Clinical governance questions Flashcards
What are the elements of clinical governance
Staff management: organisational culture, management of poor performance
Patient and public involvement: culture of openness
Audit: review and refine clinical practise
Risk management: for patients, practitioners and organisations
Clinical effectiveness: using evidence based guidelines, benchmarking outcomes
Information technology: to support governance and healthcare delivery
Training and education: to ensure continuous personal and professional development
How do you manage local risk
Openness of reporting of incidents and near misses
Transparent and fair culture: how it happened rather than who was at fault
User complaints as a marker of risk
Monitoring of incidents (Datex, notificiation of occurence) and take action to prevent future occurence
If patient harm has occurred, be open: acknowledge mistake, apologise, explain what happened and how you are investigating to prevent reoccurence.
Set up local protocols
How is risk managed nationally
National Reporting and Learning system - reporting of patient safety incidents in order to learn lessons, identify risks, prevent harm and track progress
National Clinical Assessment Service (a division of the NHS LA): An advisory body that provides case management services to organisations and individual practitioners where there is concern about practise, to ensure their practice is safe and valued
Health research authority: protect and promotes interests of patients in health research
National confidential enquiries: comes under responsibilty of Healthcare Quality Improvement Partnership, whose aim it is to increase impact that clinical audit has on patient care
What is the Francis Report
An inquiry into the high mortality and substandard care in Stafford Hospital
Criticised the management culture that put cost-cutting and target-chasing before quality of care
Inadequate nursing staff training for use of equipment, inexperienced doctors in charge of critically ill patients
Culture of ascribing more weight to positive information than information that caused concern
Failure of communication between agencies
Assumption that monitoring and intervention were the role of someone else
What is the Keogh Report
A subsequent inquiry into 14 NHS trusts that were persistent outliers in mortality indicators, looking into reasons for high mortality but also looking more broadly into quality of care and treatment in these trusts
As a result, several trusts were put into ‘special measures’ to improve and for the public to hold them to account
How is quality of a laboratory assessed
Clinical Pathology Accrediation (CPA) assessment
EQAs
KPIs - turnaround times
Benchmarking - comparison with other laboratories
Safety - number of errors and clinical incidents
User experience
What is the purpose of revalidation
Ensures doctors are “up to date and fit to practise”
Protect patients from poorly performing doctors
Promote good medical practise
Increase public confidence in doctors - the “justified confidence of patients”
4 strands of evidence: reflection, proof of learning, MSF, patient surveys
ARCPs (juniors), Annual Appraisal (doctors)
How is safety maintained in histopathology
Double reporting of eosophageal HG dysplasia, severely dysplastic naevi/melanomas
Double heading of cases pre-MDT
Stringent laboratory and reporting processes to minimize mistakes
Documentation and investigation of clinical incidents
