Advertisement

Clinical Governance and Risk Management for Medical Administrators

  • Alison DwyerEmail author
Chapter

Abstract

Clinical Governance at a health service level requires structures, processes and frameworks that articulate the key roles, responsibilities and accountabilities at all staff levels from Board, management and clinicians. These structures are enabled by robust data, culture, education and training and a continuous learning environment. Clinical governance encompasses the domains of clinical effectiveness, risk management, patient safety and consumer engagement, and should address the priority areas and accreditation requirements of any national regulatory bodies.

Successful clinical governance requires strong authentic medical engagement, at a leadership, senior and junior medical staff level, that allows the advice, guidance and leadership from medical staff across a suite of patient safety areas, while utilising their time in an efficient and effective manner.

The Medical Administrator is also an essential element within the clinical governance system, by providing the patient safety advocate on the Executive, performing a translator role between management and medical staff, and facilitating trust with medical colleagues for an open and transparent patient safety culture, while still ensuring compliance and verifying the system’s integrity.

This chapter outlines the literature and practical examples of implementing Clinical Governance within a health service, provides strategies to effectively engage medical staff, and addresses the essential role of the Medical administrator within the clinical governance system.

Keywords

Medical administrators Clinical Governance in Health Services Risk management for medical administrators National Safety and Quality Health Service Standards 

Notes

Acknowledgments

I would like to acknowledge the previous Director Quality Safety and Risk Management, Ms. Filomena Ciavarella, for the collaborative leadership of the Clinical Governance Framework at Austin Health.

