You Should Write 1000 words Divided into Intro about clinical governance and then policies of clinical governance and then models of clinical governance and conclusion. A sample will be provided to make it more easy for you.
Clinical governance was first introduced in 1997 as a comprehensive framework to improve the healthcare quality in the National Health Service (NHS) (Department of Health, 1997). Since its introduction, differing perceptions and organizational interpretations on the concept have emerged, together with a proliferation of definitions, policies and models on clinical governance (Flynn, 2002; Franks, 2001; Som, 2004). This report aims to critically appraise some of the policies and models relating to clinical governance.
Policies of Clinical Governance
Department of Health (DoH) and Scottish Office Health Department (SOHD)
Clinical governance is defined as “a framework through which NHS organisations are accountable for continuously improving the quality of their service and safe guarding high standards of care, by creating an environment where excellence in clinical care will flourish” (Scally and Donaldson, 1998, p.61). The White Paper – The New NHS: Modern, Dependable, presented a refocusing of the NHS approach from an internal market which centred on competition and financial performance, to an integrated care approach which emphasized on collaboration and quality care; and introduced the new system of clinical governance (Department of Health, 1997).
Following the White Paper, a more detailed document - A First Class Service: Quality in the new NHS, was published (Department of Health, 1998). It detailed the key policy principles towards improving healthcare quality through setting, delivering and monitoring of standards with patient and public involvement. Clinical governance sits in the centre of this quality agenda, together with professional self-regulation and lifelong learning. It presented with 4 main components of clinical governance which include clear lines of responsibilities and accountability, comprehensive programme of quality improvement activities, clear policies at managing risks; and procedures to identify and remedy poor performance. These 4 components aptly set the paradigm that clinical governance sits on: a responsible and proactive organization, with an enabling and learning culture; which emphasizes on quality and safety in patient care. The Health Service Circular provided further guidance on the implementation of clinical governance (Department of Health, 1999).
The Management Executive Letter, MEL(1998)75– Guidance on Clinical Governance, echoed the direction of the White Paper and provided the guidance for the introduction and implementation of clinical governance in the NHS in Scotland (Scottish Office Health Department, 1998). NHS Scotland, correspondingly, defined clinical governance with 5 key principles – managing clinical effectiveness, managing risks, involving patients, patient safety and incident reporting; and using evidence. These principles appropriately encompass the key ideologies surrounding clinical governance: patient-centric care with strong organizational responsibility and emphasis on quality and safety.
While these 2 policies originate from different government bodies, they reiterate the same principles surrounding clinical governance – an emphasis on continuous improvements, quality, safety and a learning culture. These policies set out the framework for NHS organizations to improve and assure the quality of clinical services; and draw attention to the corporate accountability and statutory duty of quality. Clinical governance, hence, positions itself between the healthcare provider and the patient, linking activities owned and led by the clinicians into a structured framework, marrying clinical judgement and professional self-regulation with national standards, to ensure that consistent standards and quality care are met; and patient safety is assured.
Models of Clinical Governance
Likewise, there had been a proliferation of mixed metaphors with regards to the models surrounding clinical governance. In practice, the scope and scale of clinical governance embraces a combination of different processes and activities and involves a highly diverse set of managerial procedures and organizational tasks (Flynn, 2002). These are manifested by the various models of clinical governance as discussed.
“Clinical Governance is ACE” Model
Wakefield and Pontefract Community Health NHS Trust developed a simple model of clinical governance called, “Clinical Governance is ACE”, which captured the links between Accountability, Culture and Effectiveness (Figure 1) (Holland and Fennell, 2000). The centre of the pyramidal model is quality patient care with culture, accountability and effectiveness at each of its apexes. It provides a macro view of how clinical governance can be instituted from a corporate standpoint and how clinical governance is dependent upon the people and effective processes of the organization in the delivery of results.
In contrast to ACE model, the model proposed by Franks (2001) shifted the focus of clinical governance from a macro-, corporate level to one of a micro-, clinical team level (Figure 2). It examined the concept of clinical governance as a restructuring of quality assurance processes, as evident by the behaviour and practice change at the clinical service, and clinical team level. The three elements of quality assurance as laid out were: standardised skills; standardised outcomes and standardised processes, while maintaining the balance between professional autonomy and external efforts to assure quality. Quality of service at local level is governed by the policies and elements of clinical governance at the macro-, corporate level. Frank’s model would thus be an adjunct to higher, macro- level models of clinical governance. The strength of Frank’s model is that it is a bottom-up approach, instilling the culture of quality on the people who are in direct contact with the patients through standardized care. With the emphasis on standardized approach to patient care, risk-taking behaviours by the physicians will be minimized. Conversely, blind adherence to the standardized approach may stifle the doctor’s autonomy and the use of their professional judgement. Striking a balance between professional autonomy and quality assurance through standardization is the key to success.
Model for Clinical Governance in Primary Care Groups