clinical and care governance strategy 2019 2021 making
TRANSCRIPT
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Clinical and Care Governance Strategy
2019 – 2021
Making Quality Real
“Our ambition is that every day every one of us delivers, sees and experiences standards of
healthcare that we would want for our own loved ones. This can only happen by putting the
person receiving care, and their carer, at the centre of everything we do, working as a team
and making sure we have the information and data we need to deliver excellent care and
treatment”
Professor Peter Stonebridge Mrs Sarah Dickie
Medical Director Interim Nurse Director
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Version Control
Version Number
Purpose Change Author Date
1.0 Document presented to Tayside NHS Board
Medical Director and Nurse Director
05 December 2013
2.0
Document reviewed and presented to Clinical and Care Governance Committee 17th August 2017 Updates
Realistic Medicine (SG 2016)
HIS Review of Quality of Care
Integration Joint Boards and new arrangements of Clinical Governance across HSCP
i-matter and culture and collective leadership framework
Development of staff and curricula for Quality Improvement
Volunteering
Patient Information
Medical Director and Nurse Director
17 August 2017
3.0
Document reviewed and presented to Clinical Quality Forum for approval on 11 November 2019 and endorsed by Care Governance Committee 5 December 2019 Updates:
Information condensed and made easier to read and understand.
Addition of reading list.
Addition of Duty of Candour legislation.
Inclusion of the Health and Social Care Standards: My support, my life. Scottish Government (2017).
Medical Director and Nurse Director
11 November 2019
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Contents
1. INTRODUCTION TO THE CLINICAL AND CARE GOVERNANCE STRATEGY .................... 4
2. DOMAINS OF CLINICAL AND CARE GOVERNANCE........................................................... 6
2.1. ADVERSE EVENT AND CLINICAL RISK MANAGEMENT ..................................................... 6
2.2. CONTINUOUS IMPROVEMENT ................................................................................................. 7
2.3. PERSON-CENTREDNESS ........................................................................................................... 8
2.4. CLINICAL EFFECTIVENESS ....................................................................................................... 9
APPENDIX 1 – STAFF CONTRIBUTIONS TO CLINICAL AND CARE GOVERNANCE .............. 11
APPENDIX 2 - RECOMMENDED READING LIST ....................................................................... 12
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1. INTRODUCTION TO THE CLINICAL AND CARE GOVERNANCE STRATEGY
“Clinical governance is a system through which NHS Organisations are accountable for
continuously improving the quality of their services and safeguarding high standards of care by
creating an environment in which excellence in clinical care will flourish.” (Scally and Donaldson,
1998).
This strategy details the responsibilities that all staff have in contributing to the quality of care for
people who use NHS Tayside and Tayside Health and Social Care Partnership services and the
importance of culture and organisational arrangements in achieving safe, effective and person-
centred care.
In 2000, the Scottish Executive described four levels of clinical governance responsibilities. NHS
Tayside defines these levels below and each will be referred to throughout this document and
within additional supporting documents.
Overseeing – members of Clinical Quality Forum and Care Governance Committee, non-
executives.
Delivering – management structure, including clinicians involved in management –
Triumvirate and management leads, clinical governance leads
Practising – clinical, administrative and support staff
Supporting – staff employed in activities underpinning clinical governance, e.g. those
involved in clinical effectiveness, audit, complaints handling and risk management.
Each of these roles are important if quality of care is to be given the highest priority across NHS
Tayside and partner organisations. Every member of staff has a role in quality and this strategy
helps staff understand their role across the entire scope of clinical and care governance.
A one page document (Appendix 1) has been developed
in collaboration with staff to lift the veil on what clinical
and care governance is and how they contribute to this
on a daily basis, regardless of what their role may be.
This is also available on the Clinical Governance and
Risk Management Staffnet page HERE.
A recommended reading list (Appendix 2) has also been developed to support the one page
document and this strategy. The reading list details documents and websites that staff need to be
aware of or have read according to their role.
