Health

Clinical governane supporting safe practice

Introduction

The private and public health care system are suffering from the challenge of maintain patient’s safety and security in the recent years where 1 out of 300 patients are suffering from injuries ion the period of the hospitalisation compared to 1 out of 1000000 patients during aircrafts (WHO, 2017). Due to fast moving, complex and pressurised environment, it is not possible for the health and social workers to provide safeguard to the social communities as a whole. Due to unsafe and inadequate health care service, 1 out of 10 patients in the public hospitals are suffering from severe injuries but the health and social care professionals try to safeguard them and prevent 50% of the patients. Hereby, it is ever growing concern that safety and security needs to be managed, but it is difficult for the health care professionals and in this context the term clinical governance in introduced to maximise patient’s care (Sadeghi-Bazargani et al., 2015).

The health care professionals are responsible to maximise patients care, prevent injuries and safeguard the social communities as a whole and in this regard clinical governance provide them a chance to maximise the values for all the patients in long run by delivering quality care and proper support to them (HSE, 2012). The clinical governance is also beneficial as it provides a scope to the health and social care professionals to develop effective framework for managing clinical accountability for delivering safeguard, being responsive, developing patient’s centred care in the public hospitals. There are seven components under the clinical governance which are such as staffing and staff management, education and training, using information and IT, clinical effectiveness and research, patient and public involvement, risk management and audit through which it is possible to deliver quality care and effective treatment to all the patients as per their health condition and personal preferences (Brennan & Flynn, 2013).

The essay aims at discussing the components of clinical governance by focusing on mainly two pillars which are audit and education and training, and this is helpful to emphasis the strategic planning of improving health care outcome so that the health and social workers can maximise patient’s care. There are significant impacts of managing clinical governance on the health and social care service where the standard of health and social care can be maintained in the public hospitals and the staff members can improve the health and social care service (Flynn, 2013). The audit is one of the best tools and technique to measure the quality of health and social care where the discrepancies between evidence based standard and actual practice can be evaluated and it also provides a scope to identify the need for change so that it is easy to deliver quality care and proper support to the individuals (Pearson, 2017). On the other hand, education and training is also beneficial for the health care professionals to improve the efficiently to treat the patients carefully and develop patient’s cantered care in the public health care institutions. The education and training are also beneficial for developing the clinical governance where the staff members can share and develop own abilities to deliver high quality service to the patients (Stonehouse, 2013).

Role of audit in health and social care

The incident of adverse situation of the patients and the incident of death varies country to country and year to year from 3 to 17% due to unsafe and poor hospital condition. In this regard, auditing is one of the main pillars of clinical governance where the health care managers aim at detecting adverse effects of risks and improving the risk management technique to improve patient’s care (Esposito & Canton, 2014). Auditing in this regard is effective to measure base line performance and it helps to identify the limitations so that the limitations can be manged well for maximising the organisational performance. The strategy of auditing is therefore beneficial for continuous improvement of patient’s care, promoting safety and security of the individuals and maximise clinical performance (HSE, 2016b). Hanskamp-Sebregts reports, the effect of auditing on patient outcome and performance of the staff members varies from none to substantial. It intensifies maximum of 70% of compliance with desired professional practice (Fox-Smith, 2012).

The auditing practice is accompanied by Quality Improvement Plans (QIPs) for successful improvement of the health and social care service. National Early Warning Score (NEWS) is implemented in the public hospitals for identifying the physiological deterioration (Hanskamp-Sebregts et al., 2013). Odell (2014) reports is about the audit of compliance with proper clinical guidelines that identifies and monitors vital signs has improved. However, it also measures and investigates the factors that contribute to the suboptimal clinical practice of monitoring patients (Odell, 2014). As per the report, the fundamental issues in the health and social care institutions are such as ineffective communication between doctors and nurses, lack of education and training, multidisciplinary and lack of skill for which the health care service providers fail to provide ultimate health outcome (Vasli et al., 2018). For patient’s safety and improving health and social care quality, it is necessary to improve cooperation and internal communication and teamwork so that all the nurses, doctors, health care professionals, general physicians and social workers can work collaboratively and meet the team objective (Ivers et al., 2012).

