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Components of Clinical Governance

  • Aim1 Objective 1: Chief Executive responsible for assuring quality.
  • The Chief Executive now has accountable officer status for clinical governance which must be reflected in the job description of the CEO.
  • The Trust business and strategic plans clearly incorporate components of clinical governance.
  • Trust organization charts reflect the CEO accountability for clinical governance

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Components of Clinical Governance

  • Aim 1 Objective 2: Designated senior clinician responsible for systems and their monitoring.
    • An appropriate clinician is appointed to take the lead for managing clinical governance and evaluating its effects, this needs to be reflected in their job description
    • The lines of responsibility are communicated to all staff both internally and externally to other NHS organisations, which ensures a two way communication system

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    Components of Clinical Governance

  • Aim 1 Objective3: Formal arrangements for Trust Boards e.g. a clinical governance committee.
    • There must be an active clinical governance committee. Each trust must have in place a committee whose role is specifically to oversee and manage clinical governance
    • Membership must be multidisciplinary to ensure all specialities and aspects of the service are represented
    • All members of staff across the organisation are accountable for individual clinical governance which must be reflected in their job descriptions
  • (Appendix 1 Terms of Reference, List of members)
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    Components of Clinical Governance

  • Aim 1 Objective 4: Regular reports to Trust Board on quality of clinical care.
    • There must be a monthly clinical governance report to the Trust Board. Suggested items:
    • Clinical Performance Indicators
    • Clinical Audit
    • Clinical Effectiveness
    • Response Times
    • Progress against HImP’s and NSF’s
    • Risks including adverse incidents and complaints analysis
    • Reporting against action plans and milestones identified by baseline assessment

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    Components of Clinical Governance

  • Aim 1 Objective 5:Annual Report on Clinical Governance.
    • As an element of the NHS Trust Annual Report a Clinical Governance section should be included which encompasses the following items:
    • Clinical Audit
    • Clinical Effectiveness
    • R&D
    • Clinical Risk
    • CPD/Lifelong Learning

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    Components of Clinical Governance

  • Aim 2 Objective 1: Full participation by all clinicians in audit, including external audit from CHImP.
    • Trusts should carry out multidisciplinary clinical audit with other NHS organisations to benchmark against NSF’s
    • Professional ambulance staff should be encouraged to evaluate their performance in terms of compliance to protocols and patient outcomes

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    Components of Clinical Governance

    • Aim 2 Objective 2: Full participation in the current four National Confidential Enquiries.
    • Currently these do not apply to ambulance trusts although should this situation change this aspect will be reviewed.

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    Components of Clinical Governance

    • Aim 2 Objective 3: Evidence based practice is supported and applied routinely.
    • Key areas of prehospital practice should be routinely subjected to evaluation by clinical audit and the results reviewed by an appropriate body and incorporated, where appropriate, into service standing procedures to ensure best clinical practice
    • Services should be encouraged to share results and findings to ensure best practice is disseminated across all UK ambulance services through the ASA/JCALC Clinical Effectiveness Committee

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    Components of Clinical Governance

  • Aim 2 Objective 4: Implementation of NSF clinical standards and NICE recommendations.
    • There must be a multidisciplinary approach to all NSF’s in association with other health care organisations
    • Any evidence produced must be fed back to all stakeholders to ensure integrated care pathways provide the patient with a truly seamless progression through the health service
    • At the present time there is only one applicable NSF to do with CHD, however as further NSF’s are produced it is important that NHS ambulance trusts react accordingly to establish a baseline which in turn will allow a platform for improvement
    • As the aims and objectives of NICE evolve it is important that ambulance service trusts react accordingly to ensure compliance

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    Components of Clinical Governance

    • Aim 2 Objective 5: Workforce planning and development is integrated in the Trust’s service planning
    • Trusts should have in place a human resource strategy that ensures the recruitment and retention of a workforce capable of delivering high quality patient care
    • These objectives should be set by the Director of Personnel and form part of the trusts human resource strategy

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    Components of Clinical Governance

