Implementing Clinical Governance in an AOD treatment service

Venetia BrissendenCatchment ManagerReGen

“Clinical governance provides the opportunity to understand and learn to develop the fundamental components required to facilitate the delivery of quality care – a no-blame, questioning, learning culture, excellent leadership and an ethos where staff are valued and supported as they form partnerships with patients. These elements have perhaps previously been regarded as too intangible to take seriously or attempt to improve.”

Halligan, A. & L. Donaldson (2001) “Implementing clinical governance: turning vision into reality”, BMJ VOL 322, pp. 1413-1417

Why?

• Operating in an environment increasingly attentive to risk and quality (child safety, cultural appropriateness, critical incidents, coronial inquiries, royal commissions etc)

• Increasing emphasis on evidence based practice

• Organisations genuinely wanting to know that we are providing the right service in the right way at the right time for the right outcomes

At ReGen

• 2008 – Victorian Department of Health states they have “an expectation that all health services [in Victoria] will have a formal and effective clinical governance framework in operation”

• 2011 – Clinical Governance briefing paper developed to recommend an appropriate framework for implementing Clinical Governance at ReGen

• 2011 – Clinical Governance Committee formed – has met monthly since then

• 2011 – present. Clinical Governance embedded into the organisational culture and structure of ReGen and has become an important driver for continuous improvement in clinical work and staff development

• 2014 – Clinical Governance Committee formed for North West Metro AOD Service partnership

•“[Clinical governance is] the system by which the governing body, managers and clinicians share responsibility and are held accountable for patient care, minimising risks to consumers and for continuously monitoring and improving the quality of clinical care.”

•(Australian Council on Healthcare Standards (2004), ACHS News, Vol 12 1-2, Sydney)

Briefing paper

• No particular structure, system or process is mandated through the adoption of a clinical governance framework.

• Organisations in the UK and Australia have operationalised clinical governance very differently

• The nature of an organisation will dictate the formal and informal structures used to maintain and improve clinical quality

“The aim of clinical governance is to integrate apparently discrete and independent domains of activity into a unified whole... By bringing together all clinical quality activities under a single umbrella, clinical governance [ensures] ... quality improvements can benefit the whole organisation.”

Oyebode, F. (2000) “Devolution of clinical governance mechanisms to units and teams”, Psychiatric Bulletin, 24, pp. 442-443

Most important is a policy framework that identifies

• Domains – what are the aspects of clinical work that need to be monitored and continuously improved? What contributes to good and safe clinical practice?

• Elements – Who are the various actors in these domains, e.g. Board, senior management, staff, consumers

• Mechanisms – what are the activities that are undertaken to govern clinical activity?

Clincial Governanc

e

Compliance

Effectiveness

OpennessSafety

Participation

Workforce support &

development

CULTURE

Domains

Victorian Quality Council (2005) Better Quality, Better Health Care. A Safety and Quality Improvement Framework for Victorian Health Services. Metropolitan Health and Aged Services Division, Victorian Government Department of Human Services, Melbourne.

Mechanism examplesActivities which contribute to ensuring effectiveness include:• Conducting clinical file audits and acting on findings• Monitoring staff clinical supervision and suggesting focus

areas based on audit findings• Conducting or planning research on intervention outcomes

Activities which contribute to ensuring openness include:• Feeding back to staff meetings• Well advertised and fair complaints process• Seeking out and responding to client, student and

stakeholder feedback• Developing position papers, briefing papers, seminars

Activities which contribute to ensuring participation include:• Client participation in a range of forums (e.g. leadership

groups, service planning, program evaluation, training)• Seeking input at staff meetings• Soliciting client, staff, student and stakeholder feedback• Fostering Leadership Groups to develop clinical practice

and respond to emerging service challenges

Activities which contribute to ensuring safety include:• Collating reports and responding to trends in critical

incidents and near misses• Conducting and responding to OH&S audits• Planning workforce development activities in

response to findings from file audits, critical incidents, annual appraisals, etc

In operation• Regular meetings important – we’ve tried to

make it bimonthly but this was too far apart• All of the decision makers in the various

domains need to be involved – otherwise nothing will happen

• Clinical Governance needs to be close to CEO and Board to inform them of any risks but also needs to be across service delivery – in a large organisation this may require different levels of structure, activity and decision making

Clinical Services Leadership Group

Methamphetamine Leadership Group

Service User Participation Leadership Group

Staff Action Group

OH&S Committee

Family Inclusive Practice Leadership Group

Leadership Groups Reporting to Committee

Board of Governance

CEO

Senior Management Team

Clinical Governance Committee

Evaluation & Communications Team Leader

Manager Workforce Development & Diversion

Programs

Director Clinical Services 

Director Education & Advocacy

Senior HR Officer (also holds OH&S portfolio)

Clinical Services Managers

Consumer Participation Facilitator

Regular Reports Provided to Committee

Performance against targets

Client feedback (complaints, compliments, surveys, etc)

Critical incidents and near misses

Annual performance appraisals summary, including identified

training needs

Staff Survey

Legal compliance

RTO Audit

Clinical Audits

Clinical Governance at ReGen

Sequencing of information

Much of the reports and activities considered by Clinical Governance need to be sequenced to appear in a timely manner for consideration – for example, a training calendar should not be decided until the results of the clinical file audits, staff appraisals and critical incident summary reports are considered

For this and other reasons admin support is strongly recommended

Clinical Governance Committee - sequencing of agenda items

  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Standing agenda items

See agenda

Quarterly reports

Incident Reporting Summary – quarterly (HR)

X     X     X     X    

Data Reports

  X   X     X     X    

Appraisal reports    X     X     X     X

Legal Compliance    X     X     X     X

Six monthly reports

Report to CEO and Board on CG activity           X         X