Clinical Governance and Risk Management - Essay Example

Name : xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Tutor :xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Title : Clinical governance and Risk management Institution : xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date :xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx @ 2010 Clinical governance and Risk management Introduction Clinical governance can be defined as an approach that can be taken systematically to improve and maintain patient care quality in a hospitals or any health care system; Valentine (2002). Risk management may involve the measures taken in order to prevent the occurrence of risks at the clinic. According to the standards of risk management and clinical governance of the National Health Service Quality Improvement Scotland, risk management is defined as a systematic process of risk treatment and identification or an ongoing process of preventing risks at the individual and organization level Kerfoot, (2001). Clinical governance and risk management are therefore integrated to bring about good care of the patient and clinic environment where all risks are reduced. This is the responsibility of clinical personnel who operate under the leadership of a nurse leader. It is therefore the duty of a nurse leader to ensure proper safety, patient care, and reduced possibility of risks in the organization or health care system he or she is involved with. A good and well executed program of clinical governance and risk management should therefore provide proper safety and care for patients through risk reduction and ensure the safety of the general organizational environment; Antrobus, & Kitson, (1999). There is no such a successful program without the professional integration of these two aspects of health care. The use of the term clinical governance was widely adopted in 1995 at the time of the Bristol babies’ scandal. At this time Dr Stephen Bolsin revealed the shocking cases of high deaths in children going through surgery at Bristol Royal Infirmary. This term was later defined in the National Health Service of the United Kingdom as: “A framework through which National Health Service organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (Horton-Deutsch, & Mohr 2001). Riyadh military hospital The Riyadh Military Hospital is found in the city of Riyadh which serves as the capital city of Saudi Arabia. The military hospital acts as the department of medical services for the defense and aviation ministry. It opened its doors in December 1978. It has the major hospital, new south west corner extension and the south west corner. More facilities are under construction to take care of the increasing population and to better the patient health care being provided; Antrobus, & Kitson, (1999). Riyadh Military hospital is not spared of the problems affecting other hospitals in Riyadh. Although these problems do affect the quality of health care provided to patients little has been achieved in solving them. One such problem is the misuse of resources in the hospital. An assessment done on health staff indicated that a large number of respondents believe that there is in appropriation of the resources of the hospital. Physicians are involved in this appropriation when they yield to pressure by patients or their families to admit or delay discharge. Misappropriation is also done through other ways which are rarely open to the public. As a matter of fact patients are not in apposition to know the levels of misappropriation taking place; Horton-Deutsch, & Mohr, (2001). When resources are used in the wrong ways it is the quality of the health care in terms to clinical governance and risk prevention services done for the patient that are affected. Although Riyadh hospital has a clear bill of rights for patients there is no comprehensive coverage of the contents of the bill when it comes to taking care of the patient. Many of those patients’ rights displayed on the bill have been violated in many instances. This is not to say that there is totally zero achievement in patient health care. Their highly set standards are yet to be realized at the hospital when it comes to taking care of patients. One problem that has been observed at the hospital is understaffing because the number of health care personnel present are unable to attend to the patients very well. This means that the care provided to the patients is not 100% effective. Health practitioners are exposed to risk because there are no proper measures to ensure that they are well protected (Perra, B.M 2000). On the bill of rights for the patients at Riyadh patients have the right to have information on the professional status of the practitioner dealing with their case. Unfortunately, this information is rarely provided if one had to request for it. Some of the things put on paper are practically not there; Antrobus, & Kitson, (1999). Service provision should be fast in any high standard hospital of the level of Riyadh Military Hospital. However because the services provided are free of charge, there can be annoying delays in the process of acquiring health care or service in the hospital. Although this is a problem that plagues many government hospitals in the city Riyadh should be different because it serve the military and enjoys full funding from the government; Kerfoot, (2001). Fast services can only be created if there is adequate and disciplined efficient staff. A shortage of personnel is the key to more serious problems. It becomes serious when for example a soldier has been wound in some operation and an urgent surgery is required because the wound can turn fatal. A delay in such a case will lead to great suffering for the patient and his or her relatives. Delays could be the cause of some of the lives that have been lost at the hospital. The hospital looks conservative in the way men and women are handled. It does not have a mixed reception area where both men and women can wait for treatment or appointments. The waiting areas are simple and without anything like a magazine ot television screen to keep the patients occupied. A waiting area is just a