‘What [really] is Clincial Governance

ACSLM Scientific Education Development Event

Maureen Flynn, HSE Quality Improvement Division 24 September 2016

Person and family engagement

Starts with…

Impromptu Network

• What [really] is clinical governance?

• Pairs - find strangers or colleagues in groups/functions different from their own

• In each round, 1 minute per person to answer the question

• Three rounds 2, 2, 2

Health care is Complex

Why Quality and Safety Systems..

• Irish Study – Eight Hospitals

– 1574 randomly selected inpatient adult charts

– Retrospective (2009)

– Trigger tool (45% charts)

• Results – Prevalence of adverse events

12.2%

– Incident of 10.3 per 100 admissions

– 70% considered preventable

– 9.9% causing permanent impairment

– 6.7% contributing to death

Clinical Governance

• Clinical governance is described as: –the system through which healthcare teams are

accountable for the quality, safety and experience of patients in the care they have delivered

• For health care staff this means: –Specifying the clinical standards you are going to

deliver and showing everyone the measurements you have made to demonstrate that you have done what you set out to do

• “find it’, ‘fix it’ and ‘confirm it” (O’Connor and Paton, 2002)

Integrated Corporate and Clinical Governance

“The main lesson I take from the problems at Mid-staffs is that in future, we must never separate quality and financial data.

They are always two sides

of the same coin.” (Secretary of State

for Health, England, 2010)

“….corporate and clinical

governance arrangements

must include unambiguous

lines of accountability for

assuring, performance

managing and improving

the quality and safety of

services at a national,

regional, local and clinical

level” (Minister for Health, 2013)

Governance for Quality

…‘it’s a system by which you are trying to ensure that the best possible outcome occurs for individual patients and their families and in so doing you are enabling staff who are delivering the care and support to be able to do that in a proper and response environment’…

(former CEO and current Board Member, 2016)

Defining Quality

Reference:

HIQA: National

Standards for Better Safer Healthcare , 2012

The combined and unceasing efforts of everyone to make changes

Defining Quality Improvement

Reference:

Batalden, Davidoff QualSafHealth Care 2007

The Six Drivers for Improvement

• Enablers

• When combined together create the environment and acceleration for improvement

The Six Drivers for Improvement

• Enablers

• When combined together create the environment and acceleration for improvement

With: Quality and Safety Culture

With: Structures and Processes

• Purpose – heighten safety awareness

– assist teams in being proactive about the challenges they face in providing safe high quality care for patients

• Practical – why, who, when and how

– focused on one question ‘what patient safety issues do we need to be aware of today’

– 4Ps patient, professional, processes, patterns

– resulting in immediate actions

• Outcomes – Tests in acute general, children's and mental

health I feel a valued member of staff now, I was never asked for my input before.... Everyone sees the benefit, safety is all our concern…. it has been good for the team

Daily: putting the focus on safety

Strengthening: Team Working

Through the Eyes of the team

Creating joy, meaning and safer healthcare

• Can each person in my unit answer yes to these three questions

– Am I treated with dignity and respect by everyone?

– Do I have what I need so I can make a contribution that gives meaning to my life?

– Am I recognised and thanked for what I do?

Meaning: the sense of importance of an action

Joy: the emotion of pleasure, feeling of success, and satisfaction as the result of

meaningful action/work in healthcare

Source: Lucian Leap Institute (2013) http://www.patientcarelink.org/uploadDocs/1/Through-Eyes-of-the-Workforce_online.pdf

Governance for Quality Having the necessary

• Structures

• Processes

• Standards and

• Oversight in place to enable the delivery of services that are safe and provide excellent quality of care

What opportunities do

YOU see for applying clinical governance in your area of

work?

1-2-4-All

http://www.liberatingstructures.com/

Where to find the resources

Twitter: @HSEQI

Web: www.qualityimprovement.ie

Email: nationalqid@hse.ie

Maureena.flynn@hse.ie