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Article
Publication date: 6 March 2017

Jane Currie, Jane Mateer, Damien Weston, Elizabeth Anderson and Jackson Harding

In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement…

Abstract

Purpose

In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement tool through which excellence in deployed healthcare is achieved. The purpose of this paper is to describe the implementation of this clinical governance framework to 17 CSS Bde and present feedback provided by users on their application of the clinical governance framework.

Design/methodology/approach

An electronic survey was disseminated to the four 17 CSS Bde deployable health battalions (n=1,061). Qualitative data were analysed using descriptive statistics and qualitative data using thematic analysis.

Findings

In total, there were 105 responses providing valid data for analysis. The data identified mixed understanding and awareness of clinical governance amongst participants, and pinpointed aspects of the framework that needed refinement.

Practical implications

The results highlight important challenges implementing a clinical governance framework for deployable health units. The authors propose embedding clinical governance education in all army soldier and officer health courses to remedy deficits in knowledge and understanding. Recommendations for further development of the clinical governance framework are also made with particular emphasis on education, clinical risk and clinical evaluation.

Originality/value

This paper offers unique insight into the implementation of a clinical governance framework to the 17 CSS Bde, Australian Army. The results suggest that levels of understanding and awareness of clinical governance are stalling its translation through the military hierarchy. The data identify that implementation of a clinical governance framework is not easy, even within a military environment where the culture is to follow orders and obey the chain of command.

Details

International Journal of Health Governance, vol. 22 no. 1
Type: Research Article
ISSN: 2059-4631

Keywords

Article
Publication date: 1 July 2014

Susan A. Nancarrow, Rachael Wade, Anna Moran, Julia Coyle, Jennifer Young and Dianne Boxall

– The purpose of this paper is to analyse existing clinical supervision frameworks to develop a supervision meta-model.

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Abstract

Purpose

The purpose of this paper is to analyse existing clinical supervision frameworks to develop a supervision meta-model.

Design/methodology/approach

This research involved a thematic analysis of existing supervision frameworks used to support allied health practitioners working in rural or remote settings in Australia to identify key domains of supervision which could form the basis of supervision framework in this context. A three-tiered sampling approach of the selection of supervision frameworks ensured the direct relevance of the final domains identified to Australian rural allied health practitioners, allied health practitioners generally and to the wider area of health supervision. Thematic analysis was undertaken by Framework analysis methodology using Mindmapping software. The results were organised into a new conceptual model which places the practitioner at the centre of supervision.

Findings

The review included 17 supervision frameworks, encompassing 13 domains of supervision: definitions; purpose and function; supervision models; contexts; content; Modes of engagement; Supervisor attributes; supervisory relationships; supervisor responsibilities; supervisee responsibilities; structures/process for supervision and support; facilitators and barriers; outcomes. The authors developed a reflective, supervision and support framework “Connecting Practice” that is practitioner centred, recognises the tacit and explicit knowledge that staff bring to the relationship, and enables them to identify their own goals and support networks within the context in which they work.

Research limitations/implications

This is a thematic analysis of the literature which was argely based on an analysis of grey literature.

Practical implications

The resulting core domains of supervision provide an evidence-based foundation for the development of clinical supervision models which can be adapted to a range of contexts.

Social implications

An outcome of this paper is a framework called Connecting Practice which organises the domains of supervision in a temporal way, separating those domains that can be modified to improve the supervision framework, from those which are less easily modifiable. This approach is important to help embed the implementation of supervision and support into organisational practice. This paper adds to the existing growing body of work around supervision by helping understand the domains or components that make up the supervisory experience.

Originality/value

Connecting Practice replaces traditional, more hierarchical models of supervision to put the practitioner at the centre of a personalised supervision and support network.

Article
Publication date: 1 July 2006

Anne Maddock, Debbie Kralik and Judy Smith

The purpose of this paper is to describe a clinical governance framework applied in a community nursing setting. Significant opportunities for improving quality and safety…

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Abstract

Purpose

The purpose of this paper is to describe a clinical governance framework applied in a community nursing setting. Significant opportunities for improving quality and safety of clinical practice through clinical governance within a community‐nursing organisation are idendified.

