Health Governance and Management

CNA632 LEARNING AND TEACHING IN HEALTHCARE SETTINGS

Introduction:

Clinical governance is widely recognized as a resource for public health organizations to improve the quality and safety of services in services provided by staff, facilities, and contractors. The integration of a common clinical governance framework in health organizations refers to the mandatory requirement of a consistent organizational structure. The interpretation of recent incidents in which the aspects of clinical governance have been widely considered by healthcare organizations for inducing long-term improvements in the delivery of healthcare services. However, the effectiveness of clinical governance in modern healthcare is often mired in controversies based on its classification as an abstract concept.

On the contrary, the contemporary healthcare scenario is characterized by dynamism leading to unprecedented changes and health system failures. Hence, the changes are responsible for inducing subsequent reforms in the clinical governance systems which could be complemented by the involvement of clinicians (Baba-Djara, Conlin & Trasi, 2016). Therefore, it is imperative to consider undertaking a comprehensive review of the origins and changes in clinical governance followed by a critical analysis of principles and frameworks about governance and management (Clark & Beatty, 2016).

The following report aims to present a critical review of the origins and relevance of clinical governance in healthcare alongside the significance of governance and management in the improvement of quality care. The report would also illustrate the probable setbacks in governance and their relevant implications on clinical governance. The concluding section would comprise personal reflection on a specific experience as a recipient of healthcare which would help draw recommendations to improve the quality of healthcare through a clinical governance framework (Dickinson, et al., 2015).

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Origin and Relevance:

Clinical governance emerged in 1997 in the form of an abstract concept by the NHS for the improvement of the quality of care. The reasons for the emergence of clinical governance could be explicitly anticipated in the wide range of incidents that indicated the failure of the NHS. One of the examples of such incidents which led to the proliferation of the clinical governance concept could be observed in the case of the Bristol Royal Infirmary Inquiry in 2001 which investigated 23 deaths (Dimitropoulos & Thompson, 2014).

The investigations revealed that the patients suffering from cardiac surgical pediatric afflictions were subject to unwarranted variations in clinical practices as well as undesired outcomes. Other notable incidents such as the case of the GP Harold Shipman and the Royal Liverpool Children’s Inquiry were also responsible for inviting widespread political and public concern thereby increasing the emphasis on realizing the potential of clinical practices for causing harm to individuals. This factor could be used to perceive the necessity of clinical governance. Furthermore, the necessity for clinical governance was also responsible for developing concerns among health professionals for inducing major reforms in the delivery and management of healthcare services based on critical analysis and comprehensive reflection.

Quality healthcare is one of the major concerns of every individual and is often accounted as the determinant of an individual’s perception of their life (Fattore & Tediosi, 2013). The lack of coordination among general practitioners, primary care professionals, nurses, and managers could also be accounted as a significant necessity for establishing clinical governance frameworks. The implementation of clinical governance can be accounted as a remedial measure for addressing the issues that were observed in patient outcomes. Clinical governance could be effective for realizing outcomes such as improving health outcomes of a considerable share of the population, enhancing quality standards, developing services, and commissioning different hospital services (Ferlie, et al., 2017). Even though it is clear that the NHS adopted the concept of clinical governance to address the sudden increase in several incidents related to discrepancies in the provision of quality care, the apprehension of the reason for which the issues increased unprecedentedly is necessary.

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Some of the factors could be explicitly apprehended in the rising costs of healthcare which are complicated further by the impact of macroeconomic factors such as lack of public funding or aging populations. These factors are responsible for drastic changes in the delivery of healthcare services which could also be affected by the trends in purchasing behavior of customers. The minimal emphasis of the healthcare service providers on the quality of care services as well as the implications of patient demands according to modern scenarios refer to potential reasons for which the issues related to variations in patient outcomes escalated drastically all of a sudden.

The lack of precise guidelines for patients and regulations for their privileges in terms of preferences for engagement in the healthcare framework could also be accounted as a profound reason for the rise in issues related to patient outcomes (Fletcher, 2016). Another explicit factor that could be observed in the context of the rise in issues related to patient outcomes is the lack of transparency of processes and information for patients which served as a major influence on the quality of the outcomes.

