Domains 13 Flashcards
Define clinical governance
A framework through which organisations 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.
What are the objectives of clinical governance ?
• High standards of care
• Transparent
• Responsibility
• Accountability
What are the elements of clinical governance?
○ Education and training
○ Clinical audits
○ Clinical effectiveness
○ Research and development
○ Openness/ transparency
duty of the professional clinician
It is the duty of the professional clinician, to remain up-
to-date via Continuing professional development (CPD)
Clinical audit aim
Cyclical process with the goal of refining the clinical practice by measuring performance against agreed standards of care
How to implement Change in Practice in the light of evidence-based research?
Change in Practice in the light of evidence-based research
• This is done via critical appraisal (the process of carefully and systematically examining research evidence to judge its trustworthiness, its value and relevance in a particular context)of the literature, the development of guidelines, protocols and implementation strategies
Processes which are open to public scrutiny, while respecting individual patient and practitioner confidentiality,
and which can be justified openly, are an essential part of quality assurance
Balancing the risk components
• Risks to patients
• Comply with statutory regulations, Uphold medical ethical standards
• Risks to practitioners
• Occupational exposure, safe environment physically and mentally
• Risks to the organisation
• Decrease risk by implementing high quality employment practice a providing a safe environment
Define quality?
A Strategy for Quality Assurance (1990)
Quality = the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are
consistent with current professional knowledge.
SIX AIMS OF QUALITY IN HEALTH CARE
Mnemonic:STEEPE
Safety
• Safety of patients & staff.
• Full Disclosure of Possible complications of procedure
Timelines
• Reduced wait time and avoid delays
Effective
• Evidence based decisions, NNT vs NNH
Efficiency
• Maximum gain for minimum input
Patient centred care
• Respect for patient values, beliefs, dignity.
• Emotional & physical wellbeing
Equality
• Absence of discrimination
Frameworks for Improving Quality
Ask
○ What are we trying to accomplish?
○ How will we know that a change is an improvement?
○ What change can we make that will result in Improvement?
》》 plan: make a plan for the test of change, including predictions of results and how data will be collected.
》》Do : Test change on a small scale, document data, observations and problems that occur
》》 Study : use data from previous stages to build new knowledge and make predictions
》》 Act : adopt the change or use knowledge grained to plan or modify the next test of action
》》Study》》act 》》plan》》 Do 》》
What are the steps in the leaner sigma process for quality improvement?
○ Define : goals of the improvement project. Obtain necessary support and resources and put together a project team
○ Measure : establish appropriate metrics. Measure baseline performance of the current system.
○ Analyze : examine the system for possible areas of improvement
○ Improve: the system through implementation of ideas. Statistically validated improvements
○ Control : institutionalise the new system and monitor its stability over time.
Clinical Audit Definition
A quality improvement process that seeks to improve patient care and
outcomes through systematic review of care against explicit criteria and the
implementation of change
Key components of an audit
The key component of clinical audit is that performance is reviewed (or audited) to ensure that what you should be doing is being done
Types of audit
• Standards-based audit
• Adverse occurrence screening and critical incident monitoring
• Surgical audit (Data collected on all surgical cases – evaluate outcomes)
• Peer review (peer review of a specific individual case)
• Patient surveys and focus groups
What are medical adverse events?
• “event attributable to medical management” (not the course of
disease)
• Preventable AE: - due to error
• Negligent AE – satisfies the criteria for negligence
Three part test for negligence:
• Reasonable foreseeability of harm;reasonable precautions to prevent the occurrence of such foreseeable harm; and.failure to take the reasonable precautions.
1. Duty of care
2. Breach of this duty
3. DIRECTLY due to this breach – harm was caused
Classes of medical error:
- Error of execution – outcome not as intended
- Error of planning – path to achieve outcome taken was not correct
Types of error:
Diagnostic
• Therapeutic
• Preventative
• Other (equipment)
Cost of error:
• 1999 (United States) – direct and indirect costs $37.6 billion
• Of which $17 billion preventable (58% of total number of AE’s)
• In aviation 68% of crashes are due to human error
Death due to error:
Exceeds the 8th leading cause of in-hospital mortality
To err is human meaning
• Humans are vulnerable to distraction / bias / error
• Contributing factors / latent threats usually add up in sequence to
allow error
James Reason’s model of accident causation
Latent defects plus failures of
redundancies = error
Shortfall of root cause analysis
• Root cause analysis can always find a failure on the part of an operator
• If the analysis stops at this point, the operator may be wrongly blamed
Hey element of an HRO
• Culture of safety
• Optimal structures and procedures (incl appropriate hierarchy)
• Training and practice / simulation
• Organisational learning (audit cycles, focus on QI not on blame)
7 Pillars of professionalism
Elements of professionalism
Be the best
Professionals strive to excel. It takes effort and commitment to remain at that standard and to even look to excellence. A maritime professional focuses at the expectations of his position and seeks out the skillset, knowledge and training to reach them.
Be dependable
Seafarers accept the duties of the role and position and keep their promises, meet their commitments, learn from their mistakes, and take responsibility for their errors. For instance, a Master is accountable for all; this could be an ultimate praise for professionalism.
Be a team player
Take for example ship navigation and/or mooring operations. They do not necessarily imply professionalism. It is mainly about how you plan yourself; how you communicate and cooperate with your mates. Professionals know how to contribute to a larger cause and make others around them better.
Be respectful
Harassment, aggressive attitude, and offensive personal habits can face suspension of seafarers’ contracts. The multicultural nature of shipboard work requires every seafarer to adapt to the diversity and understand the positive aspects. Good business etiquette is a sign of respect for those around you, respecting others is not only good, it is good for your career.
Be positive
It important that a seafarer, his/her collogues and the organisation maintain a positive, resilientoutlook even when things get tough. There are many methods by which stress could be reduced while working andmindfulnessis one of them.
Be ethical
Those working in acknowledged seafaring professions exercise specialist knowledge and skill. Responsible maritime professionals work to avoid any ethical lapses and weigh their options carefully when facing ethical delimmas.
Competence, Knowledge, Conscientiousness, Integrity, Respect, Emotional Intelligence, Appropriateness, and Confidence.
Accepting Responsibility