References

  1. 1.
    Scally F, Donaldson LJ. Clinical governance and the drive for quality improvement tin the new NHS in England. BMJ. 1998;317:61.CrossRefGoogle Scholar
  2. 2.
    Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards. Sydney: ACSQHC; 2011.Google Scholar
  3. 3.
    Institute of Medicine. To err is human, November 1999. Accessed 25 Sept 2017.Google Scholar
  4. 4.
    Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in Australian health care study. Med J Aust. 1995;163(9):458–71.PubMedGoogle Scholar
  5. 5.
    Kennedy I. The Report of the public inquiry into childrens’s heart surgery at the Bristol Royal Infirmary 1984-1995: learning from Bristol, July 2001. Available at http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPOlicyandGuidance/DH_4005620. Accessed on 18 June 2015.
  6. 6.
    Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive Summary. 2013. Available at www.midstaffpublicinquiry.com/sites/default/files/report/Executive%20summary.pdf. Accessed on 18 June 2015.
  7. 7.
    Russell DP. Lessons for the Australian healthcare system from the Berwick report. Aust Health Rev. 2013;38(1):106–8.CrossRefGoogle Scholar
  8. 8.
    Duckett S, Cuddihy M, Newnham H. Executive summary targeting zero: supporting the Victorian hospital system to eliminate avoidable harm an strengthen quality of care, Report of the Review of Hospital Safety and Quality Assurance in Victoria, Victorian Government. 2016. Available at https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/hospital-safety-and-quality-review.
  9. 9.
    Kim YC, Kim MH, Song JE, Anh JY, Oh DH, et al. Trend of methicillin-resistant staphylococcus aureas (MRSA) bacteremia in an institution with a high rate of MRSA after the reinforcement of antibiotic stewardship and hand hygiene. Am J Infect Control. 2013;41:e39–43.CrossRefGoogle Scholar
  10. 10.
    Beitler JR, Link N, Bails DB, Hurdle K, Chong DH. Reduction in hospital-wide mortality after implementation of a rapid response team: a long term cohort study. Crit Care. 2011;15:R269.CrossRefGoogle Scholar
  11. 11.
    Groene O, Sunol R. The investigators reflect: what we have learned from the deepening our understanding of quality improvement in Europe (DUQuE) study. Int J Qual Healthcare. 2014;26(S1):2–4.CrossRefGoogle Scholar
  12. 12.
    Leggat S, Balding C. A qualitative study on the implementation of quality systems in Australian hospitals. Health Serv Manag Res 2017;30(3):179–86.CrossRefGoogle Scholar
  13. 13.
    Australian Commission on Safety and Quality in Healthcare (ACSQHC). June 2017, Australian Atlas of Healthcare Variation. Available at https://www.safetyandquality.gov.au/atlas/, Accessed 28 Sept 2017
  14. 14.
    Pronovost PJ, Marsteller JA. Creating a fractal-based quality management infrastructure. J Health Organ Manag. 2014;28(4):576–86.CrossRefGoogle Scholar
  15. 15.
    Sutcliffe KM, Paine L, Pronovost P. Re-examining high reliability: actively organizing for safety, BMJ Qual Saf published on line March 21 2016. Available at http://qualitysafety.bmj.com/content/early/2016/03/21/bmjqs-2015-004698. Accessed 17 Oct 2016.
  16. 16.
    Ghaferi AA, Myers CG, Sutcliffe KM, Pronovost P. The next wave of hospital innovation to make patients safer. Harvard Business Review; 2016.Google Scholar
  17. 17.
    Victorian Department of Health and Human Services. Victorian Health Incident Management System Internet site. 2017. Available at https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/clinical-risk-management/vhims. Accessed 28 Sept 2017.
  18. 18.
    Clinical Excellence Commission. About the CEC. 2017. Available at http://www.cec.health.nsw.gov.au/about/about-cec. Accessed 25 Sept 2017.
  19. 19.
    Bismark MM, Walter SJ, Studdard DM. The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria. Aust Health Rev. 2013;37(5):682–7.CrossRefGoogle Scholar
  20. 20.
    Dekker SWA, Levenson NG. The systems approach to medicine: controversy and misconceptions. BMJ Qual Saf. 2015;24:7–9.CrossRefGoogle Scholar
  21. 21.
    Perla RJ, Provost LP, Parry GJ. Seven propositions of the science of improvement: exploring foundations. Q Manage Health Care. 2013;22(3):170–86.CrossRefGoogle Scholar
  22. 22.
    Brand C, Tropea J, Ibrahim J, Elkadi SO, Bain CA, et al. Measurement for improvement: a survey of current practice in Australian public hospitals. MJA. 2008;189:35–40.PubMedGoogle Scholar
  23. 23.
    Victorian Department of Health and Human Services Root Cause Analysis Training internet site, available at https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/clinical-risk-management/clinical-risk-education/root-cause-analysis. Accessed 28 Sept 2017.
  24. 24.
    Doran GT. There’s a S.M.A.R.T way to write management’s goals and objectives. Manage Rev. 1981;70(11):35.Google Scholar
  25. 25.
    Behal R. Safety Step 2.0 A systematic framework for case review and action plans for improving patient safety. 16 October 2016. Available at https://itunes.apple.com/au/book/safetysteps/id521567746?mt=11. Accessed 28 Sept 2017.
  26. 26.
    Hayes CW, Batalden PB, Goldmann D. A ‘work smarter, not harder’ approach to improving healthcare quality. BMJ Qual Saf. 2015;24(2):100–2.CrossRefGoogle Scholar
  27. 27.
    Perla RJ, Provost LP, Murray SK. Sampling considerations for health care improvement. Q Manage Health Care. 2013;22(1):36–47.CrossRefGoogle Scholar
  28. 28.
    Nuckols TK, Bell DS, Liu H, Paddock SM, Hilbourne LH. Rate and types of events reported to established incident reporting systems in two US hospitals. Qual Saf Health Care. 2007;16:164–8.CrossRefGoogle Scholar
  29. 29.
    Levtzion-Korach O, Alcali H, Orav EJ, Graydon-Baker E, Keohane C, Bates DW, Frankel AS. Evaluation of the contributions of an electronic web-based reporting system: enabling action. J Patient Saf. 2009 Mar;5(1):9–15.CrossRefGoogle Scholar
  30. 30.
    Evans SM, Smith BJ, Esterman A, Runciman WB, Maddern G, et al. Evaluation of an intervention aimed at improving voluntary incident reporting in hospitals. Qual Saf Health Care. 2007;2007(16):169–75.CrossRefGoogle Scholar
  31. 31.
    Evans SM, Berry JG, Smith BJ, Esterman A, Slemin P, O’Shaughnessy J, De Wit M. Attitudes and barriers to incident reporting: a collaborative hospital study. Qual Saf Health Care. 2006;15:39–43.CrossRefGoogle Scholar
  32. 32.
    Benn J, Koutantji M, Wallace L, Spurgeon P, Rejman M, Healey A, Vincent C. Feedback from incident reporting: information and action to improve patient safety. Qual Saf Health Care. 2009;18:11–21.CrossRefGoogle Scholar
