Governance

Question 1

What is governance?

Answer 1

Clinical governance is a structure and process of accountability and reflection within an organisation to protect patients and improve staff safety, education and effectiveness.
- As well as being a practical framework and process it also has cultural benefits.

Question 2

Why is governance important?

Answer 2

On a practical level it holds us accountable to work within defined and agreed protocols and to acknowledge where we are in relation to those targets. This should ideally be reportable back to body independent of that department to maintain accountability and objectivity and support. This should also be recognised as a process beyond an organisation and be reportable to and open with an independent body. For healthcare, it is fundamental to maintaining patient safety.

Possibly on a more significant level is the cultural change that these processes bring. Not only does it regularly enforce the common ethos of patient safety, but it also brings together people from diverse disciplines within the organisation to understand each others roles and how they interact.

Question 3

How do you maintain safe practice?

Answer 3

Individual practices:
- keeping abreast of developments in clinical evidence and practice in critical care (Critical Care reviews, BJA, BMJ, attending conferences)
- Teaching - engaged in education as faculty and organiser on FFICM courses.
- mandatory training
- regular appraisal
- working within competencies
- Educational supervision
- maintaining airway and practical skills with theatre sessions.

Departmental practices:
- Regular M&M meetings
- MDT approach
- collaboration with colleagues inside and outside the department
- QI and audit lead and NICE guidance updates.
- Engagement with departmental clinical governance.
- Staff and patient feedback processes.

Trust wide:
- Trust audit and interdepartmental processes (e.g. acute care pathways such as DKA management and NIV and referral protocols).
- DATIX reporting

Regional and National:
- contributing to national guidelines and protocols (Raised ICP protocol and inadvertent arterial puncture protocol).

Question 4

What are the 7 pillars of clinical governance? How do you demonstrate them?

Answer 4

1) Clinical effectiveness and research - involvement in research and development of local and national guidelines.

2) Audit/QI - multiple audits (approx 2 per year since qualifying. Delegated audit lead. Ongoing local audits for referrals and ICU patient diaries.

3) Risk management - participation in governance, M&M meetings

4) Education and training:
- Personal: Attending courses, conferences, journal reading, reflective practice.
- others: regional teaching, undergraduate, postgraduate, presenting audits and QI projects nationally, educational supervision, trainee welfare and feedback.
- Aiming to be ACCP lead trainer

5) Patient & public involvement:
- ICU f/u clinic
- ICU steps

6) IT: Patient electronic referrals
Aiming to re-introduce photos to ICU diaries

7) Staffing and resource management:
- staff retention is a big issue and aiming to be ACCP lead