room with a line of chairs. If this was to be compared to a private hospital there could be a big difference. In a private hospital one finds quick service with open and mixed waiting rooms that may possibly have a television. The problem with separating men and women is that while waiting for service, a family that came in together is forced to break for that long as they wait to be served. A husband and wife and children cannot wait together in the same room; Antrobus, Kitson, (1999). Riyadh military hospital does have some good equipment that are technologically powerful. This means the quality of treatment offered at the hospital should be high. Some extent it is high although its quality is diluted by some other factors. For example the lack of luxurious environment of modern hospitals where one can have his own room where his or her family can visit and chat. These things add value to the health care quality that is given to patients; (Antrobus, & Kitson 1999). The major problem at Riyadh military hospital can be experienced in the area of attendance to patients. There is some more work that needs to be done in order to ensure that the patients’ bill of rights is followed. It should not just be mere paper work which is not put into practice. Nurses and other practitioners look like they are tied on the job. The management of the hospital needs to consider giving them some freedom so that their morale can be boosted if they have to give better results. Staff should be hired whenever there is a gap to be filled so that there is no delay or failure in service provision; Valentine (2002). My role as a nurse leader The job of a nurse leader is rewarding but also demanding. It needs one to have both excellent nursing and managerial skills. It also needs a lot of experience and high level education because a nurse leader must handle personnel issues like performance at work, training and others that of a legal nature. A nurse leader is put in charge of a specific department like pediatrics or intensive care (Kerfoot 2001). A nurse leader should be in a position to provide the right leadership through mobilization and coordination to ensure that the requirements of the clinical governance and risk management program in a given organization are met. This will ensure that the safety of the organization, its property and that of the patients and staff is not compromised. In this definition of clinical governance and risk management, three important aspects are catered for. These are good care standards, clear accountability and responsibility in order for the standards to work well and continuous varied improvements to be attained. Valentine (2002) Clinical governance has no dictatorship over the structure or system to be utilized in the improvement and maintenance of care quality. It has six elements or components which make it up. A number of processes aimed at improving the services offered are regulated by one ideology. These processes are the ones which make up clinical governance. As a nurse leader I need to ensure that these elements are considered and achieved in the day to day activities of the organization as per the standards that govern the clinical practice in the area of location of the organization; Kerfoot, (2001). As a nurse leader I should be able to control the nurses’ activities in my department in order for the patients to be given care that is of the best quality possible. I need to select the nurses I want to work with in that department (Antrobus, & Kitson 1999). After the selection I should work together with them to ensure that they are working efficiently and without problems. I will also need to do an evaluation to see if their performance is up to date. The quality standards of the hospital or organization in my department are very important. I also need to keep track of them and make sure that those nurses working under me are keeping them and trying their level best to meet those standards. I also need to ensure that my department does not lack anything in terms of the resources needed; Horton-Deutsch, & Mohr,(2001). Another important element needed is education and training which demands that a person involved in the provision of medical care must attain additional training in the process of his career. The knowledge gained in training fades off very fast and becomes out dated. As a nurse leader I should be in a position to help my subordinates to realize the importance of continued education so that they can enroll for it. If possible I should convince the management of the organization to provide training facilities and programs for them or at least facilitate their training as they work. I should make sure that I am planning development classes for my nurses for them to continue with their training (Perra 2000). As a nurse leader or manager I will also need to work in coordination with others in other departments to facilitate health care for the whole hospital and to arrange for the provision of health care in the long term. Another role I need to play is to make the estimates of the budget needed to run my department. In this regard I will keep an eye on purchases and the money spent to ensure that it does not mess the rest of the budget. I also need to assign those nurses in my department to the patients they are supposed to attend to and develop the plan of treatment for the patients available; Perra, (2000). I need to control and coordinate the healthcare that my team provides to the patients. In case of staff shortage in my department I will need to convince the relevant authorities about the problem so that appropriate action is taken to bring in more staff. On top of the above responsibilities it is my duty to know how to deal with issues of human resource since I will be doing coordination through out. I need to link my departmental staff to the management of the organization and other departments and also relate with them well to ensure that there is progress in that department (Kerfoot 2001). Another group that needs my attention is the nursing union which also has its demands on the nursing profession. As a leader of the nurses I also need to ensure that