Clinical governance in hospitals making good progress

The largest and most complex survey of the New Zealand health workforce has just been completed showing good progress across many DHBs in the development and implementation of clinical governance by health professionals in public hospitals.

The extensive survey was led by the University of Otago's Centre for Health Systems in collaboration with 19 DHBs, with facilitation and support from the DHB Shared Services (DHBSS). It was commissioned by the National Health Board, the Health Quality and Safety Commission and the DHBSS.

The 'Clinical Governance Assessment Project' (CGAP) will be presented at a final meeting of stakeholders at the University of Otago, Wellington on Thursday December 6 at 0930 by the Minister of Health, the Hon. Tony Ryall. This will be followed by a series of lectures on various aspects of clinical governance in this country and the UK.

"These reports update and assess how well the government's objective of enhancing clinical governance in our public health system has progressed since 2009," says project leader Professor Robin Gauld from the University of Otago's Centre for Health Systems. "It also recommends ways of further developing clinical governance in the future."

"The overall picture, after 165 face to face interviews with staff in over 19 DHBs and over 10,000 on-line surveys, is positive. Good progress has been made in the application and understanding of clinical governance by health professionals; that is doctors, nurses, midwives and allied staff."

Authors Professor Gauld and Dr Simon Horsburgh say many respondents in public hospitals confirmed they were involved in shared decision-making with management; that DHBs have fostered the development of clinical leadership; that quality and safety are key over-riding goals; and that many DHBs have given responsibility to health professionals for clinical service decisions.

On three leading questions on quality and safety the report notes that:

• 57% of those surveyed believe health professionals work well together in co-ordinated teams
• 70% of respondents say they involve patients and families in efforts to improve care
• 69% of respondents agree it is easy to speak up when they see problems.

 

It says that compared to earlier research covering responses from Association of Salaried Medical Specialists members, this much wider study shows solid progress, albeit with some significant variations between DHBs.

It details areas where more work needs to be done to engage health professionals in improving management at the clinical and departmental level.

In that regard Professor Gauld recommends a number of actions:

• Development of a national project so DHBs and health professionals receive ongoing information on clinical governance.
• More sharing of information between DHBs in terms of what works to assist in the implementation of clinical governance.
• More training of health professionals in what clinical governance means and how it is carried out.

 

The report says there is a need to get more health professionals, especially doctors, involved in clinical governance as well as achieving the right balance between various professional groups such as nurses, midwives and allied health professionals. Educational and training institutions, as well as professional colleges, have a crucial role to play in this regard says the report.

Professor Gauld says: "Health professionals are only as good as the systems in which they work and they have an obligation, in partnership with their DHB employers and the government, to ensure that these are safe, equitable, efficient, accessible and patient-centred."

However he says that the part-time nature of many senior doctors' employment creates difficulties with DHBs in clinical governance. He says that solutions to this require further analysis and debate. In that regard better administrative and other support for clinical leaders should be on the agenda of government and DHBs.

The Centre for Health Systems at the University of Otago says these comprehensive reports provide a robust template for the future assessment of clinical governance. They also determine important areas to focus on to progress clinical governance and leadership in New Zealand's public hospitals.

Both reports can be obtained by emailing nicola.casey@otago.ac.nz.

They can also be accessed via the Centre for Health Systems website.

Definition of clinical governance
"Clinical governance is a system through which health 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"  Source: Scally and Donaldson