Clinical governance was also required to inhibit the formidable setbacks delivered by superficial investigations in poor patient outcomes. The feedback delivered by patients was not appropriately documented nor processed appropriately to identify the sources of error in the delivery of healthcare services. It is also essential to observe that the lack of any profound patient advocacy groups in the 1990s reflected minimal pressure on healthcare providers and organizations for considering the quality of outcomes in clinical practices (Gill & Benatar, 2017). Therefore, it can be aptly perceived that the healthcare services that were facilitated without clinical governance were not centered on the demands of customers which could be assumed as a major reason for the observed pitfalls.

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Governance and Management for Quality Care:

The apprehension of the distinct structures involved in the healthcare service provision framework could be used for addressing the significance of governance and management in the delivery of quality care. Thereafter, it is essential to observe the individuals responsible for establishing the different structures involved in a healthcare service framework as well as the rationale for the design of the structures (Greaves & Greaves, 2017).

The interpretation of the significance of governance and management in the provision of quality care should also comprise references to the factors determining the necessity of governance and management in healthcare frameworks and the issues which arise in terms of quality improvement (Kickbusch, 2016).

Governance and management could be considered as primary attributes for the induction of awareness among public health organizations to be consistently inclined towards the improvement of quality of healthcare services as well as preservation of high standards in healthcare. The aim of governance in such cases could be observed in creating a favorable environment in which research and excellence in clinical care could be promoted effectively.

The implications of governance structures could be identified in the effectiveness of a systematic approach to realize the objectives of promotion and maintenance of quality care (Klaedtke, Chable & Stassart, 2016). The structures for governance and management in healthcare could be considered crucial and mandatory additions to assure the highest possible quality of care provided to patients. One of the formal reasons to apprehend the presence of structures in health could be identified in the favorable outcomes that can be obtained from systems of accountability and formal reporting.

The limited empirical research on structures of health in the context of governance in clinical practices could be addressed through the anticipation of the generic interpretation of the structure of clinical governance. The key components involved in the structure of clinical governance reflect on the significance of the foundations of the components as well as the underlying philosophies which are largely dependent on quality care and patient-centric approaches. The structure of clinical governance was developed by the NHS for the interactive involvement of patients in the healthcare process as well as the empowerment of patients (Kuhlmann, Batenburg & Dussault, 2016). The necessity of integrating these structures in healthcare provision could be perceived as a crucial initiative for addressing contemporary trends in the domain of healthcare.

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From a critical perspective on the incidents of inappropriate patient outcomes, the use of governance and management structures is imperative. The application of governance structures in health could enable the systematic recognition of sources and the impact of the issues through clinical audits (Mattei, 2016). The need for governance structures could also be validated on the grounds of the integration of research, reflective practice, and consistent professional development which leads to a comprehensive review of the situation. Furthermore, it is imperative to apprehend the various challenges which are faced by governance frameworks in the improvement of the quality of primary healthcare. The estimation of the different reasons is liable for providing a credible impression of the possible measures which could be implemented for reforms in the structures of healthcare governance and management.

The different reasons which validate the efficiency of governance in improving the quality of care could be assumed as motivation to deal with the issues of quality improvement. Some of the key issues could be identified in the proliferation of clinical leadership, the dedication of staff members, the emphasis of strategies on systems, and evidence-based developmental approaches. The improvement of quality could be ensured only through the implementation of reasonable reforms according to the observations from the incidents which characterized unfavorable patient health outcomes. The critical reflection on poor patient health outcome incidents concerning the theoretical and empirical research about clinical governance could enable the proliferation of feasible insights into the potential contingencies that can be implemented in quality improvement initiatives. The barriers of uncertainty regarding the pace of change and the substantial volume of work involved in realizing a new quality improvement framework in a conventional setting could be accounted for as primary issues for quality improvement (Nikogosian & Kickbusch, 2016).

Another potential factor that is related to the inhibition of quality improvement in healthcare settings could be apprehended in culture conflicts that inhibit the promotion of information sharing and learning. The approaches followed by a healthcare organization for quality improvement could be subject to ambiguities due to the variations in different levels of healthcare, financial resources, and information technology competence.

These factors could lead to detrimental consequences for clinical governance initiatives alongside depicting formidable references to the outcomes such as a steeper learning curve, prolonged time for absorbing and comprehending multiple initiatives complemented with longer working hours. Another potential issue that arises for quality improvement is observed in the form of confusion related to the development of the role of managers and leads (Rahman, 2016). The emphasis on the significance of the clinical governance lead, the emotional impact of the role on the individual as well as long-term uncertainty associated with governance in healthcare settings could also be accounted as issues hampering quality improvement.

