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Author Has Joshi 8/4/99
"In The Modern and Dependable NHS Clinical governance involves’ action to ensure that risks are avoided, adverse effects are rapidly detected, openly investigated and lessons learnt, good practice is rapidly disseminated and systems are in place to ensure continuous improvement in clinical care.’
Clinical governance is largely a new name for established concepts. It is a framework for the improvement of patient care through commitment to high standards, reflective practice,risk management and personal and team development.
Clinical governance in primary care is about developing people, teams and systems within primary care while protecting patients. Where unacceptable care is encountered, this must be addressed as part of a comprehensive quality improvement programme.
Three Key concepts
Protecting patients
Developing people
Developing teams and systems
Elements of clinical governance
Protecting patients
Registration of professional qualifications and revalidation of that registration.
Identifying unacceptable variations in care and areas in need of improvement
Managing and minimising poor performance in colleagues
Risk management
Developing people
Continuing professional development or life long learning
Development and implementation of guidelines and protocols for ‘best practice’
Personal accreditation
Recognising and celebrating success
Developing teams and systems
Learning from what others do well
Clinical audit
Development and implementation of guidelines and protocols for ‘best practice
Recognising and celebrating success
Evidence based clinical practice
Improving cost- effectiveness
Listening to the views of the patients and carers
practice accreditation
Through all these promoting accountability and transparency
Future deliverance
Clinical governance
An effective system for monitoring the performance of teams and individuals
An effective system for risk management
An effective system for life long learning for individuals and teams
An effective system for implementing and monitoring evidence based guidelines and National Service Frameworks
An effective system for accrediting teams and individuals
Skills for leadership
Clinical governance
"The leader for clinical governance must be clinically respected in the locality; must deploy their generic clinical skills in carrying out this task; and should have a close relationship with their professional bodies, preferably being a member of their college or equivalent professional body."
engaging those who work in primary care(availability, accessibility);
listening, hearing and asking right questions(gathering facts);
establishing facts(investigating);
establishing a common perception of the situation;
agreeing a plan of action(treatment plan);
reviewing progress(follow up).
Implementing clinical governance- first year
A diagnostic programme
A consultation exercise
A communication strategy
An intervention strategy
A strategy for non-principals
A plan for resources for quality improvement through clinical governance
Systems delivering clinical governance-subsequent years
Changing the culture and leadership
Establishing a system for monitoring the performance of teams and individuals
Action where serious problems have been identified
Encouraging a system for risk management
Promoting life long learning
Establishing the accreditation of individuals and teams
Working with reluctant practices and individuals
Responding to research
Involvement in research