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.

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.

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.

The effect of small peer group continuous quality improvement on the clinical practice of midwives in The Netherlands

Midwifery ◽  
2003 ◽  
Vol 19 (4) ◽  
pp. 250-258 ◽  
Author(s):  
Yvonne Engels ◽  
Nicole Verheijen ◽  
Margot Fleuren ◽  
Henk Mokkink ◽  
Richard Grol
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
The Netherlands ◽  
Continuous Quality Improvement ◽  
Peer Group ◽  
Continuous Quality

scholarly journals Use of prescribing safety quality improvement reports in UK general practices: a qualitative assessment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nada F. Khan ◽  
Helen P. Booth ◽  
Puja Myles ◽  
David Mullett ◽  
Arlene Gallagher ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Clinical Practice ◽  
General Practitioners ◽  
Qualitative Assessment ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Case Review ◽  
Local Networks ◽  
Quality Culture

Abstract Background Quality improvement (QI) initiatives are increasingly used to improve the quality of care and reduce prescribing errors. The Royal College of General Practitioners (RCGP) and Clinical Practice Research Datalink (CPRD) QI initiative uses routinely collected electronic primary care data to provide bespoke practice-level reports on prescribing safety. The aim of this study was to explore how the QI reports were used, barriers and facilitators to use, long-term culture change and perceived impact on patient care and practices systems as a result of receiving the reports. Methods A qualitative study using purposive sampling of practices contributing to the CPRD, semi-structured interviews and inductive thematic analysis. We interviewed general practitioners, pharmacists, practice managers and research nurses. Results We conducted 18 interviews, and organised themes summarising the use of QI reports in practice: receiving the report, facilitators and barriers to acting upon the reports, acting upon the report, and how the reports contribute to a quality culture. Effective dissemination of reports, and a positive attitude to audit and the perceived relevance of the clinical topic facilitated use. Lack of time and failure to see or act upon the reports meant they were not used. Factors influencing use of the reports included the structure of the report, ease of identifying cases, and perceptions about coding accuracy. GPs and pharmacists used the reports to conduct case reviews and directly contact patients to discuss unsafe prescribing and patient medication preferences. Finally, the reports contributed to the development of a quality culture within practices through promoting audit activity and acting as a reminder of good prescribing behaviours, promoting future patient safety initiatives, contributing to continuing professional development and improving local networks. Conclusions This study found the reports facilitated individual case review leading to an enhanced sense of quality culture in practices where they were utilised. Our findings demonstrate that the reports were generally considered useful and have been used to support patient safety and clinical practice in specific cases.

scholarly journals Plain Language Summary: Benign Paroxysmal Positional Vertigo

2017 ◽  
Vol 156 (3) ◽  
pp. 417-425
Author(s):  
Neil Bhattacharyya ◽  
Deena B. Hollingsworth ◽  
Kathryn Mahoney ◽  
Sarah O’Connor
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Benign Paroxysmal Positional Vertigo ◽  
Evidence Based ◽  
Plain Language ◽  
Positional Vertigo ◽  
Effective Diagnosis ◽  
Evidence Based Guideline ◽  
Paroxysmal Positional Vertigo

Objective. This plain language summary serves as an overview in explaining benign paroxysmal positional vertigo, abbreviated BPPV. This summary applies to patients ≥18 years old with a suspected or potential diagnosis of BPPV and is based on the 2017 “Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).” The evidence-based guideline includes research to support more effective diagnosis and treatment of BPPV. The guideline was developed as a quality improvement opportunity for managing BPPV by creating clear recommendations to use in medical practice.

scholarly journals Translating research into clinical practice: quality improvement to halve non-adherence to methotrexate

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 125-131
Author(s):  
Anne Barton ◽  
Meghna Jani ◽  
Christine Bundy ◽  
James Bluett ◽  
Stephen McDonald ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Motivational Interviewing ◽  
Cost Savings ◽  
Serum Levels ◽  
Response To Therapy ◽  
Self Report ◽  
Time Points ◽  
Remission Rates ◽  
Consistent Information

Abstract Objective MTX remains the cornerstone for therapy for RA, yet research shows that non-adherence is significant and correlates with response to therapy. This study aimed to halve self-reported non-adherence to MTX at the Kellgren Centre for Rheumatology. Methods An anonymous self-report adherence questionnaire was developed and data collected for 3 months prior to the introduction of interventions, and then regularly for the subsequent 2.5 years. A series of interventions were implemented, including motivational interviewing training, consistent information about MTX and development of a summary bookmark. Information on clinic times was collected for consultations with and without motivational interviewing. Surveys were conducted to ascertain consistency of messages about MTX. A biochemical assay was used to test MTX serum levels in patients at two time points: before and 2.8 years following introduction of the changes. Remission rates at 6 and 12 months post-MTX initiation were retrieved from patient notes and cost savings estimated by comparing actual numbers of new biologic starters compared with expected numbers based on the numbers of consultants employed at the two time points. Results Between June and August 2016, self-reported non-adherence to MTX was 24.7%. Following introduction of the interventions, self-reported non-adherence rates reduced to an average of 7.4% between April 2018 and August 2019. Clinic times were not significantly increased when motivational interviewing was employed. Consistency of messages by staff across three key areas (benefits of MTX, alcohol guidance and importance of adherence) improved from 64% in September 2016 to 94% in January 2018. Biochemical non-adherence reduced from 56% (September 2016) to 17% (June 2019), whilst remission rates 6 months post-initiation of MTX improved from 13% in 2014/15 to 37% in 2017/18, resulting is estimated cost savings of £30 000 per year. Conclusion Non-adherence to MTX can be improved using simple measures including focussing on the adherence and the benefits of treatment, and providing consistent information across departments.

scholarly journals Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

2020 ◽  
Author(s):  
laura Allum ◽  
Chloe Apps ◽  
Nicholas Hart ◽  
Natalie Pattison ◽  
Bronwen Connolly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Care Delivery ◽  
Cochrane Library ◽  
Future Research ◽  
Care Plans ◽  
Icu Stay ◽  
Structured Care ◽  
High Dependency ◽  
Prolonged Icu Stay

Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety, however these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational, and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2021 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Performance Measurement ◽  
Clinical Performance ◽  
The United States ◽  
Performance Measure ◽  
Care Performance

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This review contains 1 figure, 3 tables, and 56 references Keywords: Quality of care, performance measure, quality improvement, clinical practice, sigma six, transparency

Sign in / Sign up

Export Citation Format

Share Document