  33. 33.
    Pham JC, Girard T, Pronovost PJ. What to do with healthcare incident reporting systems. J Public Health Res. 2013;2:e27.CrossRefGoogle Scholar
  34. 34.
    Harrison R, Lawton R, Stewart K. Doctors experiences of adverse events in secondary care: the professional and personal impact. Clin Med. 2014;14(6):585–90.CrossRefGoogle Scholar
  35. 35.
    Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2007. Available on www.IHI.org.
  36. 36.
    Joint Commission Sentinel Event Policy and Procedures. 2017. Available at https://www.jointcommission.org/sentinel_event_policy_and_procedures/. Accessed 6 Dec 2017.
  37. 37.
    Victorian Department of Health and Human Services. Sentinel Event Program. 2017. Available at https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/clinical-risk-management/sentinel-event-program. Accessed 28 Sept 2017.
  38. 38.
    Shojania KG, Wald H, Gross R. Understanding medical error and improving patient safety in the inpatient setting. Med Clin North Am. 2002 Jul;86(4):847–67.CrossRefGoogle Scholar
  39. 39.
    Dwyer AJ, Visser P, Russell L. Interpreting the coroners act at the bedside: how do junior doctors know they are doing it correctly? Med J Aust. 2013;199(1):25–6.CrossRefGoogle Scholar
  40. 40.
    Dwyer AJ. Medical managers in contemporary healthcare organisations: a consideration of the literature. Aust Health Re. 2010;34(4):514–22.CrossRefGoogle Scholar
  41. 41.
    Dwyer AJ. Roles, attributes and career paths of medical administrators in public hospitals: survey of Victorian metropolitan directors of medical services. Aust Health Rev. 2010;34(4):506–13.CrossRefGoogle Scholar
  42. 42.
    Goodall AH. Physician-leaders and hospital performance: is there an association? Soc Sci Med. 2011;73(4):535–9.CrossRefGoogle Scholar
  43. 43.
    Swensen S, Pugh M, McMullan C, Kabcenell A. High impact leadership: improve care, improve the health of populations, and reduce costs. IHI White Paper Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013.Google Scholar
  44. 44.
    Dwyer AJ, Becker G, Hawkins C, McKenzie L, Wells M. Engaging medical staff in clinical governance: introducing new technologies and clinical practice into public hospitals. Aust Health Rev. 2012;36(1):43–8.CrossRefGoogle Scholar
  45. 45.
    Bisognano M. Healthcare Improvement Guru Maureen Bisognano sees Hospitalists as Agents for Change. The Hospitalist, 2015 February; 2015 (2). Available at http://www.the-hospitalist.org/hospitalist/article/122592/healthcare-improvement-guru-maureen-bisognano-sees-hospitalists-agents. Accessed 28 Sept 2017.
  46. 46.
    Choosing Wisely Australia 2015. Australian College of Emergency Medicine: tests treatments and procedures that clinicians and consumers should question. Available at http://www.choosingwisely.org.au/recommendations/acem. Accessed 6 Dec 2017.
  47. 47.
    Singh H, Sittig DF. Advancing the science of measurement of diagnostic errors in healthcare: the safer dx framework. BMJ Qual Saf. 2015;24(2):103–10.CrossRefGoogle Scholar
  48. 48.
    Jackson TJ, Michel JL, Roberts RF, Jorm CM, Wakefield JG. A classification of hospital acquired diagnoses for use with routine hospital data. MJA. 2009;191:544–8.PubMedGoogle Scholar
  49. 49.
    Provenzano A, Rohan S, Trevejo E, Burdick E, Lipsitz S, Kachalia A. Evaluating inpatient mortality: a new electronic review process that gathers information from front-line providers. BMJ Qual Saf. 2015;24:31–7.CrossRefGoogle Scholar
  50. 50.
    Bottle A, Aylin P. Strengths and weaknesses of hospital standardised mortality ratios. BMJ. 2011;342:c7116.CrossRefGoogle Scholar
  51. 51.
    Mackenzie SJ, Goldmann DA, Perla RJ, Parry GJ. Measuring hospital-wide mortality pitfalls and potential. J Healthc Qual. 2014;38(3):187–94.CrossRefGoogle Scholar
  52. 52.
    Evans SM, Scott IA, Johnson NP, Cameron PA, McNeil JJ. Development of clinical-quality registries in Australia: the way forward. Med J Aust. 2011;194(7):360–3.PubMedGoogle Scholar
  53. 53.
    Grace BS, Clayton P, McDonald SP. Increases in renal replacement therapy in Australia and New Zealand: understanding trends in diabetic nephropathy. Nephrology (Carlton). 2012;17(1):76–84.CrossRefGoogle Scholar
  54. 54.
    Bufalino VJ, Masoudi FA, Stranne SK, Horton K, Albert NM, Beam C, et al. The American Heart Association’s recommendations for expanding and applications of existing and future clinical registries, a policy statement from the American Heart Association. Circulation. 2011;123:2167–79.CrossRefGoogle Scholar
  55. 55.
    Clinical Registries, Centre of Research Excellence in Patient Safety. Available at http://www.crepatientsafety.org.au/registries/. Accessed on 18 Mar 2012, last updated 13 June 2011.
  56. 56.
    Moran JL, Solomon PJ, for the ANZICS Centre for Outcome and Resource Evaluation (CORE) of the Australian and New Zealand Intensive Care Society (ANZICS). Mortality and intensive care volume in ventilated patients from 1995 to 2009 in the Australian and New Zealand binational adult patient intensive care database*. Crit Care Med. 2012;40(3):800–12.CrossRefGoogle Scholar
  57. 57.
    Retegan C, Russell C, Harris D, Andrianopoulos N, Beiles B. Evaluating the value and impact of the Victorian audit of surgical mortality. ANZ J Surg. 2013;83:724–8.CrossRefGoogle Scholar
  58. 58.
    Vinluan J, Retegan C, Chen A, Beiles CB. Clinical management issues vary by specialty in the Victorian audit of surgical mortality: a retrospective observational study. BMJ Open. 2014;4:e005554.CrossRefGoogle Scholar
  59. 59.
    ANZICS Centre for Outcome and Resource Evaluation Annual Report 2012-2013, ANZICS Melbourne.Google Scholar
  60. 60.
    Dwyer AJ, McNeil J. Are clinical registries actually used? The level of medical staff participation of clinical registries and reporting within a major tertiary teaching hospital. Asia Pac J Health Manage. 2016;11(1):56–64.Google Scholar
  61. 61.
    Twigg DE, Duffield C, Evans G. The critical role of nurses to the successful implementation of the national safety and quality healthcare standards. Aust Health Rev. 2013;37(4):5410546.CrossRefGoogle Scholar
  62. 62.
    Veronesi G, Kirkpatrick I, Vallascas F (2013) Clinicians on the board: what difference does it make? Soc Sci Med, vol 77, 2013, p 147–155.CrossRefGoogle Scholar
  63. 63.
    Glasziou P, Ogrinc G, Goodman S. Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Qual Saf. 2011;20(Suppl1):i13–7.CrossRefGoogle Scholar

