Balding, C. (2008). "From quality assurance to clinical governance"
Aust Health Rev 32(3): 383-91.

ABSTRACT: Clinical governance is seen as a relatively new concept; but a long history of health care quality improvement sits behind it. Over the last 20 years, a number of approaches have been tried and discarded, with some inadequately implemented and others poorly adapted from other industries. Quality programs have evolved slowly, hampered by a conservative and complex health care culture and a lack of focus, data and resources. Despite the advent of clinical governance, driven by a patient safety crisis, many of these issues remain unresolved, and are impacting current clinical governance implementation. Reflecting on the quality journey clearly demonstrates that the potential of clinical governance cannot be realised without the leadership, commitment and support of governing bodies and executives.

Source: Meditext Database  Clinicians Health Channel: Keyword: Clinical Governance

Braithwaite, Jeffrey & Travaglia, Joanne F. (2008). "An overview of clinical governance policies, practices and initiatives."
Aust Health Rev 32 (1): 10-22.

ABSTRACT: OBJECTIVE: To map the emergence of, and define, clinical governance; to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. METHODS: Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. RESULTS: Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services’ clinical and corporate governance; the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement; the creation of clinical governance structures to improve safety and quality and manage risk and performance; the development of strategies to ensure the effective exchange of data, knowledge and expertise; and the sponsoring of a patient-centred approach to service delivery. CONCLUSIONS: A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.

Source: Australian Health Review journal web site

S.J. Duckett, M. Coory, et al. (2007). "Identifying variations in quality of care in Queensland hospitals"
Med J Aust 187(10): 571-5.

Identifying and acting on variations from good practice is one of the critical tasks of clinical governance. We describe one aspect of Queensland's post- Bundaberg clinical governance arrangements: the use of variable life-adjusted displays (VLADs) to monitor outcomes of care in the 87 largest public and private hospitals in Queensland, which together account for 83% of all hospital activity. VLAD control charts were created for 31 clinical indicators using routinely collected data, and are disseminated monthly. About a third of hospitals had a run of cases in the 3-year period that flagged at the 30% level (local level investigation). For three indicators, about one in five hospitals had sufficiently cumulatively more deaths than statistically expected that the hospital was highlighted for state-wide review. VLADs do not provide definitive answers about the quality of care. They are used to develop ideas about why variations in reported outcomes occur and suggest possible solutions, be they ways of improving data quality, improving casemix adjustment, or implementing system changes to improve quality of care. Critical to the approach is that there is not just monitoring - the monitoring is tied in with systems that ensure that investigation, learning and action occur as a result of a flag. (author abstract)

Source: Meditext Database  Clinicians Health Channel: Keyword: Clinical Governance

I.A.Mitchell, B. Antoniou, et al. (2008). "A robust clinical review process: the catalyst for clinical governance in an Australian tertiary hospital."
Med J Aust 189(8): 451-5.

OBJECTIVE: To determine if a robust clinical review process can influence an organisation's response to adverse patient outcomes. DESIGN AND SETTING: Retrospective analysis of the activity and outputs of the Clinical Review Committee (CRC) of a university-affiliated tertiary hospital from 1 September 2002 to 30 June 2006. MAIN OUTCOME MEASURES: Engagement of clinicians (number on CRC, number interviewed for the clinical review process, number of specific referrals from clinicians); and numbers of cases reviewed, system issues identified, recommendations made to the hospital board, and ensuing actions. RESULTS: A multidisciplinary CRC with 34 members established a robust clinical review process and identified 5925 cases for initial case review. Of these, 2776 (46.8%) fulfilled one or more of the specified criteria for adverse events and progressed to detailed review; 342 of these (12.3%) were classed as serious or major. A total of 317 staff (11%) were interviewed, and 881 system issues were identified, resulting in 98 specific recommendations being made to the Clinical Board and implementation of 81 practice changes (including seven hospital-wide projects) to improve patient care. CONCLUSION: A robust, multidisciplinary clinical review process with strong links to managers and policymakers can influence an organisation's response to adverse patient outcomes and underpin a clinical governance framework. (author abstract)

Source: Meditext Database  Clinicians Health Channel: Keyword: Clinical Governance