Clinical governance

2020 ◽  
pp. 72-82
Author(s):  
Leroy C. Edozien
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Outcomes ◽  
Patient Experience ◽  
Clinical Governance ◽  
Service Users ◽  
Basic Principles ◽  
Analyse Data ◽  
Integrated Domains ◽  
The Right

Clinical governance is the totality of structures and processes that are in place to ensure that, as far as practicable, the right person receives the right treatment, in the right way, at the right time, in the right place, with the right outcome. This goal does not happen by chance; it has to be secured by conscious effort, and that effort—creating and sustaining the required structures and processes—has to be actively and efficiently managed. This chapter describes the basic principles of clinical governance and provides a framework—the RADICAL framework—for delivering and monitoring clinical governance. The framework comprises the following domains: Raise awareness, Apply quality improvement methodology, Design for quality (including safety), Involve service users, Collect and Analyse data, and Learn from experience. The lofty aims of achieving optimal clinical outcomes and the best possible patient experience are best achieved when clinical practice addresses these integrated domains.

Clinical governance: quality improvement and clinical audits in practice

2020 ◽  
Vol 11 (9) ◽  
pp. 388-393
Author(s):  
Amanda Curtis
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Governance ◽  
Governance Quality ◽  
The Many ◽  
Clinical Audits ◽  
Human Healthcare

Quality improvement (QI) has been employed successfully across various industries, including human healthcare, as well as the aviation and automotive industries. In the veterinary sector, practices are starting to see the many benefits that QI can offer — particularly those that come from conducting clinical audits. Clinical audits are a part of QI and aim to look at how closely clinical practice is carried out when compared with set guidelines or protocols. This article looks at the steps of clinical auditing and some of the main barriers faced when first trying to implement them into clinical practice.

scholarly journals Case-based discussion: a useful tool for revalidation

2011 ◽  
Vol 35 (6) ◽  
pp. 230-234 ◽  
Author(s):  
Laurence Mynors-Wallis ◽  
Denise Cope ◽  
Andrew Brittlebank ◽  
Fauzan Palekar
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Implications ◽  
Service Users ◽  
Quality Improvement Tool ◽  
Case Based

Aims and methodRevalidation is the process by which doctors demonstrate that they are up to date and fit to practise. Case-based discussion has been identified by both psychiatrists and service users and carers as a potentially useful tool for revalidation. The aim of this study was to examine the feasibility of case-based discussion for assessments to use in revalidation. A pilot using case-based discussion as an assessment/developmental technique for revalidation was undertaken in six trusts involving 86 consultant psychiatrists.ResultsThe average time taken for each case-based discussion including preparation and reflection was 48 min. All but one of the doctors involved in the case-based discussion pilot described the process as useful or very useful in improving clinical practice. In total 87% of the assessed doctors and all of the assessors reported that they considered case-based discussion to be a useful part of the revalidation process assessed. The majority of doctors assessed believed that cases should be chosen at random (91%).Clinical implicationsCase-based discussions have the potential to be a useful quality improvement tool for revalidation.

Intentions and their Effects on the Legality of Dispositions and Contracts

2002 ◽  
Vol 4 (1) ◽  
pp. 130-141
Author(s):  
Abdullah Muhammad al-Shami
Keyword(s):  
Basic Principle ◽  
Islamic Law ◽  
Human Action ◽  
Basic Principles ◽  
Human Actions ◽  
Special Place ◽  
Legal Contract ◽  
Islamic Jurisprudence ◽  
Legal Opinions ◽  
The Right

In Islamic law judgements on any human action are usually evaluated in terms of the intention involved. Accordingly, the rules of substantive issues have to be accommodated under the basic principles of Islamic jurisprudence. The understanding of these principles by the juristic scholar is highly rewarding because it will lead the muftī to the right path in deriving legal opinions from the original sources. The basic principle of Islamic jurisprudence, which stipulates that ‘all actions depend on intentions,’ has played an important role in the construction of Islamic jurisprudence. Moreover, this rule has a special place in the theory of Islamic legal contract. So what is the effect of intention in the validity of human actions and legal contracts? It is known that pure intention has significant effects on spiritual worship and legal contracts of transaction. It also gives guidance for earning rewards from Almighty Allah. This article concentrates on the effect of intention in perpetual worship, the concept of action and intention in Islamic legal works, the kind of contract with all its components, and the jurists' views on the effects of intention in human action and legal contract along with their discussion and counter-arguments.