In response, WHO and the UK National Health Service recommended ISBAR (Identify-Situation-Background-Assessment-Recommendation) proposed communication tool named ISBAR Tool for promoting patient’s centred care and maximising the values for overall social communities (DOH, 2013). As per the Raymond and Harrison report qualitative evidence of optimal patient care and prompt senior medical personnel review, it is possible to improv health and social care service through utilising the communicative tools where all the staff members can share their views and experience with others for better patient’s outcome. As Royal College of Physicians (RCP) launched first national clinical audit in 1998, there is the significant improvement in high-quality patient care. Hereby, through auditing, it is possible to maximise the patient’s care and improve evidence-based patient’s care successfully by maintaining the health and social care standard (Raymond and Harrison, 2014).

Despite of the quality improvement, there is no such evidence of overall improvement of health and social care service through audit (Hands et al., 2013). The process of audit is time taken and the health care professionals cannot measure their performance through audit as the therapeutic relationship cannot be measured but it plays crucial role in providing quality acre to the individuals. The process of auditing is not always right as it does not measure the overall performance of the staff members and additionally, if the staff members are engaged in auditing process the time for communicating with patients may be wasted (Shearer et al., 2012). Through these are the main issue in conducting auditing process for managing the performance of the health and social care professionals, it helps to improve performance of the staff in delivering high quality service and treatment to the patients as auditing helps to measure the knowledge and skill of the health care service providers and monitor their performance so that it is possible to improve overall performance of all the staff members in the public health care institutions (RCSI, 2012).

Impacts of education and training in the health and social care institution

Quality care and service for the patients is the main responsibility of the health and social care professionals where it is necessary to meet the health needs of the patients and deliver quality care as per their preferences. The principle of clinical governance in this regard is important to improve evidence-based knowledge and skill to treat the patients successfully with quality care and support (Hammond et al., 2013). The training and development program and education provides an opportunity to the patients to increase patient’s centred care and maximise the patient’s values by providing quality care. Critical thinking and knowledge can also be improved through providing training program and in this regard, it is beneficial for the management of health and social care institutions and public hospitals to improve organisational performance as a whole (Morton, 2014). Self-esteem, knowledge, technical skill, clinical performance and interpersonal skill can also be improved which are essential for the health and social care professionals to deliver quality care as per the health needs and preferences of the individuals (Stewart et al., 2016).

Continuous development through training is also beneficial to improve clinical practice safely, legally and efficiently to develop knowledge and improve experience. Furthermore, simulation in this regard is also beneficial to improv confidence, learning abilities, systematic skill and decision-making skill where the staff members can take effective decision to treat the patients with proper care and treatment (Fox-Smith, 2012). The Nursing and Midwifery Professional Development Unit (NMPDU) also tries to collaborate with Midwifery Board of Ireland (NMBI) and with the office of the nursing service director (ONSD) for strategic expansion and providing quality health care to thy patients so that it is possible to maximise values for overall social communities. Promoting leadership skill of the nurses can also be possible through training and education where they can provide optimal patient care (Odell, 2014). Recognising the actual health needs and making effective decisions of providing the right treatment and care to the right patient needs in depth knowledge and clinical skill and in this context training and development program provides an opportunity to the nurses to enhance their skill to treat the patients carefully (NMBI, 2014).

As per the evidence, the number of patient’s death is increasing about 1000 a month due to the failure of early detection of the disease and lack of experienced health care professionals. in this context, in order to mitigate the issue, the training n dedication of the health care service providers play a significant role in promoting quality care and treatment for the patients. The ONMSD and national acute medicine programme (NAMP) undertaken a survey in March 2016, for maximising the HSE National Service Plan objective of providing clinical education to promote the acute medical assessment unit (AMAU)/Acute medical unit (AMU) nurses (Rahman et al., 2015). The report is hereby effective to evaluate the importance of training and education and it has been seen that there is high requirements of education and training related top latest technology to treat the patients (HCPC, 2012). Hereby, education training provides an opportunity to the nurses and other health care professionals to improve own skill and clinical knowledge as well as abilities to treat the patients with quality acre and continuous support (Kelly et al., 2014). The nurses become efficient and they can enhance their experience through utilising the skill and knowledge and this further helps to improve the optimal health outcome (NHS, 2015).

