Clinical Governance - a Definition Clinical Governance - a Definition “A framework through which NHS “A framework through which NHS organisations are accountable for organisations are accountable for continually improving the quality continually improving the quality of their services and safeguarding of their services and safeguarding f th i f th i i i d d f f di di high standards of care by creating high standards of care by creating an environment in which excellence an environment in which excellence Anil Kumar Mulpur in clinical care will flourish” in clinical care will flourish” M.B.B.S, M.S, M.Ch, F.R.C.S (Edinburgh), F.R.C.S (Glasgow) F.R.C.S Cardiothoracic (Edinburgh), FETCS Donaldson and Scally Donaldson and Scally 1
MANAGEMENT /ADMINISTRATION DOCTORS DOCTORS AND PATIENTS PATIENTS DOCTORS PATIENTS MEDIA QUALITY INFRASTRUCTURE PROFESSIONAL NATIONAL / INTERNATIONAL COMPARISON QUALITY QUALITY NURSING ADMINISTRATION MEDICAL COST QUALITY PROFESSIONAL PROFESSIONAL PROFESSIONAL QUALITY QUALITY QUALITY • I AM PAYING TAX / I AM TOO POOR • CANNOT WAIT TO BE SEEN • SPEND LEAST MONEY / • NO DELAY IN OUT PATIENT DEPARTMENT GET THE BEST POSSIBLE CARE • DOCTORS / NURSES TO BE COURTEOUS DOCTORS / NURSES TO BE COURTEOUS • NO HEALTH CARE WITHOUT MONEY NO HEALTH CARE WITHOUT MONEY • NO DELAY IN INVESTIGATION • SOMEBODY ELSE TO SPEND • VOLUNTARY HEALTH ORGANIZATION • NO DELAY IN INTERVENTION • GOVERNMENT • INSURANCE • SHORT / SWEET STAY • EMPLOYER 2
Clinical Governance - a Definition Clinical Governance - a Definition • GOOD FOOD / GOOD TOILETS “A framework through which NHS “A framework through which NHS / GOOD ENTERTAINMENT organisations are accountable for organisations are accountable for • NO COMPLICATIONS continually improving the quality continually improving the quality of their services and safeguarding of their services and safeguarding f th i f th i i i d d f f di di • PATIENT FORUM / ATTENDERS FORUM PARENTS FORUM / EXPRESS UNHAPPINESS high standards of care by creating high standards of care by creating an environment in which excellence an environment in which excellence • MEDIA WANT MASALA !!! in clinical care will flourish” in clinical care will flourish” Donaldson and Scally Donaldson and Scally “CREATING AN ENVIRONMENT IN WHICH EXCELLENCE IN INTERACTION ADMINISTRATION CLINICIANS CLINICAL CARE WILL FLOURISH” POSITIVE ATTITUDE NEGATIVE ATTITUDE • MUTUAL SUSPICION • HEALTHY ADMINISTRATION • BACK STABBING / CLINICIANS • PRODUCTIVE BACK BITING BACK BITING OR OR MANAGEMENT INTER RELATIONSHIP • TRANSPARENT • UNHEALTHY UNPRODUCTIVE • WITH A VIEW TO EXCEL OPAQUE “NO HOSPITAL / DEPARTMENT CAN “EXCEL” • DETERIORATION IS DEFINITE WITHOUT A HEALTHY INTERACTION CLINICIANS = DOCTORS CREATING AN ENVIRONMENT ROLE OF CLINICIANS • PROFESSIONALLY QUALIFIED INTERACTION INTERACTION • PROFESSIONALLY COMPETENT O SS O CO CLINICIANS ADMINISTRATION • CONTINUING MEDICAL EDUCATION • CONTINUE TO IMPROVE SKILLS 3
ROLE OF CLINICIANS ROLE OF CLINICIANS • REVIEW THE PERFORMANCE PERIODICALLY IF YOU THINK YOU REACHED THE TOP… • AUDIT / RESEARCH • INTER PERSONAL RELATIONSHIPS THERE IS ONLY • INTRA DEPARTMENTAL RELATIONSHIPS ONE WAY TO GO… • INTER DEPARTMENTAL RELATIONSHIPS TUMBLING DOWN !!! ROLE OF MANAGEMENT OR ADMINISTRATION MAN POWER MATERIAL KEY GROUPS OF PEOPLE • RECRUITMENT POLICY • BALANCE BETWEEN COST • RETENTION POLICY AND QUALITY • EMPLOYEE SATISFACTION • PROMOTE EXCELLENCE • REWARD EXCELLENCE • REWARD EXCELLENCE • “ IF YOU DON’T GIVE • IF YOU DON T GIVE • “BLACK SHEEP” EXCELLENT MATERIAL OPINION LEADERS - DEAL WITH TACT YOU CANNOT EXPECT • ENFORCE DISCIPLINE EXCELLENT RESULTS” Everybody listens to them… MISERABLE DOUBTERS Pour cold water on everything Accountable Accountable Safe & high quality Safe & high quality Safe & high quality Safe & high quality Open & questioning Open & questioning 4
Teamwork Teamwork Leadership Leadership Ownership “What went “Blame wrong?” and train” Systems Communication Communication Awareness Root cause Environment analysis of fear 5
