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Making Clinical Governance Work for You Making Clinical Governance Work for You Ruth Chambers Gill Wakley Radcliffe Medical Press Making Clinical Governance Work for You Ruth Chambers and Gill Wakley Forewords by David Haslam and Alison Norman Radcliffe Medical Press ©2000 Ruth Chambers and Gill Wakley Illustrations ©2000 Martin Davies Radcliffe Medical Press Ltd 18 Marcham Road, Abingdon, Oxon OX14 1AA All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the copyright owner. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN 1 85775 413 1 Typeset by Advance Typesetting Ltd, Oxfordshire Printed and bound by TJ International Ltd, Padstow, Cornwall Contents Forewords v Preface vii About the authors ix List of abbreviations x Part One Introduction 1 1 What is clinical governance and how does it fit with professional and service development? 3 2 How to do it: identify your service development needs and your associated learning needs 7 3 Use a range of methods to identify your service development and learning needs 11 4 Where do you want to be and how do you get there? 19 5 Setting priorities for developing clinical governance 23 6 You have identified your learning needs – now what? 27 7 Baseline review 29 Part Two The 14 themes of clinical governance 31 Module 1 Establishing and sustaining a learning culture 33 Module 2 Managing resources and services 49 Module 3 Establishing and disseminating a research and development culture 67 Module 4 Reliable and accurate data 79 Module 5 Evidence-based practice and policy 93 Module 6 Confidentiality 105 Module 7 Health gain 119 Module 8 Coherent teamwork 139 Module 9 Audit and evaluation 153 Module 10 Meaningful patient and public involvement 167 Module 11 Health promotion 183 Module 12 Risk management 195 Module 13 Accountability and performance 207 Module 14 Core requirements 223 iv Contents Part Three Quality improvement 239 Challenges of quality improvement 241 Appendix: resources 247 References 251 Index 261 Foreword There are some words and phrases that should never have been invented. That simple word ‘audit’ created astonishing levels of antibodies amongst healthcare professionals when it was first introduced, but these were nothing compared to the irritation, puzzle- ment and resentment that the words ‘clinical governance’ have caused. For perhaps a majority of the potential readers of this book, the concept of clinical governance has become something as unwelcome as a dental check up. We know that we have to do it, we know that it is really for the best, but we simply cannot dig deep and find any enthusiasm for the process. Which is really very odd, as clinical governance simply refers to a systematic way of ensuring that what we do is of quality, allied with finding ways in which we can improve. And none of us would want to argue with that. If you are wondering how you or your practice can begin to tackle clinical governance, and do not simply want to be spoon fed a programme by someone else, then this book is for you. It is a workbook, not a textbook. Old-fashioned textbooks are like lectures, but this is the literary equivalent of the small group discussion. It will make you think, it will make you question what you do, and inevitably it will make your work improve. Our patients deserve nothing less. David Haslam General Practitioner Cambridgeshire June 2000 Foreword To be successful in enabling us to provide healthcare of good quality and effectiveness, clinical governance must become a tangible reality to all frontline practitioners. This will involve a learning and development challenge for NHS organisations big and small, managers and clinicians. Clinical governance is an overarching term for a range of prac- tical approaches which together will provide a greatly improved service to patients and clients. Demystifying the jargon and explaining the approaches and how they fit in practice is the objective of this book. The material contained within it is valuable across the range of healthcare professions and may be usefully employed by multidisciplinary teams. In an environment where increasingly we are recognising the need for partnerships and collaboration in healthcare, it is good to see a publication which has relevance for all healthcare providers and I commend it to you. Alison Norman CBE HonDSU Executive Director Nursing, Combined Healthcare NHS Trust President, UKCC June 2000 Preface For doctors, nurses, health visitors, therapists and practice managers, and any other staff as individuals and as workplace or practice teams to apply clinical governance in their workplace. This is the book for you, whether you are employed by a general practice, or a community trust. The material is also available through the website of Radcliffe Online, www.primary careonline.co.uk The book presents a more detailed version of the online programme, for those who prefer to work from a book rather than a computer screen. All clinicians are expected to approach their continuing professional development in a more systematic way now, rather than in the ad hoc manner of the past. We should be moving towards team-based learning that includes everyone, whether they are a doctor, nurse, therapist, manager or provide non-clinical support. Clinical governance will underpin individuals’ and team-based professional development plans, which in turn should link into the business plans of their PCG/PCT or NHS trust. The quality of the workforce dictates the quality of healthcare they deliver. An effective workforce is one where individuals are competent to carry out their current roles and responsibilities, and their training anticipates new models of service delivery. Achieving this requires sufficient resources and the right learning environment throughout the health service. The future is in multidisciplinary learning as work- based teams, addressing topics that are relevant to the needs of the local population with clinicians and managers working closely together to put that learning into action. Clinical governance underpins this way of working and accounting for: • sustaining quality improvements • minimising inequalities in the health of different subgroups of the population • reducing variations in healthcare services • defining standards • demonstrating achievements. The emphasis in the book and online programme is on what individuals and work- place teams can do themselves to identify their own learning needs, and then draw up and prioritise their own action plans. The material is based around 14 themes as viii Preface components of a quality healthcare service. We hope to help you overcome the gulf that exists between theory and practice, or between talking about something and actually doing it. So we have integrated ‘thinking and doing’ throughout these 14 themes. Ruth Chambers Gill Wakley June 2000 About the authors Ruth Chambers has been a GP for 20 years. Her previous experience has encompassed a wide range of research and educational activities, including stress and the health of doctors, the quality of healthcare and many other topics. She is currently the Professor of Primary Care Development at the School of Health at Staffordshire University. She was the Chair of Staffordshire Medical Audit Advisory Group and a GP trainer for many years. Ruth has initiated and run all types of educational initiatives and activities. She and Gill have run workshops to teach GPs, hospital consult- ants, nurses, therapists and non-clinical staff about clinical governance. The experiences of the workshops and how the participants put their learning about clinical governance into action inform this book. Gill Wakley started in general practice in 1966, but transferred to community medicine shortly afterwards and then into public health. A desire for increased contact with patients caused a move back into general practice, together with community gynae- cology, in 1978. She has been combining the two, in varying amounts, ever since. Throughout she has been heavily involved in learning and teaching. She was in a training general practice, became an instructing doctor and a regional assessor in family planning, and was until recently a senior clinical lecturer with the Primary Care Depart- ment at Keele University, Staffordshire. Like Ruth, she has run all types of educational initiatives and activities from individual mentoring and instruction, to small group work, plenary lectures, distance learning programmes, workshops, and courses for a wide range of health professionals and lay people. List of abbreviations CHI Commission for Health Improvement CPD continuing professional development HImP Health Improvement Programme IT information technology NICE National Institute of Clinical Excellence NSF National Service Framework PCG primary care group PCT primary care trust SWOT strengths, weaknesses, opportunities and threats Meaningful involvement of Evidence-based Health patients/public practice and gain policy Risk Confidentiality management Audit and evaluation Accountability Core and requirements performance Health promotion Co-ordinated clinical governance Coherent team Managing resources and Reliable Research and Learning services data development culture Figure A ‘Routes’ and branches of clinical governance. This page intentionally left blank PART ONE Introduction This page intentionally
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