The 3 documents below provide the historical context for clinical governance:
Clinical Governance NHS MEL (1998) 75
Clinical Governance NHS MEL (2000) 29
Clinical Governance Arrangements NHS HDL (2001) 74
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The strategy describes the four key domains of clinical and care governance as:
1. Adverse event and clinical risk management
2. Continuous improvement
3. Person centredness
4. Clinical effectiveness
These domains are detailed fully within this document and include the expectation of staff dependent on their role.
“Clinical governance is about … accountability, structures and processes. However, it will only achieve
the desired outcomes of improved quality of care and public reassurance about standards of care, if it
is underpinned by a wide range of activities most of which require to be owned and led by clinicians
individually and collectively. Clinical governance is not the sum of all these activities; rather it is the
means by which these activities are brought together into a structured framework and linked to the
corporate agenda of NHS bodies” (Clinical Governance NHS MEL (1998) 75).
The current whole system arrangements for clinical governance in health and social care in Tayside
are illustrated in Figure 1. These arrangements will adapt given the maturing landscape and
anticipated changes and developments across the organisation.
Figure 1: Clinical and Care Governance Arrangements across the whole system from people
receiving care to the Board
NHS Tayside Board
Care Governance Committee Standing Committee for Clinical Governance
Clinical Quality Forum Assurance and learning across NHS Tayside and the
three Health and Social Care Partnerships
Local Clinical Governance Groups and Forums within Divisions and Health and Social Care Partnerships Clinical Care and Professional
Governance Forums
Clinical Risk
Management
Local Teams / Wards / Departments / Communities who
support people receiving care, their carers and families
Organisational Support for Clinical Governance and Risk Management Clinical Governance Chairs
Patient Safety, Clinical Governance and Risk Management Team Professional and Clinical Leadership/Hospital Huddles
Nursing and Midwifery Directorate Improvement and Organisational Development
Business Unit
Quality and Performance Reviews/Assurance Frameworks
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2. DOMAINS OF CLINICAL AND CARE GOVERNANCE
2.1. ADVERSE EVENT AND CLINICAL RISK MANAGEMENT
The aim of this domain is to ensure there are adequate
and effective adverse event and risk management
processes in place throughout the organisation to enable
learning from adverse events which will reduce the risk of
future harm. It focuses on the reporting and reviewing of
adverse events and near misses, in an open, honest and
safe environment; continually highlighting good practice;
identifying improvements, ensuring business continuity
plans are in place and the implementation of patient
safety programmes.
Included within this domain are:
Adverse Event Review – Reviewing adverse events and near misses at an appropriate level to
ensure continual learning and improvement to services for people who access our services and
staff.
Duty of Candour – Ensuring that people receiving care, and their families, are informed when they
have been harmed, either physically or psychologically as a result of the care provided. This
ensures that services are compliant with the Duty of Candour Procedure (Scotland) Regulations
2018.
Risk Management – Continual development, monitoring and review of service and strategic level
risks to ensure these are proactively managed and progressed across the organisation with clear
timescales and actions plans associated to these.
Business Continuity Plan – Developing and maintaining effective and up to date business
continuity plans to increase the resilience of the organisation so that it is able to continue to deliver
the critical services that our users rely upon. Ensuring our services are compliant with the business
continuity plans element of the Civil Contingencies Act 2004.
Patient Safety - Working collaboratively and in conjunction with services/partners, to develop
approaches that systematically improve the safety for patients through generating new ideas, sharing
knowledge and spreading safe practice.
Staff responsibilities at each of the four levels for this domain:
Overseeing
Seek assurance through Care Governance Committee, Clinical Quality Forum and
Quality and Performance Review processes on all aspects of adverse event and
clinical risk management and ensure actions and learning have been identified and
shared throughout the organisation.
Delivering
Provide assurance to the members of the Quality and Performance Review panel
in relation to their adverse event and risk management processes. Ensure there
are appropriate structures and mechanisms in place to consider and act on
information, highlight good practice and identify and share learning to ensure there
is continual improvement in systems, practice and care for people accessing
services.
