Our Children’s Complex Care team are dedicated to delivering quality care for children and young people. One way they do this is through implementing clinical governance which seeks to continually improve quality in service provision.
Yvonne Mujeri, Director of Clinical Services in our Children’s Complex Care team, is a registered children’s nurse with over 20 years’ experience in the sector. In this blog, she provides an in-depth look in her own words into what clinical governance is and why it plays an important role in quality care.
“In my career, I’ve worked for the NHS, different care agencies and in a children’s hospice.
When you work in different acute settings looking after very sick children, you see first-hand the value and impact quality care has on children, young people and their families.
Children and young people with complex care needs can deteriorate very rapidly. However, in my experience, whenever clinical governance is in place alongside robust care and escalation plans, these situations are easier to manage.
Clinical governance – quality accountability
When we talk about the clinical governance framework, we’re talking about how we make organisations accountable for quality care. It focuses on how you can safeguard high standards of care by creating an environment where clinical excellence can flourish.
The framework includes six key pillars that are fundamental to quality. Without them, you can’t measure the quality of the service you’re providing.
Asking me which clinical governance pillar is the most important, is like asking a parent ‘who is your favourite child’.
Because they go hand in hand and as a collective, are imperative to great quality care and improving outcomes.
The six clinical governance pillars are:
Education and Training
This enhances the quality of the service that we provide. It ensures staff are providing safe care to the children and young people we look after and that we’re keeping staff knowledge up to date.
This is one of my personal favourites. Without audits, how do we know how to improve the quality of our service? How can we be assured that our healthcare assistants and nurses are providing the service we’re commissioned to provide?
You can only do that through in-depth, clinical audits and effective actioning of the completed audits.
This looks at the effectiveness of the service. So, are we meeting the needs of the child and the family? Are we effective in covering the rota? Do we successfully manage incidents? Are care plans succinct and up to date?
This starts all the way at the top or the organisation and how it’s filtered down to each person we support. This pillar encompasses all departments in an organisation, because every single person has a role to play.
Openness and candour
Openness is very important because it instils an element of trust and confidence in in our service. Having an open approach means you should be clear about both barriers and achievements for each care package.
You should report on all complaints, compliments, and incidents and share this information with clear actions plans to help you make positive changes.
Research and development
This is an important pillar that goes in tandem with education and training. It requires you to follow current guidelines and best practice, implementing these as a way of effectively improving quality of care.
Healthcare is constantly evolving and developments on equipment, best practice and care delivery allow for improvements in the health sector and it is vital to be aware of and implement changes.
This is a favourite pillar of mine that puts safety at the forefront in mitigating risks. It’s fundamental to always ensure that you have, to the best of your ability, protected people and safeguarded them from harm. Because that is what we are here to do.
Effective risk management should always be pro-active. It’s always better to risk assess prior to the event, accounting for the worst-case scenario so we lower risks. You cannot take shortcuts when it comes to safety.
Why clinical governance is important
When utilised effectively, clinical governance helps you drive high quality care for the people you support. And the different pillars help you benchmark quality care against other organisations.
It also plays a huge part in quality assurance. Essentially, quality assurance is the overall aim in service provision. Whereas clinical governance is the way you achieve it. It’s the method and the how behind it. So, if you’re meeting all those pillars of clinical governance, you’re assured of quality.
It’s important to add that while the Care Quality Commission (CQC) have their own quality measures, when you look at their key lines of enquiry, they’re all based on the pillars of clinical governance.
The future of clinical governance and its role in quality care
When clinical governance was first introduced, there were five pillars. In recent years, they’ve changed these to six and in some health sectors, seven pillars are used.
In the wake of COVID-19, I think we’re going to see more community specific pillars added in. Maybe something like service delivery and user experience, to ensure the people we support remain central to care provision.
COVID-19 really has changed the care landscape, causing disparity between the NHS and community care settings. I feel moving forward, this could lead to a clear separation in terms of how each setting approaches clinical governance and quality. Perhaps we could even see separate clinical governance models and pillars for each setting entirely.
Plus, as Clinical Commissioning Groups (CCGs) merge into larger CCGs, certainly as we’ve seen in London, this will have a bearing too. It will determine how quality is measured, how quality is assured and essentially on what clinical governance looks like in the community.
Personally, I’d like to see user satisfaction added as a pillar because it warrants its own section. Even in complaints you make improvements and in compliments you know what you’re doing well and can continue to build on them.
After all, the people we support and their families are the ones receiving the care. They should be able to formally influence quality through a pillar in this framework.”