Clinical Governance

One topic in relation to which you can be almost certain to receive a question during a senior clinical NHS interview

It is very important to detect this question. It may be couched in subtle terms. How would you improve the clinical outcomes in this unit? / What are the challenges to safety and efficiency here? Whose help would you seek to ensure you can provide excellent care in this Trust?

DESCRIPTION

A framework to guide safety and efficacy of clinical practice

Its objective is to help provide high quality care safely

The framework of clinical governance should both support the above objective, and also facilitate effective change in order to bring about high quality, safe care, when this is lacking

DEFINITION

Clinical governance (CG) in the NHS refers to the organisational framework responsible for high quality care being able to flourish safely.

COMPONENTS

Describing components of CG will hopefully cause an interviewee to wonder how they relate to the traditionally described pillars of governance. The good news is that they are one and the same.

A conceptual problem has been created by the rather pillock idea of naming the often quoted 7 items as “pillars’.

A better description is possible by thinking of CG as a house, and the so called 7 items as being the components that maintain the integrity of the house - so in the analogy, these would be things like walls, doors and windows, electricals, waterworks, furniture, roofing, foundation and ‘joining bits’.

Calling the 7 items pillars is confusing, because you wouldn’t expect each pillar to be that different to the other.

Think of them as 7 components of the house of clinical governance, instead.

The original seven “building blocks” of CG are memorably encapsulated in the sentence Educated trainee Researchers develop Audits for Clinically Effective Risk management of Open PPIs

Education and training / Research and development / Audit / Clinical Effectiveness / Risk management / Openness / Patient and Public Involvements.

Over time, there have been changes, not the least of which is that 7 have morphed into 8.

Openness seems to have become “Staff Management”

R&D has been replaced by Information Management Technology

The new kid on the building block is ‘Clinical Governance Policies’.

CHARACTERISTICS : The Attributes of the above construction materials

Carrying on with the house building analogy, one could think of the qualities you would like the building materials to uniformly subscribe to. In the case of cement, wood, wiring, pipes etc., these may be safety, efficacy and durability, for instance. You would like the materials used in building your house to be safe (you won’t get electrocuted or flooded), effective (water will come through the pipes, the windows will open) and durability (it won’t all stop being safe or functional a few months after you move in).

Along similar lines, what are the qualities or characteristics that underlie the 7 components in our Educated trainee Researchers develop Audits for Clinically Effective Risk management of Open PPI claims tag-line above?

Three specific characteristics of all the components of CG are usually alluded to. These can be described, memorably, using the acronym BAD :

Benchmarking : ensuring that the organisation respects accepted benchmarks of a high standard of care in each relevant clinical area of work

Accountability : ensuring that there is clarity and transparency about which individuals or structures within the organisation are responsible for maintaining the above standards

Dynamism : embracing a cultural willingness to promote change in order to produce necessary improvements