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Emerald Group Publishing Limited
Copyright © 2009, Emerald Group Publishing Limited
Best in class
Article Type: Editorial From: Clinical Governance: An International Journal, Volume 14, Issue 3
World class is becoming increasingly used to describe the ambition for all aspects of our health service; whether it be service commissioning, health outcome measures or clinical research, we strive to be “best in class”.
The Health Foundation has charted the nation’s progress over the last 12 years and although significant improvements have been achieved, the UK still has more to do in areas like mortality rates due to cancer and circulatory disease where, for example, Australia and France have significantly better outcomes. The Nation’s Stroke Services are also poorly performing in the world rankings which has resulted in stroke being a top priority in the NHS operating framework, supported by new guidelines from the National Institute for Health and Clinical Excellence. Common mental health disorders are also increasing, particularly amongst middle aged women in the UK which is a very real concern for the Health Care Commission.
In commissioning terms, “world class” was initially perceived as something of a self congratulatory term, but now the metrics are known and the results are in, we have 18 per cent of all PCTs on green lights for strategy, governance and finance but no PCT achieved a “best” score for any of the ten competencies. So, what does that tell us? For those that are underperforming, a dose of directed development is needed; for those that are doing well, an opportunity to showcase their practice, but interestingly the competency that is perceived to best reflect “world class”, namely stimulating the market, was the poorest performing indicator of all.
And what of research excellence? The research assessment exercise has given us something of a mixed message about where the focus of investment should be in terms of research excellence going forward whereas the Bioscience and Academic Health Science Centre designations have given us a very clear message that world class means hyperselectivity.
In the round, if you seek to work in a health economy that is best in class in all aspects of its work it is likely that clinical governance and patient safety will have to be in good order.
This issue contains some examples of how to develop good practice.
Manoj K. George and Renju Joseph look at concerns in complaints handling and the importance of good communication and record keeping (“Complaints procedures in the NHS – are they fair and valid?”).
Rajiv Singh describes a framework for implementing clinical governance within a mental health and addiction service and the importance of merging the managerial and clinical imperatives (“Clinical governance in operation – everybody’s business: a proposed framework”).
Paul Bowie et al. investigate some of the difficulties in applying audit methods across professions in the west of Scotland (“Independent feedback on clinical audit performance: a multiprofessional pilot study”); while Kamran Siddiqi and James Newell look at lessons learned from clinical audit in Cuba, Peru and Bolivia (“What were the lessons learnt from implementing clinical audit in Latin America?”).
Finally, two studies looking at clinical governance in psychiatry, Mohammed Ashir and Karl Marlowe look at early intervention in psychosis teams and a UK survey of ADHD service provision by paediatricians is presented as a short report: contributions that seek to make continuous improvements to service delivery but recognise that we are not yet best in class.