Role of health care providers in managing clinical governance

The health and social care plays a crucial role to deliver high quality medical outcome for the patients through improving own skill and abilities to perform better for treating the patients successfully (Bliss & Aitken, 2017). core and basic skill, experience of the staff members and advanced technical skill of the staff members in the recent era of complex health and social care, the patients try to access efficient treatment and care from the health care professionals so that it is possible for them to improve their living standard (Waldie et al., 2016a). In this regard, communication and interactive skill as well as cooperative working practice are essential for maximising the values of the patients where the health and social care service providers try to share their responsibility and improve understanding to treat the patient carefully (Waldie et al., 2016b).

The health care professional care responsible in this context for attending regular audit in order to evaluate their performance and manage clinical governance. In this regard training and education is also important to improve the skill and abilities of all the health and social care professionals where they can improve their own knowledge to treat the patients carefully with effective treatment and quality care (NPSA, 2007). Productive team performance depends on training and education in the health and social care institutions and in this regard, it is beneficial for the management of hospitals and public health care units to arrange effective training and educational program for the health and social care professionals to improve their skill and knowledge (Jansson et al., 2013). Clinical governance in this regard is important for managing patient’s safety and maximising patient’s care where the health and social care professionals plays a crucial role to manage clinical governance and improve patient’s care successfully (Butler, 2018).

The health and social care professionals try to attend the training program to encourage each other’s and share information and knowledge with others in order to improve group performance. This in turn helps to improve patient’s care as well as enhance the safety and security of the patients (Babiker et al., 2014). The managers of the public health acre institutions to identify the employees who are underperforming and monitor the performance of the junior staff so that through providing training and development program, it is possible to enhance the skill and performance of all the staff members (HSE, 2016a). Managing quality in the health and social care is the responsibility of the managers and higher executives who monitor and evaluate the performance of the staff members and the health care professionals also try to cooperate with the managers to maximise the organisational performance as a whole. Through training and development program, the health care professionals try to improve own abilities and acknowledge the actual needs of the patients (Price and Reichert, 2017).

The health care professionals also have the scope for professional development through improving clinical education, attending registered courses and certified courses which provides an opportunity to improve their technical skill and clinical knowledge as well as experience of working efficiently for managing the quality of the health and social care service (Bush & Lowery, 2016). It also enhances the skill and competences where the health care professionals can detect the health needs at early stage and provide quality service top the patients to improve ultimate outcome. Critical thinking, decision making and problem solving can also be improved through training program and additionally the health care service providers try to improve their leadership skill through Continuous professional development (CPD) (Brennan & Flynn, 2013). Hereby, audit as well as training and education are effective for all the staff members in the health and social care institutions to maximise patient’s care by providing the high-quality health care service and support to the individuals (Butler, 2018).

Conclusion

Clinical governance is mainly concerned with the patient’s safety and security as well as providing quality health and social care where through the components of clinical governance it is possible to improve accountability and harmony in the workplace which in turn helps to maximise patient’s care. Among the components, audit and education and training are the major two components which provide a scope to maximise the value of the patients by improving the personal and professional development of the health and social care staff members. Auditing is helpful to measure the clinical performance of the staff members and it is accompanied by QIPs which helps to improve patient’s centred care and support. The audit loop and EWS are also beneficial to monitor the performance of the clinical staff members and other social service providers and it further helps to improve their performance through provioidi9ng proper clinical; guidelines. Hereby, audit is one of the best tactics to ensure high quality clinical service and social care through which it is possible to create values for the social communities. Through auditing is time consuming where there is calculations and paper work, but it provides a scope to resolve the existing gap between the service provided by the staff and the patient’s expectations.

On the other hand, education and training is another effective pillar through which it is possible to enhance the organisational performance as a whole. The staff members can learn from effective training program and they can improve their personal knowledge and technical skill for doing their work strategically for meeting the aim of providing high quality health and social service. the health care professionals required core training or improving technical skill and clinical knowledge and for which developing effective training and development program is beneficial for the care professionals to enhance their performance and deliver high quality social care service. CPD in this regard is an effective learning process through which the health care professionals improve their skill and it is possible for them to follow the guidelines and enhance the clinical governance in the public health care institutions. Hereby, audit and education and training under the clinical governance are advantageous for improving the abilities of the staff members and follow evidence-based standard as well as maximise interpersonal skill and clinical knowledge for delivering quality service to the patients as per their health needs. Through managing clinical governance, it is hereby easy to enhance staff’s performance and manage the patients with care and proper treatment where the quality of patient’s centred care can be maximised.