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Practising
Ensure all staff are able to report adverse events, are aware of Duty of Candour
legislation and patient safety initiatives and can access information regarding any
aspect of adverse event and clinical risk management as required. Have open and
honest discussions with patients and their families when there has been harm.
Supporting
Provide training, information, tools and methods to enable teams to report, monitor
and learn from their adverse events and near misses and ensure they are
proactively monitoring and mitigating risks across their services. Support teams to
ensure they are meeting legal and national requirements in relation to duty of
candour, continuity planning and patient safety. Produce an annual duty of candour
report that is available in the public domain.
2.2. CONTINUOUS IMPROVEMENT
The aim of this domain is to ensure that all services learn
about what works and what doesn’t and supports teams
to make improvements. The key policy drivers include the
Chief Medical Officer’s Annual Report 2014-15, Realistic
Medicine and Excellence in Care approach. These
reports emphasise the need to put the person receiving
health and care at the centre of decision-making and
create a personalised approach to their care. They also
recognise the importance of valuing and supporting all
health and care professionals as vital to improving outcomes for the people in their care.
Included within this domain are:
Applied Quality Improvement – Application of improvement models, tools and techniques within
clinical areas, such as the ‘Model for Improvement’.
Capacity and Capability – Building capacity and capability in quality improvement and design
skills through a variety of courses and programmes, such as Scottish Improvement Leadership
(ScIL).
Innovation - Forging and maintenance of links with Academic Health Science Partnership; links to
industry, support for funding application, academic evaluation, business development, publishing
and income generation.
Quality Improvement Infrastructure - Management and coordination of a physical and virtual
infrastructure to support innovation and collaboration. Physical elements – Improvement academy
facility and funding for backfill to support innovation. Virtual elements – Website and local, national,
UK and international networks.
Staff responsibilities at each of the four levels for this domain:
Overseeing
Tayside NHS Board is committed to quality improvement demonstrated by the
commitment to NHS Tayside Vision and Values, the Transforming Tayside
programme and work on culture. The Clinical Quality Forum supports quality
improvement at all levels providing the platform for assurance and the identification
and support to key areas of work requiring improvement specifically closing the
loop for quality of care.
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Delivering
Continuous improvement is supported at executive level by ensuring the resources
to drive improvement are effectively used. Clinical leads and managers have a
responsibility for developing programmes of quality improvement adopting
improvement science as an approach to improving clinical care. This ensures
quality improvement is at the heart of everything the Boards do and strategies are
collaborative with the people of Tayside at the heart of our work.
Practising
Local teams identify quality improvement work supported by measurement and
evaluation. These quality improvement ideas can be supported by improvement
practitioners and other support functions, or by accessing an appropriate
educational offer. This approach allows for the flexible use of a range of quality
improvement methods across a range of settings, as it is our experience that
successful quality improvement work can be achieved using a plurality of methods
across a range of settings.
Supporting Provide training, information, tools and methods to enable teams to undertake
quality improvement.
2.3. PERSON-CENTREDNESS
The aim of this domain is to enable all practitioners and
leaders to develop cultures of person-centredness that
positively contribute to patient and staff well being. It
focuses on:
enhancing care experiences
sharing decision making
enhancing how we engage the public in
reviewing and improving our services
implementing best person-centred practices as
advocated by Scottish Government through
‘Excellence in Care’ and Healthcare Improvement Scotland; practical examples include
person-centred visiting and advocacy
developing capability within the system to create environments where staff and therefore
evidence based care flourishes.
Included within this domain are:
Shared decision making – Enabling practitioners and the public to engage in decision making
that meets the needs of people, their preferences and values.
Enhancing care experience – Ensuring our services are compliant with the patient feedback
element of the Patient Rights (Scotland) Act 2011. Enabling services to create cultures and
processes that support learning, act on care experience information, including complaints, survey
feedback, patient stories; Care Opinion contributions and informal verbal comments.
