CLINICAL GOVERNANCE A Framework for High Quality Care Marian Balm Sir Charles Gairdner Hospital

1. CLINICAL GOVERNANCE A Framework for High Quality Care Marian Balm Sir Charles Gairdner Hospital

2. Background • Bristol Inquiry • KEMH - Douglas Inquiry HIMMA June 03 Clinical Governance

3. In Australia • 1995 -The Quality in Australian Health Care Study (QAHCS) • Wilson RM, Runciman WB, Harrison B et al • reported an adverse event rate of 16.6% • Re-analysis in keeping with the US study - • about 2% of serious adverse events. • 1.7% to serious disability and 0.3% to death • Overall, about 10% of hospital admissions in Australia are associated with an adverse event. HIMMA June 03 Clinical Governance

4. Findings...King Edward and Bristol • Environment unsupportive of openly disclosing errors and adverse events • Failure of management to respond effectively to clinical problems raised by staff • Non-existent or ineffective systems to monitor, report and respond to performance problems • Non-existent or ineffective systems to identify, report and respond to errors and adverse events HIMMA June 03 Clinical Governance

5. Findings...King Edward and Bristol cont... • Poor communication with patients and families, particularly when things went wrong • Poor management of complaints and potential medical negligence cases • Inadequate training and credentialling to ensure clinicians were sufficiently skilled • Inadequate state level morbidity & mortality monitoring & review systems HIMMA June 03 Clinical Governance

6. Means: Individuals doing the right thing as part of a safe & high quality system with appropriate accountability to individual patients, management and the community Demonstrated by: Best practice, teamwork, credentialing & supervision, risk management, audit & reporting, open disclosure when things go wrong Clincial Governance HIMMA June 03 Clinical Governance

7. Framework for CG in WA CLINICAL PERFORMANCE & EVALUATION CLINICAL RISK MANAGEMENT PROFESSIONAL DEVELOPMENT CONSUMER VALUE COMMUNICATION CULTURE SUPPORT OPTIMAL PATIENT OUTCOMES ACCOUNTABILITY HIMMA June 03 Clinical Governance

8. Guiding Principles • Clinician led • Needs to be ‘enabled’ • Is based on professional accountability • Is open to external audit • Multi-disciplinary approach • Shared Values - ‘no blame’ culture • Transportable to Secondary & Rural Setting • Needs to be in a form that has ‘sign-off’ by Chief Executive • A standard reporting system across the institution HIMMA June 03 Clinical Governance

9. Aim of Clinical Governance Unit at SCGH • To embed in hospital culture a AAAA cycle of quality focusing on: • Anticipate (incident monitoring, risk assessment) • Analysis (clinical audit, practice review, linked databases) • Assess (best practice and benchmarking) • Act (improve performance) to achieve: continuous review and improvement in clinical practice HIMMA June 03 Clinical Governance

10. Surrogate measures of health care safety • Unplanned return to operating room within 7 days • Unplanned re-admission within 28 days • Cardiac arrest and M.E.T calls • Unplanned return to E.D. • Unplanned use of blood HIMMA June 03 Clinical Governance

11. The safety message • Safety is the most important dimension of quality for patients and their families • The health system delivers safe care for the majority of patients • The challenge is to move from 90% reliability to 100% • Everyone can focus on safety HIMMA June 03 Clinical Governance

12. Patient Safety Context • Highly valued • Expected Needs • Patient centred values • Leadership – identified and nurtured • System redesign (use technology better) • Improvement tools (guidelines) • Measures of improvement (feedback) HIMMA June 03 Clinical Governance

13. Barriers to good governance • Culture of blame drives problems underground • Low investment in system redesign - means outdated, unsafe systems • Limited use of information technology - high costs, privacy concerns • Safe and effective staffing - health lags behind other industries • Lack of useful measurement and feedback for health professionals HIMMA June 03 Clinical Governance

14. Your task Examine your processes • Define your key services • Define indicators of quality • Define best practice protocols • Implement an audit process HIMMA June 03 Clinical Governance

15. So what then is CG Structured ACCOUNTABILITY for Safety Quality to Self Peers Community HIMMA June 03 Clinical Governance

16. CG is in essence an issue of safety and your role is to ... • Spot the Hazard • Assess the Risk • Make the Changes • Evaluate the Outcome • Spot the Hazard • Assess the Risk • Make the Changes • Evaluate the Outcome • Spot the Hazard • Assess the Risk • Make the Changes • Evaluate the Outcome • Spot the Hazard • Assess the Risk • Make the Changes • Evaluate the Outcome HIMMA June 03 Clinical Governance