References

• Babiker, A., Husseini, M, E., Nemri, A, A., Frayh, A, A., Juryyan, N, A., Faki, M, O., Assiri, A., Saadi, M, A., shaikh, F., Zamil, F, A., Paediatr, S, J. (2014) Health care professional development: Working as a team to improve patient care. Sudanese Journal of Paediatrics 14 (2), pp.9-16.
• Bliss, M., Aitken, L, M. (2017) Does simulation enhance nurse`s ability to assess deteriorating patients? Nurse Education in Practise 28, pp.20-26.
• Brennan, N, M., Flynn, A, M. (2013) Differentiating clinical governance, clinical management and clinical practise. Clinical Governance: An International Journal 18 (2), pp.114-131.
• Bush, C., and Lowery, B. (2016) Postgraduate Nurse Practitioner Education: Impact on Job Satisfaction. The Journal for Nurse Practitioners 12(4), pp.226-234.
• Butler, C. (2018) Nurses experiences of managing patient deterioration following a post-registration education programme: A critical incident analysis study. Nurse Education in Practice 28, pp.96-102.
• DOH (2013) National Early Warning score. Available: http://health.gov.ie/wp-content/uploads/2015/01/NEWSFull-ReportAugust2014.pdf [Accessed 17 December 2017].
• Esposito, P.& Canton, A, D. (2014) Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World Journal of Nephrology 3(4), pp.249-255.
• Fox-Smith (2012) Too much of our time is spent on paperwork away from the bedside. Nursing Standard 26(19), pp.32-32.
• Hammond, N, E., Spooner, A, J., Barnett, A, G., Corley, A., Brown, P., Fraser, J, F. (2013) The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation. Australian Critical Care 26 (1), pp.18-22.
• Hands, C., Reid, E., Meredith, P., Smith, G, B., Prytherch, D, R., Schmidt, P, E., Featherstone, P, I. (2013) Patterns in the recording of vital signs and early warning scores: compliance with a clinical escalation protocol. British Medical Journal Quality and Safety 22, pp.719-726
• Hanskamp-Sebregts, M., Zegers, M., Boeijen, W., Westert, G, P., Gurp, P, J. (2013) Effects of auditing patient safety in hospital care: design of a mixed-method evaluation. BMC Health Service Research 13(226), pp.1-11.
• HCPC (2012) Standards of continuing professional development. Available: https://www.hcpc-uk.org/aboutregistration/standards/cpd/ [Accessed 18 December 2017]. HSC (2011) Recognition management of the acutely ill patient. Available: http://cec.hscni.net/Courses/Details/2558 [Accessed 12 December 2017] HSE (2012) Quality and Patient Safety. Available: https://hse.ie/eng/about/Who/qualityandpatientsafety/Clinical_Governance/CG_docs/clingovassurancecheckFeb2012.pdf [Accessed 1 December 2017]. HSE (2013) A practical guide to clinical audit. Available: https://www.hse.ie/eng/about/Who/QID/MeasurementQuality/ClinicalAudit/practicalguideclaudit2013.pdf [ Accessed 10 December 2017]. HSE (2016a) AMAU-MAU-MSSU Education and Training. Available http://www.hse.ie/eng/about/Who/ONMSD/eductraining/AMAU-MAU-MSSU-Education-and-Training.html [Accessed on 20 December 2017]. HSE (2016b) SETTING THE DIRECTION: A Development Framework Supporting Nursing Practice Skills and Competencies in Acute Medical Assessment Units (AMAUs) and Medical Assessment Units (MAUs). Available: [Accessed 10 December 2017]. Ivers, N., Jamtvedt, G., Flottorp, S., Young, J, M., Odgaard-Jensen, J., French, S, D., O`Brien, M, A., Johansen, M., Grimshaw, J., Oxman, A, D. (2012) Audit and Feedback: effects on professional practise and healthcare outcomes. Cochrane Database of Systematic Reviews 6, pp. Jansson, M., Kaariainen, M., Kyngas, H. (2013) Effectiveness of educational programmes in preventing ventilator-associated pneumonia: a systematic review. Clinical Simulation in