the clinical staff posses the digital access to data records, medical images, lab results and other business data of every concerned patient.  All this subsequently offers a competitive edge to the health care organization in providing better quality services to its customers.   6.0 IMPLEMENTATION OF GMAS IN THE HEALTH CARE INDUSTRY FOR QUALITY IMPROVEMENT   1. GMAS provides fast and voluminous archived database to the Cardiology Departments   One of the first to implement the GMAS systems to enhance quality management was the cardiology department at the Kaiser Permanente Hospital in Santa Clara. GMAS was used to provide the archival storage and retrieval facility for the cardiology department. The GMAS system easily integrates along with the existing helathcare management systems with the help of the Common Internet file system and Network file systems which are a part of the GMAS system, (Brandt, 2001). Initially, the IT departments of health acre facilities in every 24 hours, used to transfer the cases from the cardiology system to the cardiology archive in order to avail space for the new cardiology cases. However, transferring these voluminous cases, every 24 hours took more than 4 hours. In the case of Kaiser Permanente Hospital in Santa Clara, fast and 24*7 accessibility of the cardiology data to the clinical staff, reduced cost of scaling, cost effective, reduced time in archiving and transferring  data, data and image protection facility in case of hardware malfunction / damage / disaster proved to be outstanding for high end quality maintenance, (Cabena, Hadjinian, Stadler, & Zanasi, 1998). GMAS systems were able to complete the data transfer in 30 to 45 minutes as compared to the initial proprietary design oriented system for data management at the Kaiser Permanente Hospital in Santa Clara.   2. GMAS offers a longer growth perspective   The GMAS storage grid software offers an easier and reasonable phased operation and deployment with the help of the grow-as-you-go approach which allows the health acre facilities to integrate new modern softwares and techniques in the system regularly for system up gradation and benefit from cost reduction. As an example, in the case of the Kaiser Permanente Hospital, the first total storage capacity offered by the GMAS set up to the cardiology department was DS4100 disk storage, which can store, retrieve information collected in six months from the department, however, with the increasing requirements, the system had to be upgraded (which was done easily) with four more DS4100 disk storage systems which raised the limit to 1.5 years of information data management. With the rise in the data storage capacity, faster computation power of the system was required. This was done easily by adding four aSeries servers with Xeon processors and Linux operating systems. With great performance and low price, the GMAS systems offer high quality maintenance and reliability to a healthcare facility. GMAS serve as a solid foundation for large storage virtualized databases which easily integrate with existing technology and are easy to implement.   3. Reliability and Resiliency to health care facilities   Within a digitalized environment of a healthcare facility, speedy, dependable storage systems facilitate the clinical staff members to respond rapidly to varying patient conditions. GMAS allows the staff a quick access, which is available at their fingertips and assist in making fast medical related decisions. With a 24*7 operating time, GMAS does not has a downtime even when systems and softwares are being integrated with it for capacity increment or maintenance. Management downtime has virtually been reduced to zero in the GMAS systems and information can be added, retrieved, shifted etc., without disrupting the clinical staff use of GMAS. In all, GMAS offers Data protection, Business continuity, Automated recovery options. GMAS maintains 2 unique sets of independent copies of data in order to maintain all time availability and integrity of the data.   GMAS maintains two physically independent copies of data to help ensure high availability and data integrity so that in case of any failure, the second copy can be used to fulfill the requirements of the clinical staff. Automated recovery saves the over exploitation of IT resources.   4. GMAS helps helathcare facilities address regulations and standards   The GMAS software systems for data management assists the health care facilities to address regulations set under the Health Insurance Portability and Accountability Act (HIPAA), which state that the patient information is to be kept private and cannot be subjected to any kind of modification. This is done by providing a unique digital signature to every patient data case / file that is saved in the database achieves and checks those signatures to every image / fact that are stored when the data is retrieved. GMAS helps to follow the flexibility and the security norms set up by the authorities.       5. Cost effective mass storage   GMAS is an open system that is built on the industry based hardware. The PACS and storage vendor neutrality of GMAS permits benefit from the existing hardware and other operating investments. Further, the execution of the GMAS prevents any kind of vendor lock-ins that exist in other similar information management systems. Further expanding the storage capacities in the form of disks and tapes is also possible with GMAS. The life cycle of information management of the GMAS robotically administers the migration of information from one department to other as per requirements and standards set by the healthcare facility management, (Brandt, Nowak, einhaupt, Pelikan, Schmidt, 2000). Moreover, the migration is under a controlled, secured and digitally authorized environment. With easier migration of clinical information on low cost tape for storage, GMAS offers cost effective massive storage capabilities.   6. Increased patient care   Initially, the clinical staff used to spend more time sitting in front of their pc’s and collecting relevant data and information. With the help of the GMAS systems, the clinical staff is now free to devote more and quality time to the patients instead of the logistics of cardiology studies. This will help the healthcare facilities in getting a cutting edge and becoming the leaders in implementing technology and quality customer care.  7.0 OTHER TECHNOLOGICAL INITIATIVES FOR QUALITY MANAGEMENT IN THE HEALTH CARE INDUSTRY The IT giant, Siemens has recently launched a new information management system under the name of Soarian, which assists the clinical staff synchronizing the various clinical processes with the department work flow which may include allocation of resources and moving of patients from one department to other within the health care facility. The Soarian system is built on the web technology and the user interface of Soarian software is also able to predict the need and work requirements of the staff and hospital employees. Soarian is designed with embedded analytics that approve the users of this software to automate, measure, and track the clinical processes and consequences thereby dropping the costs and escalating the quality of services. 8.0 CONCLUSION   As a result of the above study, to put into practice and accomplish advanced quality management and competence within health care systems, these fresh technology based initiatives will assist the health care community to advance to the next elevated level of clinical performance and patient satisfaction. REFERENCES     Cabena, P., Hadjinian, P., Stadler, R., Verhees, J., & Zanasi, A. (1998) Discovering data mining: From concept to implementation. Upper Saddle River, NJ: Prentice Hall, Inc. Groene O & Jorgensen S. Health Promotion in Hospitals – A strategy to improve quality in health care. European Journal of Public Health, 2005, 15 (1), 6-8. Kaplan R S, Norton DP. The strategy-focused Organization. How Balanced Scorecard companies thrive in the new business environment. Boston, Harvard, 2001,pg 5-10. Porter M E. Quality management in hospitals. Harvard Business Manager, Vol. 19, 1997, 3:42-58. Brandt E, Hrsg. Quality management and healthcare, Luchterhand, Neuwied und Kriftel, 2001, pg 34-67. Brandt E, Nowak C, Peinhaupt J, Pelikan JM, Schmidt W. The Challenges and Possibilities of Future Hospitals at the Outset oft the 21st Century – Consequences for National Networks of Health Promoting Hospitals. 2000, pg 12-24. Read More