Clinical Governance

Critically analyse how clinical governance can ensure accountability of individuals and teams and that nursing practice is safe and of a high standard?

As Defined by Scally and Donaldson 1998, clinical governance is:

“A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish” (NHS Executive, 1998).

The aim of the NHS is to ensure continuous improvement in the standards of clinical care, to prevent errors in clinical practice, to raise standards and improving outcomes offering access to a range of healthcare services (Freedom D, 2002). This paper intends to critically evaluate ways in which clinical governance ensures professional accountability taking into account current health policy and legislation. This assignment aims to provide knowledge into issues in relation to the management and supervision within the care of adult nursing through the use of relevant literature. Furthermore, this paper will critically analyse three components of clinical governance: risk management, clinical supervision and evidence-base practice.

Governed through an umbrella of clinical standards, the NHS ensures that these standards: risk management, clinical supervision and evidence-base practice are of a safe and high standard. (Freedom D, 2002). In 1948, the NHS was traditionally devised with no particular agenda for quality, assuming that quality would devise through the provision of the training and education of all NHS staff (Department of Health, 1997). It could be argued that clinical practitioners where traditionally part of a role culture, being unable to develop and exercise their clinical practice and are said to have been “belonged to hierarchical structures where the only way to a higher pay packet was not clinical excellence but a move into management” (Wattis et al 1999). Since its inception in 1997 the introduction of clinical governance proposed by the government came into effect (DoH, 1997).

In 1997-1998, the new labour government set out its plans for reform in a serious of reports and documents: The New Modern NHS, Dependable (England); Designed to Care (Scotland); Putting Patients First (Wales); and Fit for the Future (Northern Ireland) (Leatherman S, 1998). These documents set out the government’s proposal for the reform of national standards ensuring quality of care is given the same prominence as finance and staffing (DoH 1997). These papers ensure that an �integrated care system’ based on �partnership and driven by performance’ will create a move away from competition between trusts. Striving for �efficiency’ and �excellence’, the document proposed that health organisations would have a statutory duty to report on quality assurance, asserting that the performance of individual practitioners and teams would be accountable by statute.

Structural reform has long been a priority within the NHS in achieving clinical effectiveness, issues of efficiency and economy in regards to performance within organisations have long dominated policies within the United Kingdom (Farnham D, 1993). The history of the NHS has been created by an abundance of structural attemps to reshape and redefine the revolution of nursing care, structural reform dating back to 1974, introduced by the Joseph report, this report was aimed at consensus management focusing on unifying management systems for greater efficiency (DoH 1989). According to Scally and Donaldson (1998) the introduction of clinical governance, aimed at improving the quality of clinical standards is by far the most ambitious quality initiative that will ever be implemented through out the NHS. This report (the white paper, designed to care) is aimed at unifying national standards of care, achieved through the maturity of �excellence’ and �quality assurance’. In ensuring the delivery of these standards two new constituents have been created: The National Service Framework (NSF) and the National Institute for Clinical Excellence (NICE). The NSF and NICE create a means by which NHS trusts ensure the provision of quality standards by making NHS employees accountable for setting, maintaining and monitoring standards of care (DoH 1997). The National Institute for clinical excellence was founded in 1999 and consists of a number of specialized organisations: the NHS centre for reviews and dissemination, national prescribing agency, medical devices agency and institutes of public health. All aimed at creating and maintaining national standards through effective management and cost effectiveness, through audits and reviews of health policies. The commission for health improvement (CHI) aims to monitor the delivery of these standards provided by NICE and NSF through national surveys of the patients experience (Freedom D, 2002). This commission (CHI) sets out to review all NHS trusts including community care. Each NHS trust will be visited over three to four years and be reviewed to decide whether or not national standards are being met and NICE guidelines are being adhered to.

The late 1980s and early 1990s saw a major change of emphasis. Medical and later clinical audit became a requirement for hospital doctors working within the NHS. Clinical audit comprises: �the review of clinical performance’, �the refining of clinical practice’ and the measurement of performance against agreed standards or targets’ (QIS, 2005). Hospitals and community health services became managed organisations bringing clearer accountability for results, and hence a more critical focus on the performance of services. The concept of clinical effectiveness gained widespread acceptance within the health professions, and stimulated activity in producing guidelines and protocols to improve clinical-decision making.

Risk management (a component of clinical governance) was primarily considered a means of controlling litigation, which was a major worry for practitioners within Britain and the US. The late 1980’s and 1990’s saw a major change of emphasis (Vincent C 2001). Clinical audit became a requirement for all NHS hospitals. Community services and hospitals became organisations which are managed to bring clear accountability for quality improvements. The concept of this revolutionary approach to care in ensuring national standards gained widespread acceptance, stimulating policy development to improve clinical-decision making (Vincent C 2001). NHS Quality Improvement