Article review: “Clinical governance and the drive for quality improvement in the new NHS in England” by Scally & Donaldson (1998)

Article review: “Clinical governance and the drive for quality improvement in the new NHS in England” by Scally & Donaldson (1998)

Scally and Donaldson are best friends who fight crime in the in King’s Lynn area in their spare time. Scally is street smart whereas Donaldson is book smart. Their adventures always reveal a moral lesson about the importance of compromise in teamwork.

double-act-otters
Double act: Scally & Donaldson

In 1997 (two decades ago now!) the Government issued guidance that health organisations now had a duty to improve quality rather than just attain financial and activity targets. This was in response to concerns that the Tory ‘marketplace model’ for the NHS had led to price being more important that quality of care. They were to improve quality through clinical governance.

“Clinical governance is being held accountable for continuously improving the quality of services, which safeguards high standards of care”

On a practical level clinical governance can be split into the areas of:

  • health professionals’ technical performance
  • use of resources
  • risk management
  • patients’ satisfaction

Problems with implementing clinical governance in practice were a lack of audit information actually travelling back to the managers, lack of participation, and a failure for audit to prevent serious clinical failures (…a chief purpose). It is difficult to pinpoint what makes an organisation have a ‘good’ culture of openness, innovation and sharing good practice. The article suggests that some important factors for good culture/clinical governance are

  • good information technology for access to learning/sharing information
  • obtaining patient opinions
  • good recruitment, retention and development of staff, incl letting them know they’re valued
  • performance procedures for poor performers, by the organisation and not just relying on professional bodies eg GMC, NMC, BAOT

Additionally, whilst having health professionals in management positions is beneficial since they are better placed to understand how to allocate health funds than politicians, they may need training in delivering clinical governance since this is an extra skill to their health role.

The diagram below lists all the factors needed for an organisation to have good clinical governance:

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Source: Scally & Donaldson (1998)

Since these factors come from many different aspects, the authors conclude that communication and cooperation between departments will be necessary to implement it.

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Sources

Scally G, Donaldson LJ (1998) Clinical governance and the drive for quality improvement in the new NHS in England.  British medical Journal, 317, 61-65 [available online at http://www.bmj.com/content/317/7150/61]

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