Day 1: It’s possible! Day 2: Patient - Professional R Partnership Review/ Day 5: Day 3: think through D D D D A A RAID Model RAID M d l Agree/ Document consensus Demonstrate Day 4: Data generation I Implement/ Systems Communi- Teamwork Ownership Leadership deliver Awareness cation MANAGEMENT OR ADMINISTRATION SUCCESS TIPS • Get close - where you stand affects what you see. • Try to contact a doctor through the main switchboard. • Help your people grow - many individuals have hidden talents. • Try to contact an ICU late in the night to enquire about a patient. • Involve everyone - it is not only clinicians • Go to out patients and ask for a wheelchair Go to out patients and ask for a wheelchair. who impact on the efficiency of services. • Sit in an out patient clinic and see what happens to the person • Mistakes are opportunities - staff want to do a good job, next to you, stay till he leaves. Would you like to be help them learn from mistakes. treated the same way? • Provide the tools - people need modern tools • Spend a night on a ward bed. Use the toilets in the out patient to do a modern job. clinic/ ward. Are you happy with the conditions? SUCCESS TIPS SUCCESS TIPS • Focus your efforts - give clinical governance meetings a • Use time carefully - think carefully about your calls on practical purpose. people's time. • Make progress visible - the simple ideas are often the • Use proven techniques - to seek patients' views. best. • Help people help themselves - developing the skills of • Manage upwards - learn how senior people like to be PHCTs. kept in touch • Encourage initiative - to allow staff to redesign their • Moving together - good teams don't just happen. department. • Prove it will work - find volunteers to help you test new • Talk to the right people - if you want to make things procedures. happen 6
SUCCESS TIPS SUCCESS TIPS • Encourage volunteers - to share the development load. • Get issues in the open - to make separate departments work well together. • Use terms carefully - if you want to create a common approach. • Hear what patients say - help patients make their point. • Getting the message - use IT equipment sensibly. • Use proven techniques - mind maps can help manage complex issues. • Do your homework - to get the resources you need. • Small groups work - you don't need large groups of • Use resources flexibly - don't let traditional boundaries patients. stop development. • Get known - give your project a catchy title. SUCCESS TIPS SUCCESS TIPS • Prove it will work - by testing a new IT system. • Understand others - don't make assumptions about them and their roles. • Seek support, make space - finds ways for a time-out to tackle big tasks. • Find the right way - don't assume that you need a working group. • Help staff keep in touch - communications are an essential • Getting through the maze - meetings can be the best form of 'life-blood' of a good service. information sharing. • Show how it works - consider using experts in role-play. • Keep focused - consider carefully how to manage discussion groups. • Mistakes are opportunities - building on complaints. • Keep on track - busy people can lose direction. SUCCESS TIPS SUCCESS TIPS • Careful preparation assures success - don't overlook the • Get the right focus - with patients as key stakeholders. administrative tasks involved. • Don’t duplicate effort - when seeking the views of service users. • Make training relevant - don't assume that generic courses are relevant to everyone. • Be opportunistic - when seeking the views of service users. • Learn as you go - new skills are an essential part of personal • Don't make assumptions - about what matters to patients. development. • Make meal times happier - and a better social experience. • Make training visible - look for innovative ways to give messages tofrontline staff. • Encourage initiative - most staff can point to ways to improve their services. 7
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