Theory-Practice Gap: The Experiences of Nigerian Nursing Students

2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Titilayo Dorothy Odetola ◽  
Olusola Oluwasola ◽  
Christoph Pimmer ◽  
Oluwafemi Dipeolu ◽  
Samson Oluwayemi Akande ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nursing Students ◽  
Developing Country ◽  
The Body ◽  
Clinical Staff ◽  
Clinical Settings ◽  
Practice Gap ◽  
The Difference ◽  
Analyse Data ◽  
Theory Practice Gap

The “disconnect” between the body of knowledge acquired in classroom settings and the application of this knowledge in clinical practice is one of the main reasons for professional fear, anxiety and feelings of incompetence among freshly graduated nurses. While the phenomenon of the theory-to-practice gap has been researched quite extensively in high-income country settings much less is known about nursing students’ experiences in a developing country context. To rectify this shortcoming, the qualitative study investigated the experiences of nursing students in their attempt to apply what they learn in classrooms in clinical learning contexts in seven sites in Nigeria. Thematic content analysis was used to analyse data gained from eight focus group discussions (n = 80) with the students. The findings reveal a multifaceted theory-practice gap which plays out along four tensions: (1) procedural, i.e. the difference between practices from education institutions and the ones enacted in clinical wards – and contradictions that emerge even within one clinical setting; (2) political, i.e. conflicts that arise between students and clinical staff, especially personnel with a lower qualification profile than the degree that students pursue; (3) material, i.e. the disconnect between contemporary instruments and equipment available in schools and the lack thereof in clinical settings; and (4) temporal, i.e. restricted opportunities for supervised practice owing to time constraints in clinical settings in which education tends to be undervalued. Many of these aspects are linked to and aggravated by infrastructural limitations, which are typical for the setting of a developing country. Nursing students need to be prepared regarding how to deal with the identified procedural, political, material and temporal tensions before and while being immersed in clinical practice, and, in so doing, they need to be supported by educationally better qualified clinical staff.

scholarly journals Producing a new website for a paediatric liaison mental health team with our service users

2020 ◽  
Vol 9 (4) ◽  
pp. e001128
Author(s):  
Alexander Adams ◽  
Virginia Davies ◽  
Bethany Stubbs
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Patient Experience ◽  
Service Users ◽  
Health Issues ◽  
Web Page ◽  
Mental Health Team ◽  
Children And Young People ◽  
Specific Feedback ◽  
Source Of Information

IntroductionOnline resources are an important source of information about mental health issues and services for children and young people. Our service’s website had an out-of-date appearance and was aimed at professionals. More importantly, comments in our routinely collected patient experience data indicated that service users did not know what to expect when coming to our service.MethodsWe followed the model for improvement by testing out changes in plan, do, study and act cycles that included a review of recently updated child and adolescent mental health services’ and youth charities’ websites, designing a new web page for our service and then testing out the website in focus groups. We used routinely collected patient experience data to assess impact on wider patient satisfaction.ResultsFocus groups involving patients, parents and professionals judged the new website to be clearer, more attractive and easier to understand. Routine patient experience data did not reveal any website-specific feedback.ConclusionThis study demonstrates that it is easy and possible to create an attractive and accessible website for a mental health service using quality improvement methodology. In order to capture and integrate ongoing feedback about a service’s website from service users, routinely collected patient experience measures would need to ask specific questions related to this area. In this study, preproject and postproject patient experience data did not generate any specific comments.