Public Involvement, Communication and Engagement
Public Involvement – The process of public involvement is giving ordinary people the chance to
work in public partnership within NHS Tayside and to become involved in the decision-making
process.
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Communication and Engagement – A planned and sustained approach to communications and
engagement that will enable effective stakeholder involvement, support the delivery of our priorities
for 2019-2022, underpin our decision-making processes and protect and enhance the reputation of
health and care services in Tayside.
Person-centred cultures – Develop facilitators of person-centred cultures and care through the
practice development programme and the collective and compassionate leadership programme.
Patient Information – All patient information leaflets are to be developed, monitored and reviewed
in line with NHS Tayside ‘Good Practice Guidelines for Writing and Reviewing Patient Information’.
By doing this, we will ensure that everyone accessing our services receives information in a format
that meets their requirements and is suitable for their needs.
Equality and Diversity – Ensuring that all staff and people accessing our services are provided
with services that meet the diverse needs of its users and are given equal access to these services
regardless of protected characteristics.
Volunteering – Volunteers provide services alongside staff and make valuable contributions to
enhance the quality of the services we provide to the people we care for. NHS Tayside actively
recruits and allocates volunteers throughout the organisation ensuring necessary support
structures are in place for their volunteers and staff.
Staff responsibilities at each of the four levels for this domain:
Overseeing Clinical Quality Forum through the Quality and Performance Review process seek
assurance on progress against the Person-Centred Board work plan.
Delivering
Enable implementation of Person-Centred Board priorities into all services. Ensure
all staff are supported to understand and practice in accordance with best person-
centred principles and practice.
Practising
Be able to understand the principles of person-centred practice and contribute to
the development of more person-centred cultures and therefore better care and
care experiences and better team relationships.
Supporting
Provide support systems and processes (e.g. learning collaborative; learning
programmes; clinical supervision; guidance, training and research) that enable the
adoption of person-centred practices. Produce regular reports on progress with all
aspects of this domain.
2.4. CLINICAL EFFECTIVENESS
The aim of this domain is to ensure that people who
receive care get the right care, at the right time, in the
right way. It focuses on ensuring our staff and services
are informed and up to date with evidence based
practice; research and development and guidelines as
well as highlighting the importance of having agreed
outcome measures and established clinical audits.
Evidence Based Practice - The foundation for staff to
base their clinical practice on, it ensures that up to date
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information is used to inform clinical practice. An ‘evidence base’ can also be used for other
activities such as improvement. Evidence may be presented as advice, guidelines or standards.
The Health and Social Care Standards, My support, my life, produced by Scottish Government in
2017 set out standards on what should be expected when people use health, social care or social
work services in Scotland. There are five standards:
1: I experience high quality care and support that is right for me.
2: I am fully involved in all decisions about my care and support.
3: I have confidence in the people who support and care for me.
4: I have confidence in the organisation providing my care and support.
5: I experience a high quality environment if the organisation provides the premises.
Research and Development – Enables clinical practice to be progressed and developed, it finds
new ways of doing things.
Outcome Measures – Indicators that enable a judgement to be made on whether or not
interventions have resulted in a change in someone’s health status.
Clinical Audit – Enables aspects of clinical practice to be measured against standards to drive
improvement and provide assurance regarding practice.
Staff responsibilities at each of the four levels for this domain:
Overseeing Seek assurance through Care Governance Committee, Clinical Quality Forum and
Quality and Performance Review processes on all aspects of clinical effectiveness.
Delivering
Ensure there are appropriate structures and mechanisms in place to learn from
research and evidence. Ensure continual improvement to practice for patients and
people accessing our services by identifying and sharing learning in relation to
clinical effectiveness. Provide timely collated quality of care self assessments as
requested by Healthcare Improvement Scotland.
Practising
Ensure they are up to date with evidence based practice and change practice
according to relevant standards, guidelines and research. Contribute to audits and
research.