  • Aim 2 Objective 6: CPD is in place and supported locally.
    • There must be compliance with the IHCD standards for the maintenance of technician and paramedic status
    • Consideration should be given to the possibilities of clinical audit projects being undertaken by operational paramedics/ technicians as part of their on-going Personal Development Plans. This will also allow individuals to evaluate the level of care provided against stated aims and objectives

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    Components of Clinical Governance

  • Aim 2 Objective 7: Safeguards for access and storage of confidential patient information as per Caldicott Review.
    • There should be a board level Caldicott Guardian responsible for the implementation of the findings of the Caldicott Report
    • An assessment of the trusts compliance against the Caldicott recommendations to be undertaken with an action plan produced to introduce systems to safeguard confidential patient information
    • (See HSC 1999/012)

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    Components of Clinical Governance

  • Aim 2 Objective 8: Monitoring of clinical care with high quality systems for clinical record keeping and the collection of relevant information.
    • The patient report form used should reflect the ASA/JCALC minimum data set
    • A patient report form should be completed for every patient
    • The standards of completion should be the subject of multidisciplinary audit

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    Components of Clinical Governance

  • Aim 2 Objective 9: Processes for assuring the quality of clinical care are in place and integrated with the organisations quality programme.
    • Quality initiatives should be integrated into a cohesive strategy which leads to measurable improvements in patient care e.g. integrated pathway of care that incorporates the NSF for CHD patients
    • Professional ambulance staff should be actively involved in producing these quality initiatives and their evaluation through audit

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    Components of Clinical Governance

  • Aim 2 Objective 10 : Participation in well designed relevant R&D activity is encouraged and supported as something which can contribute to the development of an "evaluation culture"
    • Local and national links should be developed with educational institutions to promote and implement R&D projects
    • The implementation of R&D within ambulance services is at this time a relatively new concept but given the circumstances of clinical governance it should become part of day to day practice

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    Components of Clinical Governance

  • Aim 3 Objective 1: Controls assurance policies which promote self-assessment to identify and manage risks
    • There should be an aim to integrate the clinical governance framework into the controls assurance policies
    • Following the assessment requirement in relation to HSC 1999/123 (Governance and Controls Assurance), a strategy should be developed that integrates relevant aspects of clinical governance into corporate governance

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    Components of Clinical Governance

  • Aim 3 Objective 2: Clinical risks systematically assessed with programmes in place to reduce risk
    • CNST level 1 should be a minimum requirement for all ambulance trusts
    • Clinical risk cases should be reviewed and reported by an appropriate mechanism to the clinical governance committee and a process of risk reduction should be implemented following these findings

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    Components of Clinical Governance

  • Aim 4 Objective 1: Procedures for all professional groups to identify and remedy poor performance. For example Critical incident reporting ensures that adverse events are identified, openly investigated, lessons are learned and promptly applied
    • The trust must have in place robust critical incident procedures and common documentation
    • Critical incident reports should be reviewed in an open forum which promotes a blameless culture and life long learning. This will permit lessons to be learned and applied promptly.

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    Components of Clinical Governance

  • Aim 4 Objective 2: Complaints procedures.
    • In the event of a complaint being received by the trust the NHS Complaints Procedure should be implemented.
    • Any problems that the inquiry reveals should be reviewed and assessed with the prime objective of establishing the cause and avoiding any repetition.
    • Lessons learned should be incorporated into lifelong learning and also as part of the blameless culture.

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    Components of Clinical Governance

  • Aim 4 Objective 3: Professional performance procedures.
    • With the closure of paramedic title and the advent of professional self regulation, evidence must be produced that procedures are understood and followed
    • There is a joint responsibility on professional ambulance staff and the trust to ensure the level of care provided reflects best practice. Any issues which fall below the expected standard should be identified and appropriate clinical support provided

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    Components of Clinical Governance

  • Aim 4 Objective 4: Reporting procedures for staff concerns about their colleagues’ professional conduct and performance, with clear statements from the Board on what is expected of all staff.
    • This aspect in the ambulance service will require considerable development and consultation if it is to be implemented in a non-threatening manner
    • This aspect needs to be reviewed. It is suggested this is carried out by the clinical governance committee in consultation with other bodies.