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Abstract

Within this article the author will examine what clinical governance is. It will discuss some of the many different, but interlinked, components, which, when all working together, help to ensure the quality of care that individual support workers deliver, as well as the organisation as a whole. It will use as a base for its discussion 7 of the components that make up ‘The Temple Model of Clinical Governance’ devised by the Clinical Governance Support Team. Clinical governance is a mechanism that enables quality to be placed at the heart of everything that we do as support workers. Every patient has the right to know that the care they are receiving is of the highest possible standard and quality. It is therefore every member of staff’s responsibility to work towards ensuring that quality care is being delivered.
Professional
94 British Journal of Healthcare Assistants February 2013 Vol 07 No 02
C
linical governance came into general use as a
concept in the late 1990s, following the exposure
of high-profile cases of failures within the NHS:
scandals such as Bristol Royal Infirmary, with babies
dying at high rates after cardiac surgery, serial killer GP
Dr Harold Shipman and failures in cervical smear testing
services in Kent and Canterbury and breast-screening
services in Exeter. These cases highlighted to both the
public as well as health professionals that clinical care
was not always of the highest possible standard and that
patients were being placed in serious danger. These failings
have been put right, but as we are constantly reminded in
the media, other failings in care delivery continue today,
making clinical governance an issue that both individuals
and organisations need to embrace and fully implement.
So what exactly do we mean by clinical governance?
NHS Scotland (2007) describes clinical governance as
being the mechanism through which ‘health services are
held accountable for the safety, quality and effectiveness
of clinical care delivered to patients. The Royal College
of Nursing (2003) describes it as an umbrella term
Abstract
Within this article the author will examine what clinical
governance is. It will discuss some of the many different, but
interlinked, components, which, when all working together, help
to ensure the quality of care that individual support workers
deliver, as well as the organisation as a whole.
It will use as a base for its discussion 7 of the components that
make up ‘The Temple Model of Clinical Governance’ devised by the
Clinical Governance Support Team.
Clinical governance is a mechanism that enables quality to
be placed at the heart of everything that we do as support
workers. Every patient has the right to know that the care they
are receiving is of the highest possible standard and quality. It is
therefore every member of staff’s responsibility to work towards
ensuring that quality care is being delivered.
Key words
Clinical Governance Quality
David Stonehouse is a Senior Lecturer with the Faculty of Health and Social Care at Edge Hill University.
Clinical governance:
it’s all about quality
Support workers are closest to patients and their needs and are therefore key to achieving the aims of clinical governance—chiefly to
deliver care of the highest quality.
Lucie Carlier
Professional
British Journal of Healthcare Assistants February 2013 Vol 07 No 02 95
assistant practitioners (APs) should be competent in is
in contributing to the effectiveness of teams. Clause 3 of
the Code of Conduct for Assistant/Associate Practitioners
and Healthcare Support Workers (Assistant Practitioners
Coordinators Network, 2011) states that APs must ‘work
in collaboration with colleagues as part of a team to ensure
the delivery of high-quality, safe care to service users and
their families’. The guidance statement on teamwork goes
on to discuss that APs need to value and understand your
own contribution to the team.
Hallett and Thompson (2001) state that the potential
of clinical governance to deliver high-quality care is not
achievable without teamwork. Stonehouse (2011) adds
that where teamwork fails, the quality of the care delivered
will also diminish. So successful teamwork is essential to
achieving quality care. Support workers are vital members
of the heathcare team, key to delivering quality care. They
need to ensure that the teams they are in are working to
their best abilities for the patients they serve.
Ownership
The second component is ownership. Everyone within
the organisation, no matter what role they play, needs to
that incorporates all the different parts which go into
maintaining and improving quality patient care and
experience. McSherry and Pearce (2011:30) define it
simply as ‘patients/carers receiving the right care at the
right time from the right person in a safe, honest, open
and caring environment’.
Support workers are the one staff group who spend
the most quality time with patents, delivering the care,
day in, day out. They are in a privileged position of being
closest to patients and their needs and are therefore key
to achieving the aims of clinical governance—chiefly to
deliver care of the highest quality.
To discuss some of the components that come under
the umbrella term of clinical governance, the author has
chosen to use the Temple Model of Clinical Governance,
devised by the Clinical Governance Support Team
(Mansfield District Primary Care Trust, 2002).
Teamwork
The first component to be discussed is teamwork. No-one
works in isolation. Everyone is part of a team, whether
small or large. The Core Standards document (Skills
for Health, 2009) states that one of the many skills
Figure 1. ‘Templemodel showing the building blocks of clinical governance. Adapted from Clinical Governance Model, National
Clinical Governance Support Team (Mansfield District Primary Care Trust, 2002)
Professional
96 British Journal of Healthcare Assistants February 2013 Vol 07 No 02
Resource effectiveness
The sixth component is resource effectiveness. How
effectively are resources being utilised within the team? Is
it identifying where waste is occurring? This waste could
be in actual physical equipment, or could be in money,
time or staff. Through examining the working practices
of your team, can you truthfully state that the best use
is being made of all available resources, with no loss or
waste? Chambers et al (2007:93) state that to ‘achieve best
practice, resources need to be ‘in the right place at the
right time and working correctly every time.
Learning effectiveness
The last component to be discussed is learning
effectiveness. Clause 6 of the Code of Conduct for
Assistant/Associate Practitioners and Healthcare Support
Workers (Assistant Practitioners Coordinators Network,
2011) states that APs must ‘improve the quality of care to
service users by updating knowledge, skills and experience
through personal and professional development.
Every member of staff has a responsibility for constantly
updating and developing themselves. It is making sure
that this learning is effective in improving patient care.