Contribute to quality of care self assessments and reviews as requested by
Healthcare Improvement Scotland.
Supporting
Provide training, information, tools and methods to enable teams to undertake
audit, learn from adverse events and feedback. Support improvement. Collate a
register of improvement projects for dissemination. Share relevant links and
information about guidelines.
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APPENDIX 1 – STAFF CONTRIBUTIONS TO CLINICAL AND CARE GOVERNANCE
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APPENDIX 2 - RECOMMENDED READING LIST
RECOMMENDED READING LIST FOR ALL STAFF IN RELATION TO
CLINICAL AND CARE GOVERNANCE
Every member of staff working in NHS Tayside and the Health and Social Care Partnerships has a responsibility for Clinical and Care Governance and each
of us contribute everyday regardless of our role and level of leadership.
The aim of this document is to inform staff of key documents that are available about all aspects of Clinical and Care Governance to ensure that staff are
clear and well informed about how the activities that we are involved in on a daily basis contribute to the delivery of the Clinical and Care Governance
Strategy 2019 – 2021. This in turn ensures that we are supporting safe, effective and person centred care.
Within the Clinical and Care Governance Strategy 2019-2021, we refer to responsibilities falling into 4 levels (2000, Scottish Executive):
Overseeing –members of Clinical Quality Forum and Care Governance Committee, non-executives.
Delivering – management structure, including clinicians involved in management – Triumvirate and management leads, clinical governance leads
Practising – clinical, administrative and support staff
Supporting – staff employed in activities underpinning clinical governance, e.g. those involved in clinical effectiveness, audit, complaints handling and
risk management.
This reading list follows the same structure to ensure staff are clear regarding what are the key documents they need to be aware of and where to access
them for further information. The following symbols depicts the level at which you need to be aware/have read the documents dependent on your role.
*** - This is a key document/resource for your role and the expectation would be that you would be well versed in the content of it.
* - You need to have an awareness of this and where you can access it.
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Link Overseeing Delivering Practising Supporting
NHS Tayside Vision, Aim and Values https://www.nhstayside.scot.nhs.uk/YourHealthBoard/index.htm *** *** *** ***
NHS Tayside Transforming Tayside web pages
https://www.nhstayside.scot.nhs.uk/OurServicesA-Z/TransformingTayside/index.htm *** *** *** ***
Transforming Tayside Staffnet page http://staffnet.tayside.scot.nhs.uk/OurWebsites/TransformingTayside/index.htm *** * * *
Clinical and Care Governance Strategy 2019-21
http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_231679.pdf
*** * ***
How do I contribute to Clinical and Care Governance?
http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_317495.pdf *** * *** ***
Clinical Governance and Risk Management Staffnet Page
http://staffnet.tayside.scot.nhs.uk/safeeffectiveworking/ClinicalGovernanceandRiskManagement/index.htm *** * ***
ADVERSE EVENT AND CLINICAL RISK MANAGEMENT
Adverse Event Management Policy http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/docs_016314.pdf
*** * ***
Adverse Event Management Resource Pack http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_325457.pdf
*** * ***
Learning from Adverse Events through Reporting & Review – A National Framework for Scotland: July 2018
http://www.healthcareimprovementscotland.org/our_work/governance_and_assurance/learning_from_adverse_events/national_framework.aspx
*** *** * ***
Duty of Candour Legislation http://www.legislation.gov.uk/ssi/2018/57/made *** *** * ***
Duty of Candour Flowchart http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_297911.pdf
*** * ***
Quick Guide to Duty of Candour http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_302734.pdf *** * *** ***
Risk Management Strategy 2015 – 20 http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_150658.pdf
*** * ***
Risk Management Guidance Note http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_187777.pdf
