Quality in Health Care and Clinical Governance Flashcards
What is clinical governance defined by
- systematic approach to maintaining and improving the quality of px care within a health system
What are the dimensions of healthcare quality
- person centred
- safe
- effective
- efficient
- equitable
- timely
What is person centred care
- partnership between px, families and those delivering care which respects individual needs and values and demonstrates compassion, continuity, clear communication and shared decision making
What is safe care
- no avoidable injury or harm from healthcare recieved
- appropriate clean, safe environment provided for delivery of healthcare servives
What is effective care
looking at - does the intervention work?
the most appropriate interventions, support and services are provided to everyone
What is efficient care
- is the output (benefit) maximised for the given input (cost)
- waste eradicated
What is equitable care
- are px being fairly tx
- is the distribution of care based on need
- high quality services provided to everyone no matter what
What is timely care
- appropriate tx
- support and services
- provided at right time
What factors contribute to adverse effects
human
structural
clinical
What are examples of human factors
communication
teamwork
stress
burnout
What are examples of structural factors
reporting systems
infrastructure
workforce loads
environment
What are examples of clinical factors
- complexity of care
- length of stay
What are the components of clinical governence
- risk management
- education and training
- clinical audit
- clinical effectiveness
- research and development
- openness
What is meant by setting quality standards
good clinical practice changing in light of evidence from research
want to reduce time to implement research into clinical practice
Why can new research take a while to be implemented in clinical practice
‘leaks’
takes time for people to be aware, accept, apply, act (get the training), agree, adhere to the new practice
What are processes we can do to promote implementation of research into clinical practice
- critical appraisal of literature
- development of clinical guidelines and protocols
- implementation strategies
What is the definition of a clinical guideline
systematically developed statements which assist in decision making about appropriate healthcare for specific clinical conditions
What are the aims of clinical guidelines
improving care by
* providing recommendations for tx
* be used to develop standards for clinical audits
* be used in education and training
* help px make informed decisions
* improve communication between px and HCP
What is the hierarchy of evidence levels used in guidelines
- systematic review (cochrane) and RCt
- cohort
- case control
- case series
- narrative review, editorial
What are the key clinical governance activities that are done to deliver quality care
- cpd of all staff
- evidenced based practice in daily use
- openness on poor performance
- risk management
- clinical audits
- peer review
- research projects
What is a clinical audit
- process that has been defined as a quality improvement process that seeks to improve px care and outcomes through systematic review of care against explicit criteria and the implementation of change
What is the key component of clinical audit
- performance is reviewed (or audited) to ensure what should be done is being done and if not, provides a framework to enable improvements to be made
What are the steps to doing a clinical audit
- select topic
- set agreed standards and decide on data requirements
- observe practice and collect data
- analyse data and determine any deviation from standard
- identify any areas of change required
- make necessary changes
- repeat audit process and determine whether improvements have occurred
What is the audit cycle
- identify problem or issue
- set criteria and standards
- observe practice and collect data
- compare performance with criteria and standards
- implement change
What are the educational strengths of an audit
- critical review of current practice
- encourages learning about new techniques and treatments
- small group work - modifying attitudes and management of clinical conditions. reinforcement of agreed procedures
- observation of practice - indicate gaps in knowledge and/or skills - training
What is a peer review
- provides an opportunity for groups of dentists to get together and review aspects of practice
What is the aim of a peer review
- share experiences and identify the areas in which change can be made with the objective of improving the quality of care/service offered to px, share learning and implement change
- has a structured process for setting up, conducting and reporting
What is a critical incident review
- human factors appraoch
- set up meeting and discuss events
- meet and undertake a structures analysis
- implement changes and monitor progress
- write up report
- seek external comment/feedback
What are other scottish funded dental quality imrpovement activities
- practice based research project
- reflection on implications
- quality improvement projects