I create a positive atmosphere in my department that will make the other nurses feel motivated and valued for them to do their best. For me to perform this responsibility I need to be good in communication to ensure that there is a good flow of information from one end to another. I will also need to have a performance oriented tradition maintained in the department so that nurses can continuously struggle to achieve or even surpass the required health care standards; Valentine (2002) In addition to these I need to ensure that there is a clinical audit being carried out regularly in my department. A clinical audit reviews the performance of the clinic in comparison to set standards. Clinical effectiveness measures the degree of work that a specific intervention attains; Perra, (2000). Additional factors like the monetary value of the intervention and its appropriateness are included in decision making. However it can also be determined without these extra factors. In defining clinical practice, effectiveness is a good factor to consider but also it needs to take care of the safety of the patient in an efficient way. Clinical audits will help ensure that high standards of health care are maintained and that the staff works responsibly; Valentine (2002) I also need to be an integral part that will promote research and development for the organization I am working for. Implementing research practice is one important element in the activities of a health care organization because it leads to the discovery of new ideas which is incorporated in management will increase performance. Good practice in any profession need always to change (Perra 2000). Such a change may take along time. It is therefore necessary to insist on research and its implementation after which it is also used. Implementation should use techniques like critical appraisal of the research findings, project management and creation of guidelines, implementation strategies and protocols. These things need to be done under my close watch and supervision especially when it comes to the department level. I can also coordinate and facilitate other departments when necessary for a smooth project to be achieved (Antrobus, & Kitson, 1999). It is my responsibility as a nurse leader to ensure that there is openness in my department and that proceedings and meetings on clinical governance are organized in the department. If an organization boasts of being able to fulfill the needs of the public through provision of high standard health care then there is need to prove that the needs of the public are being met. As a departmental head for other nurses I need to ensure that this is taken into consideration (Porter-O’Grady 1999). I will also need to ensure that in the same effort of risk minimization there is a regular questioning and review of systems in my department for instance through ‘critical event audit’ or getting information from complaints. I need to guide other nurses to follow the medical ethical standards in order to have patient and public wellbeing and safety. I will also ensure that the second component which is risk to practitioners is taken care of. I will ensure that all nurses receive immunization to avoid infection, have a safe and good working environment and that they are always up to date. I also need to avoid possible risks coming to the organization by keeping a way poor quality performance and services offered to the public. In my department I need to ensure that there is employment practice of unrivalled quality and good policies on the involvement of the people; (Antrobus, & Kitson 1999). When people or the public is involved they feel that they are part of the organization and any thing that concerns the organization can easily involve the. This means there is guaranteed support from the community in many matters. Finally I will make sure that my department embraces all the components of risk management. These components include; risks to the organization, risks to patients and risks to practitioners. I will need to ensure that there is compliance with the written laws of the state in a bid to reduce the chances of risks occurring which can involve the patients; Horton-Deutsch, & Mohr, (2001). Conclusion In conclusion for a health care provider, be it a hospital or organization, high standards of clinical governance and risk management need to be adhered to. The organization needs to ensure that the health care regulations of the state it operates in are being followed to the latter. This helps to create accountability and responsibility in the organization. There should be provided health care of high standard to the population. Any potential causes of risks to patients should be avoided at all costs since this is the most sensitive part of health care provision. Kerfoot, K. (2001). Nurse leaders controlling various departments should ensure that their departments are well kept and the best services are offered there. The major role of a nurse leader is to oversee the progress of his department in the struggle for provision of good health care to the patients; Horton-Deutsch, & Mohr, (2001). He should ensure that the level of risk occurrence is lowered considerably and that his department is well linked and coordinated with other departments. He should therefore have both good managerial and communication skills. Poor service provision and unprofessional behavior at the work place costs the organization and even the patients and staff. A good organization therefore needs to maintain good working relations with the public and the rest of the people. Clinical governance and risk management are two things that should be worked upon by all means by all staff in an organization in order to ensure its success. A good health care system therefore needs to prioritize the things that increase efficiency and effectiveness at work; Antrobus, S. & Kitson, A., (1999). 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(1999). Quantum Leadership: New Roles for a New Age. Journal of Nursing Administration, 29(10), 37-42. Singhapattanapong, S. (2002, March 11). Nurse shortage hurts UCLA Medical Center. UCLA Daily Bruin, p.1. Read More