Further Reading1

  1. Angood P, Birk S. The value of physician leadership. Phys Exec J. 2014;2014:p6–22.Google Scholar
  2. Australian and New Zealand Society of Cardiac and Thoracic Surgeons. 2017. About the database. Available at https://anzcrs.org/database/about. Accessed on 25 Sept 2017.
  3. Australian Government Department of Health, National Core Set of Sentinel Events. Available at http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-safety-toc~mental-pubs-n-safety-5~mental-pubs-n-safety-5-8. Accessed 6 Dec 2017.
  4. Australian Health Practitioner Regulation Agency. Mandatory Reporting. Available at https://www.ahpra.gov.au/Notifications/Make-a-complaint/Mandatory-notifications.aspx. Accessed 6 Dec 2017.
  5. Australian Institute of Health Innovation, Deepening our Understanding of Quality in Australia Project, Macquarie University. Available at https://duqua.org. Accessed 25 Sept 2017.
  6. Clark J, Nath V. 2014. Medical engagement: A Journey not an event, The Kings’ Fund, July 2014.Google Scholar
  7. Conway J, Federico F, Stewart K, Campbell M. Respectful Management of Serious Clinical Adverse Events. 2nd ed. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. Available on www.IHI.org.Google Scholar
  8. Department of Health Victoria. Victorian Clinical Governance Policy Framework: Enhancing Clinical Care, Department of Health; 2008.Google Scholar
  9. Doyle P, VanDenKerkhof EG, Edge DS, Dinsburg L, Goldstein DH. Self-reported patient safety competence among Canadian medical student and postgraduate trainees: a cross sectional survey. BMJ Qual Saf. 2015;24:135–41.CrossRefGoogle Scholar
  10. Health Roundtable. 2017. Welcome. https://www.healthroundtable.org/. Accessed 25 Sept 2017.
  11. Lee TH, Cosgrove T. Engaging doctors in the healthcare revolution. Harv Bus Rev 2014;92(6):104–11, 138.Google Scholar
  12. Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, et al. Choosing Wisely: a growing international campaign. BMJ Qual Saf. 2015;24(2):167–74.CrossRefGoogle Scholar
  13. Victorian Healthcare Associated Infection surveillance System (VICNISS) 2017, What is VICNISS. Available at https://www.vicniss.org.au/aout/what-is-vicniss/. Accessed 25 Sept 2017.
  14. Victorian Quality Council. Better quality better health care: a safety and better quality better health care: a safety and quality improvement framework for Victorian health services, Victorian quality council; 2005.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Northern HealthEppingAustralia

Personalised recommendations