*** * ***
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Link Overseeing Delivering Practising Supporting
Integrated Joint Board Risk Management Policy and Strategy
http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/working_safely/documents/documents/prod_249967.pdf *** *** * *
Patient Safety Staffnet Page http://staffnet.tayside.scot.nhs.uk/safeeffectiveworking/ScottishPatientSafetyProgramme/index.htm * *** * ***
Resilience planning policy
http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_025250&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
*** * *
CONTINUOUS IMPROVEMENT
Realistic Medicines https://www.gov.scot/publications/chief-medical-officer-scotland-annual-report-2015-16-realising-realistic-9781786526731/
*** * *
Improvement Academy website http://www.ahspartnership.org.uk/ahsp/improvement-team-nhs-tayside/improvement-academy
* * ***
Service Improvement website http://www.ahspartnership.org.uk/ahsp/improvement-team-nhs-tayside
* * ***
PERSON CENTREDNESS
Informed Consent Policy (If working within a Clinical Service)
http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_016304&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
*** *** *
Volunteering Policy
http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_059981&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
*** * ***
Volunteer Services Website http://eds.tayside.scot.nhs.uk/Internet01/GettingInvolved/VolunteerServices/index.htm
*** * *
Carer Staffnet Page http://staffnet.tayside.scot.nhs.uk/OurWebsites/CarersInformation/index.htm?SSContributor=true
*** * *
Patient Information Guidelines http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/pil/documents/documents/prod_216545.pdf
*** * *
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Link Overseeing Delivering Practising Supporting
Embracing Equality, Diversity and Human Rights Policy
http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_016482&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
* *** * *
Equality, Diversity and Human Rights Staffnet Page
http://staffnet.tayside.scot.nhs.uk/OurWebsites/EqualityDiversityandHumanRights/index.htm
*** * * NHS Tayside Complaints and Feedback Staffnet Page
http://staffnet.tayside.scot.nhs.uk/safeeffectiveworking/ComplaintsandFeedback/index.htm * *** * *
Excellence in Care website https://www.nhstayside.scot.nhs.uk/OurServicesA-Z/ExcellenceInCare/index.htm
*** * *
Customer Care LearnPro https://nhs.learnprouk.com/lms/user_level/NavigatorHome.aspx
*** * *
Care Opinion https://www.careopinion.org.uk/ *** * *
SPSO – Valuing Complaints dedicated website
https://www.valuingcomplaints.org.uk/ * *** * *
HIS Patient Feedback Models https://ihub.scot/improvement-programmes/people-led-care/person-centred-health-and-care/real-time-and-right-time-evaluation-report/
*** * *
Patient Rights (Scotland) Act 2011 http://www.legislation.gov.uk/asp/2011/5/contents *** * *
Person-centredness – the ‘state’ of the art – IPDJ editorial
https://www.fons.org/library/journal/volume5-person-centredness-suppl/article1
*** * *
The Community Empowerment (Scotland) Act 2015
http://www.legislation.gov.uk/asp/2015/6/contents/enacted *** * *
NHS Tayside Participation Staffnet page http://staffnet.tayside.scot.nhs.uk/OurWebsites/Participation/index.htm
*** * *
Participation Standard http://staffnet.tayside.scot.nhs.uk/OurWebsites/Participation/ParticipationStandards/index.htm
*** * *
Transforming Tayside 2019-2022 and Communications and Engagement Strategy and Action Plan
https://www.nhstaysidecdn.scot.nhs.uk/NHSTaysideWeb/idcplg?IdcService=GET_SECURE_FILE&dDocName=PROD_320663&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
* *** * ***
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Link Overseeing Delivering Practising Supporting
CLINICAL EFFECTIVENESS
Healthcare Quality Strategy https://www.gov.scot/publications/healthcare-quality-strategy-nhsscotland/ * *** * *
Health and Social Care Standards http://www.newcarestandards.scot/ *** * *
Quality of Care Approach http://www.healthcareimprovementscotland.org/our_work/governance_and_assurance/quality_of_care_approach.aspx
*** * *
Getting it Right for Everyone – A Clinical, Care and Professional Governance Framework
Currently unavailable on Staffnet – hard copies available from CGRM team
*** * *