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In 2013, CRANAplus released A clin­i­cal gov­er­nance guide for remote and iso­lat­ed health ser­vices in Australia. 

Since then, the Aus­tralian clin­i­cal gov­er­nance envi­ron­ment has changed sig­nif­i­cant­ly. Fol­low­ing con­tin­u­ing chal­lenges faced by organ­i­sa­tions in imple­ment­ing clin­i­cal gov­er­nance process­es, the Aus­tralian Com­mis­sion on Safe­ty and Qual­i­ty in Health Care (ACSQHC) imple­mented strate­gies to sup­port patient safe­ty and clin­i­cal governance.

This includ­ed the release of The Nation­al Mod­el Clin­i­cal Gov­er­nance Frame­work and a range of broad and tar­get­ed stan­dards. Addi­tion­al­ly, ACSQHC has released a suite of resources to sup­port organ­i­sa­tions to imple­ment and uphold clin­i­cal governance.

What is Clin­i­cal Governance?

Clin­i­cal gov­er­nance’ refers to gov­er­nance in a health­care set­ting, which has the goal of estab­lish­ing sys­tems across the organ­i­sa­tion that lead to safe, high-qual­i­ty health care, and nur­tur­ing the con­tin­u­ous improve­ment of services.

Clin­i­cal gov­er­nance involves the whole team, from clin­i­cians to man­agers to health depart­ments, and includes the estab­lish­ment of col­lec­tive and col­lab­o­ra­tive process­es and sys­tems that artic­u­late respon­si­bil­i­ties and account­abil­i­ties for qual­i­ty care and safe health out­comes.

The Nation­al Mod­el Clin­i­cal Gov­er­nance Framework

The Nation­al Mod­el Clin­i­cal Gov­er­nance Frame­work demon­strates the impor­tance of the roles and respon­si­bil­i­ties of every­one involved in health care. Clin­i­cal gov­er­nance is not a top-down process or responsibility.

Patients and con­sumers, clin­i­cians, man­agers (includ­ing clin­i­cal man­agers) and gov­ern­ing bod­ies all have clin­i­cal gov­er­nance roles and respon­si­bil­i­ties. Clin­i­cal gov­er­nance also forms part of cor­po­rate gov­er­nance respon­si­bil­i­ties of health ser­vice organisations.

If you are a begin­ner in clin­i­cal gov­er­nance, it can be help­ful to devel­op a broad under­stand­ing by read­ing the overview and frame­work.

When review­ing the frame­work, consider:

  • What is the def­i­n­i­tion of clin­i­cal governance?
  • What is the pur­pose of the Clin­i­cal Gov­er­nance Framework?
  • How is the Clin­i­cal Gov­er­nance Frame­work applied and used?
  • How do clin­i­cal gov­er­nance and cor­po­rate (organ­i­sa­tion­al) gov­er­nance relate?
  • What does the Nation­al Mod­el Clin­i­cal Gov­er­nance Frame­work consider?
  • What is the role of organ­i­sa­tion­al cul­ture in clin­i­cal governance?
  • What are the roles and respon­si­bil­i­ties of clin­i­cal governance?

The Frame­work out­lines five clin­i­cal gov­er­nance com­po­nents, which are:

  • Gov­er­nance, lead­er­ship, and culture
  • Patient safe­ty and qual­i­ty improve­ment systems
  • Clin­i­cal per­for­mance and effectiveness
  • Safe envi­ron­ment for the deliv­ery of care
  • Part­ner­ing with consumers

For detailed infor­ma­tion on how to approach each of the five clin­i­cal gov­er­nance com­po­nents, down­load the frame­work.

The frame­work does not spec­i­fy how your health ser­vice organ­i­sa­tion should devel­op or imple­ment its clin­i­cal gov­er­nance sys­tems, but instead, out­lines com­po­nents to enable ser­vices to devel­op and imple­ment their own gov­er­nance sys­tems, with con­sid­er­a­tion to unique needs and com­mu­ni­ty context.

The Nation­al Safe­ty and Qual­i­ty Health Ser­vice (NSQHS) Standards

ACSQHC devel­oped the NSQHS Stan­dards (Stan­dards) in col­lab­o­ra­tion with the Aus­tralian Gov­ern­ment, states and ter­ri­to­ries, pri­vate sec­tor providers, clin­i­cal experts, patients, and carers.

The Stan­dards aim to pro­tect the pub­lic from harm and improve the qual­i­ty of health ser­vice pro­vi­sion. They also pro­vide a qual­i­ty assur­ance mech­a­nism to test and con­firm that rel­e­vant sys­tems meet safe­ty and qual­i­ty expec­ta­tions. There are eight Stan­dards; how­ev­er, not all apply to all health­care settings.

The Stan­dards pro­vide a nation­al­ly con­sis­tent state­ment about the stan­dard of care con­sumers can expect from their health ser­vice providers, includ­ing rur­al, remote, and iso­lat­ed health services.

Like the frame­work, they do not explain how health ser­vices should meet each stan­dard but instead, pro­vide indi­vid­ual items and actions to guide each unique health ser­vice to review and eval­u­ate its cur­rent resources, sys­tems, and processes.

The Stan­dards are avail­able online or via down­load.

When review­ing any stan­dards, ask:

  • Does this stan­dard apply to our service?
  • Have we got a sys­tem to meet this standard?
  • Is our cur­rent sys­tem safe, effec­tive, and efficient?
  • How do we know our cur­rent sys­tem is safe, effec­tive, and effi­cient? What evi­dence is there to sup­port this?
  • Do we need more data?
  • Do we meet the standard?
  • Can we do bet­ter in any areas and if so, how?

In addi­tion, a range of clin­i­cal and oth­er stan­dards are avail­able, which may apply to your health ser­vice. Incor­po­rat­ing addi­tion­al stan­dards into your clin­i­cal gov­er­nance approach will fur­ther sup­port safe and qual­i­ty care. These include but are not lim­it­ed to:

Resources

ACSQHC also pro­vides a range of resources to sup­port health ser­vices, and staff to con­tin­u­al­ly work towards meet­ing the Stan­dards. These include work­books, risk matri­ces and mon­i­tor­ing tools, how-to’ videos, fact­sheets and updates. When devel­op­ing your clin­i­cal gov­er­nance sys­tems, return to the ACSQHC web­site for up-to-date infor­ma­tion and new resources. We rec­om­mend tak­ing some time to explore their website.

Where to next?

Devel­op­ing the skills to par­tic­i­pate in and lead clin­i­cal gov­er­nance activ­i­ties is an excel­lent pro­fes­sion­al devel­op­ment goal for clin­i­cians, man­agers, and non-clin­i­­cal health ser­vice staff includ­ing exec­u­tives. In addi­tion to improv­ing clin­i­cal gov­er­nance, a range of lead­er­ship and man­age­ment skills and knowl­edge are sup­port­ed by clin­i­cal gov­er­nance training.

We rec­om­mend under­tak­ing an online or in-per­­son short course, attend­ing learn­ing events or review­ing resources avail­able through the Aus­tralasian Insti­tute of Clin­i­cal Gov­er­nance (AICG).