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Clinical Governance for Remote and Isolated Health
This guide provides a brief history and overview of the clinical governance environment in Australia, and links to resources of value to remote and isolated health services, clinicians and anyone interested in safe and quality health care in remote and isolated communities. It is designed to develop clinical governance capacity.
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:
- Targeted standards
- National Safety and Quality Primary and Community Healthcare Standards
- User guides such as the User Guide for Aboriginal and Torres Strait Islander Health or the Aged Care Module and User Guide for Multi-Purpose Services
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).