Design/methodology/approach

The intention in this paper is to achieve quality client outcomes by translating a clinical governance framework into the day‐to‐day practice and processes of all staff, and by developing a system of leadership that supports improvement as a fundamental part of organisational processes.

Findings

The paper finds that a comprehensive project plan was developed which involved six interrelated steps or stages that would serve as indicators of project progress.

Research limitations/implications

In the paper, the organisation continues down the journey of implementing a comprehensive clinical governance framework over a five‐year implementation plan.

Originality/value

The paper shows that the improvement plan offers many exciting challenges for the organisation over the coming years.

Details

Clinical Governance: An International Journal, vol. 11 no. 3
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 30 March 2012

Norman Young, Nicola Evans and Elizabeth Bowring‐Lossock

The aim of this paper is to offer a framework that captures the clinical activity of mental health nursing academics.

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Abstract

Purpose

The aim of this paper is to offer a framework that captures the clinical activity of mental health nursing academics.

Design/methodology/approach

Through an exploration of relevant literature and an examination of the practices of a team of mental health nursing academics, the key clinical activities that academics were engaged in were identified.

Findings

The Practice Engagement Framework offers a structure to identify the range and breadth of clinical engagement for nursing academics.

Originality/value

This framework might be useful for other mental health academics from other professional groups such as social work and occupational therapy.

Details

The Journal of Mental Health Training, Education and Practice, vol. 7 no. 1
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 15 June 2015

Maureen A. Flynn, Thora Burgess and Philip Crowley

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose…

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Abstract

Purpose

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

Design/methodology/approach

A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Findings

Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

Research limitations/implications

The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

Practical implications

The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Originality/value

Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

Details

Journal of Health Organization and Management, vol. 29 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 4 December 2017

Ben Pearson

Providers of health and social care services aim to deliver personalised care that is safe, effective, caring, responsive and well led. Multidisciplinary teams often have…

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Abstract

Purpose

Providers of health and social care services aim to deliver personalised care that is safe, effective, caring, responsive and well led. Multidisciplinary teams often have to work together, either within or across multiple provider organisations in order to achieve this aim. It is valuable to have a framework of clinical governance for such circumstances that enables a shared assurance of quality. To achieve these aims, the purpose of this paper is to present a clinical governance matrix framework developed by the author’s experiences in clinical practice, in service change and in management and leadership.

Design/methodology/approach

There are seven pillars of clinical governance; patient and public involvement, staffing and staff management, clinical effectiveness and research, using information and IT, education and training, risk management and audit. These seven pillars of clinical governance can be mapped against the five quality domains of safe, effective, caring, responsive and well led to create a matrix that in turn describes the framework we need for quality assurance.

Findings

The matrix is populated with outcome measures and these are monitored to achieve balance across the framework. The tool can be used at the level of an individual practitioner all the way up to multiple organisations in collaboration. The detail in each cell of the matrix will change accordingly and critically should be developed and owned by the subject of the framework.

Originality/value

This clinical governance matrix is presented as a methodology to monitor quality assurance in the settings of health and social care.

Article
Publication date: 12 October 2012

Joanne Kelleher and Eilish McAuliffe

Clinical governance has become internationally recognised as a whole‐system framework for the continuous improvement of quality in health service delivery. This study aims…

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Abstract

Purpose

Clinical governance has become internationally recognised as a whole‐system framework for the continuous improvement of quality in health service delivery. This study aims to explore the issues in implementing a comprehensive clinical governance framework in an organisation that provides services to children and adults with intellectual disabilities supported by a wide range of clinical interventions and therapies.

Design/methodology/approach

This was an action research study that utilised a co‐operative inquiry approach because of its capacity to facilitate engagement in a collaborative “bottom‐up” meets “top‐down” process amalgamating theory with organisational priorities to achieve practical and planned change. Action research methodologies use a problem solving approach, focus on real‐life issues, and are open and inclusive. The study aimed to identify current practices in inter‐disciplinary team working including the measurement and monitoring of quality, and to design collaboratively an integrated team‐based service delivery model that focuses on continuous improvement in the quality of clinical services.

