Governance Flashcards
What are the current challenges for the trust?
Weston Merger
Low CQC rating, poor recruitment
Closed x2 during Covid, ED permanently closed
Merging rotas, governance processes, clinical teams, leadership
Haematology started this process some years ago
Covid Recovery
Non-urgent care
Surgery
Training
Estate
Need to keep up with need - BHOC due to be expanded
Moving services off site eg Concord
Peripheral clinics
Moving patients through acute services
Workforce fatigue
Issues with recruitment and retention
Well being programme
Integrated care systems
Systems based approach to change
What are the current and future challenges for your speciality?
Reg training Clinical trials Haemophilia netwrok Integrated care systems Recruitment and retention - paed haemophilia
Equity of service across SW
Ageing population
How do you know you are a good/safe doctor?
Appraisal and revalidation, CPD
GMC GMP principles
Learn from critical incidents - departmentally and nationally
Keep up to date
Relevant qualification
Feedback from staff and patients
National networks - my practice is in line with othes
clinical effectiveness - benchmark my practice against acceptable standards Appraisal PDP CPD Ask for feedback Engage with MDT discussions Haemophilia service spec Participation in non-clinical work - teaching and research
National
Ockenden media report
Sickle care UK
Infected Blood inquiry
Review haemtrack
UKHCDO
Professionalism GMC Professional qualifications Keep up to date CPD Risk management Appraisal/PDP Ask for feedback
Tell me about a critical incident you were involved in?
Non-irradiated blood on D-7
Datix - through trust website
Risk register - departmental, divisional, corporate
Risk matrix
chance of it happening, how often, consequences
Actions and controls
Out of hours emergency treatments
Overwhelming acute service
As reg covering liaison - poor handover, not reviewed
Encourage reporting of near misses Transparent and fair culture Learning not blaming Use complaints as marker of risk Monitor what actions have been taken
Discussed with patients Duty of candour Acknowledge Apologise Explain Investigate Send outcome of investigation to patient
Actions Review patient Escalate if necessary Document in notes Datix Cooperate fully
Why is consent important?
Give permission for treatment or procedure.
Voluntary
Informed
Capacity
No capacity - ?lasting power of attorney
Take steps to ascertain wishes of individual from NOK
Relevant documentation
Consent in minors
Individual with parental responsibility can consent up to the age of 16
Children over 16 are entitled to consent to their own medical care - should have sufficient capacity to decide
Gillick competent - intelligence, understanding, competence about their treatment then <16 can consent
If parents refuse consent, this can be overuled in court if treatment thought to be in childs best interests
Mode of action
Side effects
Other options
Specific to single intervention at a point in time
Rarely be appropriate for child under 13 to consent to their treatment
What do you do if you see a colleague behaving badly?
SPIES - seek information, patient safety, initiative, escalate,
What is your take on E, D &I?
More complex - a process not a tick box Consider unconscious bias Attributional and confirmation bias Heteronormative assumptions Family units
Ask more questions
Normalise the conversation
Give an example of E, D & I in your practice
Use of gendered pronouns in information for HMB
Heteronormative language
What would you do if you had safe guarding concerns re: a child?
What is appraisal important?
Individual - motivation and career planning
Organisation - workforce performance and safety
Patients - safe, better doctors
Assessor - assurance, functional insight
Looks at four domains of good medical practice:
- knowledge, skills and performance
- Safety and quality
- Comms and teamwork
- Maintaining trust
Set PDP
Enter data on 134 fish
How do you assess quality in your field?
CQC - responsive, well led, safe, effective, caring
Downgraded - acute services and clinical leadership in this area.
Quality - patient experience, outcomes and safety
Quality driven culture
Patient experience - Kings fund, lowest since 1997
Waiting time - GP and secondary care, staff shortages, not enough spending
Audits CQC Benchmarking - peer review Specialty standards Ask trainees Patient survey - ask PALs for haemostasis specific feedback Staff survey UKHCDO annual report Haemophilia service specification Meeting outpatient review targets
Understanding of clinical governance
Staff training and management - participate in teaching reg and UG, recruitment Safety reporting and risk management - clinical incident reporting, risk regsiter, M&M Guidelines - VTE management in children, rivaroxaban Clinical audit -TTP Patient experience and involvement - Evidence based care and effectiveness - CPD
How can you demonstrate you participate in clinical govenrance
Participation in audit
Writing guidelines
CPD
What do you understand by professionalism?
Qualities and values that should underpin daily practice
Probity - honesty and integrity, how a professional should act.
Professional attributes - non-discriminatory, work together, respect commitment to quiality, compassion
- Team work, working effectively, compassion (patient centred approach), awareness of boundaries, professional developemnet
Medical leadership - managing and improving services, setting direction, networks
Ethics
Good medical practice - knowledge, skills and performance, quality, communication, trust
Difficult colleagues and criminality - whistleblowing
How do I provide patient centred care?
Choice - service around pt lifestyle, design services around health needs (GP delegated bloods, pt info leaflet)
Information - informed, clear and current, options and alternatives (Hector)
Control - No decision about me, without me
Quality
Outcomes, patient experience, safety