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Governance issues:

The understanding of the potential issues that can be observed in the case of issues with patient outcomes in modern healthcare settings could be clarified with an illustration of the primary drivers of governance and the responsibilities of individuals in charge. The issues could also be clarified with an impression of the reasons why the clinical staff has to be aware of the implications of governance alongside the need for continuous quality improvement (Raipa & Čepuraitė, 2017).

The major drivers of governance that can be identified in the domain of healthcare could be classified into three categories. The first factor which is responsible for driving governance could be identified in the environment characterized by the change. The second factor involves references to the individuals responsible for implementing governance while the third factor refers to the professional users of the governance frameworks. The environment of change in governance is characterized by the involvement of the architects of clinical governance as well as the environment in which the governance framework would be implemented (Rotar, et al., 2016).

The individuals that are associated with the tasks and responsibilities for implementing the necessary changes in governance could be accounted as leaders of change and are significant influences on the reforms in clinical governance approaches. The professional users of the governance framework could be accounted as major drivers of governance since they would be liable for integrating the governance framework into their daily routine which is observed as a mandatory concern for all staff involved in the domain of healthcare.

The assignment of responsibilities to the leaders of change could be identified as a promising initiative for fostering an environment of excellence, especially through the establishment of realistic targets and standards. The responsibilities of the people in charge in a clinical governance framework could also be identified in terms of monitoring the governance contracts with recipients of governance benefits and users of clinical governance (Roy, Litvak & Paccaud, 2013). This enables the users and recipients to obtain a credible impression of the transparency that is evident in the healthcare system thereby improving the opportunities for their involvement in the clinical processes and practices. For example, users could obtain proactive information regarding the use of penalties in the context of clinical governance to ensure their support invalid scenarios.

The necessity for awareness of staff regarding clinical governance could be validated on the grounds of their objectives. The awareness of staff members is required for apprehending the time available for reflective practice and consistent quality improvement as well as funding for implementing governance initiatives (Santos & Giovanella, 2014). The awareness of staff regarding clinical governance could also be validated on the grounds of the prevention of conflicts among national and regional regulations about the quality of healthcare.

The necessity for improvement of quality in healthcare services could therefore be validated on the grounds of opportunities to create precise frameworks that provide substantial privileges for users of healthcare services to be involved in the governance framework. The improvement of quality in healthcare could also be perceived as a necessity due to the emergence of a wide range of afflictions and the growing aging population.

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Personal reflection:

The observation of varying aspects of clinical governance such as its origin and relevance alongside the structure of clinical governance concerning a personal experience could facilitate a reasonable impression of the opportunities for quality improvement.

The personal experience involves my visit to a public health hospital due to the affliction of viral fever which validates my impression as a recipient of care. I was admitted for two days and was subject to the care facilities in the hospital. However, I was able to observe that my stay at the hospital was associated with the concerns of improper hygiene which occurred probably due to an unprecedented error in the assignment of janitors for cleaning my cabin. While my cabin was supposed to be cleaned four times a day, the cleaning personnel came only two times a day which led to an unhygienic atmosphere (Toh, et al., 2016).

The event made me consider quality since the unhygienic atmosphere caused due to lack of cleanliness could be assumed to have a profound impact on the excess of viral pathogens in the surrounding. Furthermore, the psychological impact of an unclean surroundings during recovery also affected me the most and made me consider the quality of care being provided to me. Therefore it is imperative to integrate a promising component from the clinical governance framework into the concerned personal experience to resolve quality issues. The dimension of patient involvement and experience could be integrated into the healthcare service framework for obtaining a wider range of functions such as clinical audit alongside accomplishing a first-hand impression of the patient’s experience (Santos & Giovanella, 2014).

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Conclusion:

The report presented a formal illustration of the origins and relevance of clinical governance in contemporary scenarios involving issues with patient outcomes. Then the discussion on the significance of governance and management on the improvement of quality in healthcare was also included in the report which was followed by the depiction of notable issues that inhibit clinical governance.

The final section of the report depicted a critical reflection of a personal experience as a healthcare recipient along with plausible recommendations for reforms in the clinical governance framework to accomplish desired outcomes.