Clinical Governance has evolved since its introduction in the White Paper 1998, as a means to improve the quality of care delivered by the National Health Service. The classic definition of Clinical Governance is “a framework which NHS organizations are accountable for continuously improving the quality of their services and safe guarding high standards of care by creating an environment in which excellence in clinical care will flourish” (Hill, 2003).
This framework is challenging professionals to adapt the way they are working; demonstrating that team work and communication are as important as high quality health care, risk management, and clinical effectiveness. Clinical Governance has since been developed, as a series of failures have been highlighted within the health service. Upon reviewing this downfall in quality, Liam Donaldson and Aidan Halligan attributed that, “Clinical Standards have taken a back seat to financial and resource management issues” (Mc Sherry, 2001).
Clinical Governance is composed of the following elements, Education, Clinical Audit, Clinical Effectiveness, Risk Management, Research and development and Openness. These elements are underpinned by the recognition of Communication, Teamwork and Leadership (Chambers et al. 2007). In order to provide high quality health care, all professionals are required to maintain Continuous Professional Development. Therefore, systems have been put into place to support the HCP’s continuation of their education, for example, Post Registration Education and Practice (PREP) (Dimond, 2008). The reliability of NHS Trusts and Primary care groups in education and development has been satisfactory as the programmes are fuelled by funding from both NMET and MADEL sources. Primary care trusts are accountable to Health Authorities and the commission for the Health Improvement (CHI). The Workforce Confederations are required to deliver effective education (Bridgehead Consulting, 2011).
Clinical audit is another strategy that has been utilised by the clinical governance framework to enhance the quality of care. Clinical auditing is an ongoing process of reviewing clinical standards against an agreed set of standards. Auditing is a proficient part of clinical practice and has been in place for generations. It is a priority requirement in the NHS and is facilitated by the Medical Audit Advisory groups (MAAG) (Stewart, 2003). Audit as a process starts with a reflection on the current performance, observing practice, comparing practice to standards and implementing changes if required. Closer monitoring of health care and processes is required in order to ensure that the components of clinical governance are contributing to quality care. Further, the involvement of the general public supports greater transparency and the likelihood that the services meet the needs of the local population.
Clinical effectiveness questions how effective a clinical intervention is, measuring how appropriate it is, along with its cost effectiveness (Chambers et al, 2007). NICE (National Institute for Health and Clinical Excellence) guidelines have been developed to improve clinical effectiveness. NICE is a set of guidelines based on research evidence which are a fundamental part of promotion of good health, and are a key part in the Health care system.
Working with the health of the public is a precarious matter; therefore every organization should reduce risks by monitoring risk against the quality assurance programme. Communication is the linchpin of every pillar within the framework, therefore openness and team discussions are a vital procedure. Without communication, quality of care can be affected, as the framework may not be discussed. Consequently clinicians will fail to perform to a high quality and the whole team will suffer (Swage, 2000).
2.0 Clinical Risk Management
Clinical Governance in Podiatry is paramount in ensuring clinical services are of the highest excellence, providing effective, safe and patient focused care, of which every person using the services should expect. The blame culture today has been a substantial influence on practitioners, as the huge litigation driver has forced Podiatrists to perform in a no mistakes society. This kind of culture does not leave room for mistakes, support and professional development provoking patient discontentment. Therefore, to reduce Clinical Risk Management in Podiatry, critical systems which monitor activities need to be maintained. These include incident reporting, handling of complaints, and supervision. These can all minimise patient risk, which in turn improves the quality of Podiatry treatment.