scholarly journals Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature

2021 ◽  
Vol 10 (3) ◽  
pp. e001091
Author(s):  
Jenifer Olive Darr ◽  
Richard C Franklin ◽  
Kristin Emma McBain-Rigg ◽  
Sarah Larkins ◽  
Yvette Roe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Management ◽  
Health Service ◽  
First Nations ◽  
Quality Management System ◽  
Grey Literature ◽  
Models Of Care ◽  
Clinical Governance ◽  
Aboriginal Community ◽  
Continuous Quality

BackgroundA national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector.AimThe literature review aims to answer the following: to what extent does the implementation of the International Organisation for Standardization 9001:2008 quality management system (QMS) facilitate efficiency and sustainability in the ACCHS sector?MethodsThematic analysis of peer-reviewed and grey literature was undertaken from Australia and New Zealand PHC sector with a focus on First Nations people. The databases searched included Medline, Scopus and three Informit sites (AHB-ATSIS, AEI-ATSIS and AGIS-ATSIS). The initial search strategy included quality improvement, continuous quality improvement, efficiency and sustainability.ResultsSixteen included studies were assessed for quality using the McMaster criteria. The studies were ranked against the criteria of credibility, transferability, dependability and confirmability. Three central themes emerged: accreditation (n=4), quality improvement (n=9) and systems strengthening (n=3). The accreditation theme included effects on health service expenditure and clinical outcomes, consistency and validity of accreditation standards and linkages to clinical governance frameworks. The quality improvement theme included audit effectiveness and value for specific population health. The theme of systems strengthening included prerequisite systems and embedded clinical governance measures for innovative models of care.ConclusionThe ACCHS sector warrants reliable evidence to understand the value of QMSs and enhancement tools, particularly given ACCHS (client-centric) services and their specialist status. Limited evidence exists for the value of standards on health system sustainability and efficiency in Australia. Despite a mandatory second certification standard, no studies reported on sustainability and efficiency of a QMS in PHC.

scholarly journals Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD)

2021 ◽  
Author(s):  
Toby J L Humphrey ◽  
Glen James ◽  
Eric T Wittbrodt ◽  
Donna Zarzuela ◽  
Thomas F Hiemstra
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Ckd Stage ◽  
First Occurrence ◽  
Baseline Characteristics

Abstract Background Users of guideline-recommended renin–angiotensin–aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. Methods This exploratory, retrospective analysis utilized data from the UK’s Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. Results Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8–75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. Conclusions These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.

scholarly journals The Role of Research in Guiding Treatment for Women’s Health: A Qualitative Study of Traditional Chinese Medicine Acupuncturists

2021 ◽  
Vol 18 (2) ◽  
pp. 834
Author(s):  
Mike Armour ◽  
Debra Betts ◽  
Kate Roberts ◽  
Susanne Armour ◽  
Caroline A. Smith
Keyword(s):  
Clinical Practice ◽  
Women’S Health ◽  
Women's Health ◽  
Clinical Decision ◽  
Health Conditions ◽  
Case Histories ◽  
Research Literacy ◽  
The Right ◽  
Practice Methods

Background: Surveys of acupuncture practitioners worldwide have shown an increase in the use of acupuncture to treat women’s health conditions over the last ten years. Published studies have explored the effectiveness of acupuncture for various conditions such as period pain, fertility, and labor induction. However, it is unclear what role, if any, peer-reviewed research plays in guiding practice. Methods: Acupuncturists with a significant women’s health caseload were interviewed online in three small groups to explore factors that contribute to acupuncturists’ clinical decision made around treatment approaches and research. Results: Eleven practitioners participated in the focus groups. The overarching theme that emerged was one of ‘Not mainstream but a stream.’ This captured two themes relating to acupuncture as a distinct practice: ‘working with what you’ve got’ as well as ‘finding the right lens’, illustrating practitioners’ perception of research needing to be more relevant to clinical practice. Conclusions: Acupuncture practitioners treating women’s health conditions reported a disconnect between their clinical practice and the design of clinical trials, predominantly due to what they perceived as a lack of individualization of treatment. Case histories were popular as a learning tool and could be used to support increasing research literacy.

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