Nursing 9 (9), pp. 355-360. Kelly, M, A., Forber, J., Conlon, L., Roche, M., Stasa, H. (2014) Empowering the registered nurses of tomorrow: students' perspectives of a simulation experience for recognising and managing a deteriorating patient. Nurse Education Today 34 (5), pp. 724-729. Morton, M. (2014) The problem with Quality: A tale of two audits. British Journal of Healthcare Management 20(10), pp. 478-482. NHS (2015) Improving safety through education and training. Available: https://www.hee.nhs.uk/sites/default/files/documents/FULL%20report%20medium%20res%20for%20web.pdf [Accessed 12 December 2017]. NMBI (2014) Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives. Available: https://www.nmbi.ie/nmbi/media/NMBI/Publications/Code-of-professional-Conduct-and-Ethics.pdf?ext=.pdf [Accessed 7 December 2017]. NPSA (2007) Protected Mealtimes Review Findings and Recommendations Report. Available: www.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=2654 [Accessed 11 December 2017]. Odell, M. (2014) Detection and management of the deteriorating ward patient: an evaluation of nursing practise. Journal of Clinical Nursing 24, pp.173-182. Pearson, B. (2017) The clinical governance of multidisciplinary care. International Journal of Health Governance 22(4), pp. 246-250. Price, S., Reichert, C. (2017) The Importance of Continuing Professional Development to Career Satisfaction and Patient Care: Meeting the Needs of Novice to Mid- to Late-Career Nurses throughout Their Career Span. Administrative Science 7, pp. 1-13. Rahman, A, H., Jarrar, M., Don, M, S. (2015) Nurse level of Education, Quality of care and patient safety in the medical and surgical wards in Malaysian Private Hospitals: A cross-sectional study. Global Journal of Health Science 7(6), pp.331-337. Raymond, M., Harrison, M, C. (2014) The structured communication tool SBAR (situation, background, assessment, and recommendation) improves communication in neonatology. South Africa Medical Journal 104(12), pp.850-852. RCSI (2012) Guidelines for Clinical Audit. Available: http://www.rcsi.ie/files/surgery/docs/20140212040843_Guidelines%20Clinical%20Audit%20new%20.pdf [Accessed 13 December]. Sadeghi-Bazargani, H., Tabrizi, J, S., Saadati, M., Hassanzadeh, R., Alizadeh, G. (2015) Nursing experiences of clinical governance implementation. Clinical Governance: An International Journal 20(4), pp. 183-190. Shearer, B., Marshall, S., Buist, M, D., Finnigan, M., Kitto, S., Hore, T., Wilson, S., Ramsay, W. (2012) What stops hospital clinical staff from following protocols? An analysis of the incidence and factors Australian metropolitan healthcare service. British Medical Journal Quality and Safety 21, pp.569-575. Stewart, K., Bray, B., Buckingham, R. (2016) Improving quality of care through national clinical audit. Future Hospital Journal 3(3), pp. 203–206. Stonehouse, D. (2013) Clinical governance: it’s all about quality. British Journal of Healthcare Assistants 7(2), pp. 94-97. Vasli, P., Dehghan-Nayeri, N., Khosravi, L. (2018) Factors affecting knowledge transfer from continuing professional education to clinical practice: Development and psychometric properties of a new instrument. Nurse Education in Practice 28, pp.189-195. Waldie, J., Day, T., Tee, S. (2016b) Patient safety in acute care: are we going around in circles? British Journal of Nursing 25(13), pp. 747-751. Waldie, J., Tee, S., Day, T. (2016a) Reducing avoidable deaths from failure to rescue: a discussion paper. British Journal of Nursing 25 (16), pp.895-900. WHO (2017) Patient Safety. Available: http://apps.who.int/iris/bitstream/10665/255507/1/WHO-HIS-SDS-2017.11-eng.pdf?ua=1 [Accessed 7 December 2017].