Does our development actually benefit patients and
colleagues? How effective are training courses, both
in-house and external? Did we actually learn and develop
from attending a conference, or was it perhaps time and
money wasted? When we have learnt something new, how
do we share and cascade that information? Any learning
we have either individually or as a team needs to be
effective and applied to improve patient care. As support
workers, it is important that we reflect upon the learning
we have had and identify where changes can and need to
be made.
An important part of learning effectiveness is, do we
and our organisations learn from and respond correctly to
complaints and adverse incidents? Are lessons genuinely
being learned and service delivery changing in response to
failures of care? Where errors and mistake are discovered,
there has to be a no-blame culture, where the aim is to
find solutions and improvements, rather than punishing
the staff member concerned.
Conclusion
This article has highlighted the important role support
workers play in achieving the aim of clinical governance,
ensuring high quality of care is delivered. Some 7 key
components have been discussed, highlighting the part
support workers play in achieving success. Quality is
everyones responsibility. Support workers need to be able
to guarantee that the care they deliver is of the highest
standard, no matter where they work. When these 7
components work in harmony, then quality of services to
our patients and their families will be delivered. BJHCA
Assistant Practitioners Coordinator Network (2011) Code of Conduct
for Assistant/Associate Practitioners and Healthcare Support
Workers—Working to Standards. National Health Service North
take ownership of clinical governance and of delivering
quality care. This includes volunteers, administration
staff, nurses, doctors, consultants, support workers, right
to the chief executive at the top. Everyone has to take full
responsibility for the part they play in delivering services
and care to patients.
Patients also need to take ownership of their own care
and treatment. They need to be fully involved as equal
partners, and as support workers you need to make sure
that this happens. Local communities also have to take
ownership of their own local health services. We see this
happening when communities pull together in support
of their services when cuts are threatened. But this
ownership and involvement need to happen continuously
and not just at times of perceived threat.
Patient experience
Following on from this is the third component, the patient
experience. As support workers, we need to listen to and
act upon the experiences of our patients. We need to see
our care through their eyes.
This can be achieved in a number of ways, from informal
discussion with our patients, to more formal patient
diaries, interviews, focus groups and patient feedback
surveys (Harrison et al, 2003). Patients need to have
the best possible experience of their care and treatment
and it is the responsibility of support workers to ensure
this happens.
Leadership
The fourth component is leadership. Swage (2005:43) states
that successful implementation of clinical governance
within an NHS organisation depends upon leaders who
are able to inspire and motivate others. There needs to
be a strong, positive leader at the top of the organisation,
but there also needs to be leaders at every level, including
support workers, who will inspire, motivate and lead
others in the pursuit of quality care. Support workers
should recognise their own potential to be leaders—both
in leading care delivery within teams, but also as leaders
for and with your patients.
Communication
Effective communication is the fifth component. As
McSherry and Pearce (2011:143) state, it is an integral
ingredient for the success or failure of clinical governance.
Effective communication needs to be between colleagues
within and across professional groups. It also needs
to be communication of the organisation to staff and
stakeholders, so that information, policies and procedures,
and vision and direction, flow from the decision-makers
to all interested and involved parties.
Importantly, there also needs to be effective two-
way communication between staff and patients.
Communication needs to be of the right sort, either
verbal, written or electronic, in the right way, either formal
or informal, given at the right time and within the right
environment and setting.
Professional
West, Manchester
Chambers R, Boath E, Rogers D (2007) Clinical Effectiveness And
Clinical Governance Made Easy. 4th edn. Radcliffe Publishing,
Oxford
Hallett L, Thompson M (2001) Clinical Governance: A Practical Guide
For Managers. HSJ Public Sector Management, London
Harrison S, Pollock C, Symons S (2003) Getting To Grips With Clinical
Governance. TFM Publishing, Shrewsbury
Mansfield District Primary Care Trust (2002) Framework for Clinical
Governance. www.ichn.ie/uploads/NHS%20Framework%20for%20
Clinical%20Governance.pdf
McSherry R, Pearce P (2011) Clinical Governance: A Guide To
Implementation For Healthcare Professionals. 3rd edn. Wiley-
Blackwell, Chichester
NHS Scotland (2007) Introduction To Clinical Governance. www.clini-
calgovernance.scot.nhs.uk/section1/introduction.asp (accessed 21
December 2012)
Royal College of Nursing (2003) Clinical Governance: An RCN Resource
Guide. RCN, London
Skills For Health (2009) Core Standards For Assistant Practitioners.
Skills For Health, Bristol
Stonehouse D (2011) Teamwork, support workers and conduct at work.
British Journal of Healthcare Assistants 5(7): 350–4
Swage T (2005) Clinical Governance In Health Care Practice. 2nd edn.
Butterworth Heinemann, London
British Journal of Healthcare Assistants February 2013 Vol 07 No 02 97
Key Points
Support workers are accountable for the quality of the care
they deliver
Support workers are key members of the team
Leadership at all levels is essential to delivering high–quality
care to patients
Learning effectiveness will help support workers develop and
quality will be continually improved
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... Clinical governance is another quality factoran approach that arises from two opposing needs that contribute to a single purpose: satisfaction of the patients' needs via the provision of high-quality services at minimum cost and qualitative improvement of the services provided. The Royal College of Nursing (UK) has described clinical governance as "a process that incorporates all the different parts that come into play to maintain and improve the quality of patient care" 5 . ...
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Clinical Governance: An RCN Resource Guide. RCN, London Skills For Health (2009) Core Standards For Assistant Practitioners. Skills For Health
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