Quality in Health Care and Clinical Governance

Question 1

What is clinical governance defined by

Answer 1

• systematic approach to maintaining and improving the quality of px care within a health system

Question 2

What are the dimensions of healthcare quality

Answer 2

• person centred
• safe
• effective
• efficient
• equitable
• timely

Question 3

What is person centred care

Answer 3

• partnership between px, families and those delivering care which respects individual needs and values and demonstrates compassion, continuity, clear communication and shared decision making

Question 4

What is safe care

Answer 4

• no avoidable injury or harm from healthcare recieved
• appropriate clean, safe environment provided for delivery of healthcare servives

Question 5

What is effective care

Answer 5

looking at - does the intervention work?
the most appropriate interventions, support and services are provided to everyone

Question 6

What is efficient care

Answer 6

• is the output (benefit) maximised for the given input (cost)
• waste eradicated

Question 7

What is equitable care

Answer 7

• are px being fairly tx
• is the distribution of care based on need
• high quality services provided to everyone no matter what

Question 8

What is timely care

Answer 8

• appropriate tx
• support and services
• provided at right time

Question 9

What factors contribute to adverse effects

Answer 9

human
structural
clinical

Question 10

What are examples of human factors

Answer 10

communication
teamwork
stress
burnout

Question 11

What are examples of structural factors

Answer 11

reporting systems
infrastructure
workforce loads
environment

Question 12

What are examples of clinical factors

Answer 12

• complexity of care
• length of stay

Question 13

What are the components of clinical governence

Answer 13

• risk management
• education and training
• clinical audit
• clinical effectiveness
• research and development
• openness

Question 14

What is meant by setting quality standards

Answer 14

good clinical practice changing in light of evidence from research
want to reduce time to implement research into clinical practice

Question 15

Why can new research take a while to be implemented in clinical practice

Answer 15

‘leaks’
takes time for people to be aware, accept, apply, act (get the training), agree, adhere to the new practice

Question 16

What are processes we can do to promote implementation of research into clinical practice

Answer 16

• critical appraisal of literature
• development of clinical guidelines and protocols
• implementation strategies

Question 17

What is the definition of a clinical guideline

Answer 17

systematically developed statements which assist in decision making about appropriate healthcare for specific clinical conditions

Question 18

What are the aims of clinical guidelines

Answer 18

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

Question 19

What is the hierarchy of evidence levels used in guidelines

Answer 19

• systematic review (cochrane) and RCt
• cohort
• case control
• case series
• narrative review, editorial

Question 20

What are the key clinical governance activities that are done to deliver quality care

Answer 20

• cpd of all staff
• evidenced based practice in daily use
• openness on poor performance
• risk management
• clinical audits
• peer review
• research projects

Question 21

What is a clinical audit

Answer 21

• 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

Question 22

What is the key component of clinical audit

Answer 22

• 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

Question 23

What are the steps to doing a clinical audit

Answer 23

1. select topic
2. set agreed standards and decide on data requirements
3. observe practice and collect data
4. analyse data and determine any deviation from standard
5. identify any areas of change required
6. make necessary changes
7. repeat audit process and determine whether improvements have occurred

Question 24

What is the audit cycle

Answer 24

1. identify problem or issue
2. set criteria and standards
3. observe practice and collect data
4. compare performance with criteria and standards
5. implement change

Question 25

What are the educational strengths of an audit

Answer 25

• 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

Question 26

What is a peer review

Answer 26

• provides an opportunity for groups of dentists to get together and review aspects of practice

Question 27

What is the aim of a peer review

Answer 27

• 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

Question 28

What is a critical incident review

Answer 28

• 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

Question 29

What are other scottish funded dental quality imrpovement activities

Answer 29

• practice based research project
• reflection on implications
• quality improvement projects