‘A Clinical incident is any unintended or unexpected incident, which could have or did lead to harm for one or more of the patients’ (NHS Greater Glasgow and Glyde, 2007). Clinical incidents can jeopardise the health of the patient leaving them feeling emotionally and physically distressed. Without full patient support, and satisfaction that everything is being done to prevent reoccurrence of the incident, litigation claims can be made leaving an unsatisfied patient and a demoralised health care professional. This part of risk management clearly has a fundamental affect on the partnership between practitioners’ and patients. In order to avoid hazard to the patient’s health, it is vital, as a risk management policy for practitioners to maintain an honest and open communication with the patient. Discussion of patient safety in a compassionate manner can support the patient helping them deal with any after affects, and prevent them from making any litigation claims. A MORI survey in which 8,000 people were interviewed, of which 400 had been involved in an incident, and 34% wanted an apology and reassurance that the same incident would not reoccur (National patient safety agency, 2005). Although this is a high figure, with 98,000 patients’ being involved in incident’s per year (Corrigan et al 2000), this provides an advantage, being that with a risk management policy in place, integrated with other policies, means that disciplinary action can take place to prevent reoccurrence of similar incidents, which would then reduce the figure in the future.
All complaints must be fully investigated, however stressful they are for the staff handling them. Patients can be angry, rude and aggressive towards staff members as a result of an emotional experience which may have been ignored. If a supportive systematic approach is not in place for monitoring complaints, staff can regard complaints as criticism, leading to a detrimental effect on their Podiatry practice. This can mean that the patient may not receive the best foot care treatment the practitioner is capable of. Therefore, an open honest environment in which complaints are monitored is required so complaints are taken less personally without it having a negative impact on practice, leading to improved practices and maintaining quality health care for the patients. However, if a supportive complaints system is not in place encouraging staff to change practices, patients may feel unsatisfied with the results and refuse any podiatric treatment or advice given. Obsessive behaviour can have a negative effect on foot health of the patient and lead to increased health problems. Yet, some patients feel their treatment may be compromised if they complain, but all complaints must be fully investigated and handled in the same way. Therefore, the Podiatrist should carry out their treatment in their professional manner regardless of patient complaints against then.
Clinical Supervision is another activity under risk management which requires close monitoring, in order for patient care not to suffer. “Clinical Supervision provides a support system for practitioners to ensure the provision of high quality treatments and services through the evaluation of practice and by encouraging practitioners to learn from their experiences” (Department of Health, 1999). Clinical Supervision is one of the greatest drivers in taking forward clinical care (Driscoll 2000). One of the advantages of Clinical Supervision is that it has its roots in specific failures of care from the 1990’s, highlighting unfavourable outcomes when the health service failed. More importantly, clinical supervision provides benefits for the NHS, PCT and practice, enabling problems to be identified as early on as possible. As well as this, the HCA can receive feedback about their work in order for monitoring to take place. The patient will receive quality health care from an effective supervision scheme, and there is sufficient room for staff development skills.
Although supervision allows for development of skills, it can encourage a culture of introspective contemplators who then become detached from their patients. Whereas, too much reflecting can cloud a podiatrist’s judgment and can cause a lack of confidence in practice, which can seriously have a detrimental effect on patient care. Furthermore, workers within the health profession can often feel unsupported and lonely, as they attempt to meet the terms of standards and charters. This in turn leaves little time for friendships to develop, which can lead to a feeling of hopelessness that can impact heavily on the patient-podiatrist relationship. Overall, effective supervision benefit’s the NHS, PCT, employee and patient, and therefore has many benefits. For the patient this includes effective service and employee motivation, job satisfaction, and problems are resolved earlier. In order to avoid downfalls in the process, frequent supervision is required, especially when new tasks take place and new staff is in a post. The supervision session should be fully prepared for by both the employee and the supervisor, considering that future goals and possible changes might occur within the practice.
In conclusion, it is a useful idea for the health industry to review its position on risk management, as it is both important, and effective. Managing health safety risks is particularly essential, as it puts staff in control. Clinical risk management helps to prevent accidents and ill health towards patients, which can cause problems towards the podiatry practice and to the health service in general. Risk management provides benefits to both staff and patients. Workers are educated in patient safety and guidelines that often help to lessen carelessness. Healthcare workers attempt to please the patient which as well as being a benefit towards the patient, is also beneficial for the staff, as it lowers lawsuits and enhances patient care.
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