Findings

The study highlights the benefit of adopting a co‐operative inquiry approach to the development of a clinical governance framework. Staff at all levels began to take ownership of the clinical governance agenda. The systemic perspective promoted collaboration across clinical and non‐clinical disciplines and it is anticipated that it will result in new approaches to service quality in the organisation in the future.

Originality/value

This case study demonstrates how the practical and participatory approach of the action research and co‐operative inquiry methodologies can contribute to the resolution of a real organisational issue and enable transformational change in the infrastructure of clinical services.

Details

Clinical Governance: An International Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 16 October 2009

C.V. Som

The purpose of this paper is to explore the dilemma facing the health staff regarding the achievement of targets (waiting list reduction, etc.), on the one hand, and, on…

3186

Abstract

Purpose

The purpose of this paper is to explore the dilemma facing the health staff regarding the achievement of targets (waiting list reduction, etc.), on the one hand, and, on the other hand, the responsibility of continuously improving the healthcare quality in NHS organisations.

Design/methodology/approach

In‐depth interviews were conducted using a semi‐structured interview method with a heterogeneous group of 33 key persons who have important responsibilities in an NHS Hospital Trust. The case study method was adopted to understand how the health staff are coping with the dilemma of meeting targets, on the one hand, and, on the other hand, continuously improving the quality of care (a statutory duty imposed on every member of health staff under clinical governance framework).

Findings

The findings of the research suggest that clinical governance has increased the dilemma of health staff on how to meet targets while continuously improving the quality of clinical care. The departments get additional funds only when it is clearly demonstrated that funds will be used to meet targets, whereas such additional funding is not available for quality improvement activities. Consequently, meeting targets becomes a priority, while achieving continuous quality improvement takes a backseat.

Research limitations/implications

In view of the mounting pressure on health staff to deliver the highest quality of clinical care more speedily, more research on a wider scale is necessary to understand what could be a practical solution for reducing the tensions of health staff and delivering the highest quality of care.

Practical implications

The research points out that it is almost impossible to continuously improve service quality to higher standards while meeting quantitative targets, because improving quality of healthcare would require allocation of more time to each patient and subsequent quality improvement activities. Putting too many patients through the system may reduce waiting lists but it may increase the risk of clinical errors because less time is available for individual patients.

Originality/value

The current literature provides little information on the above issue. The paper makes a valuable contribution by highlighting the failure of clinical governance to address some of the fundamental issues facing the NHS organisations. The managerial concepts of improving both quality and quantity at the same time may not be workable in healthcare organisations, because of the unique characteristics (i.e. the human dimension of clinical decision making) of healthcare management.

Details

Clinical Governance: An International Journal, vol. 14 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 1 July 2003

Keith Hurst

This article explores professional self‐regulation in the context of clinical governance. It begins by explaining clinical governance’s origins before setting out a…

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Abstract

This article explores professional self‐regulation in the context of clinical governance. It begins by explaining clinical governance’s origins before setting out a framework in which the Department of Health expects managers and practitioners to work. Description, analysis and synthesis of professional self‐regulation issues, operating within a clinical governance framework, are greatly enhanced by comment drawn from the theoretical and empirical literature.

Details

International Journal of Health Care Quality Assurance, vol. 16 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 April 2014

Luu Trong Tuan and Luu Thi Bich Ngoc

Clinical governance effectiveness is built on the responsibility of clinical members towards other stakeholders inside and outside the hospital. Through the testing of the…

Abstract

Purpose

Clinical governance effectiveness is built on the responsibility of clinical members towards other stakeholders inside and outside the hospital. Through the testing of the hypotheses on the relationships between clinical governance and its antecedents, this paper aims to corroborate that emotional intelligence is the first layer of bricks, ethics and trust the second layer, and corporate social responsibility (CSR) the third layer of the entire architecture of clinical governance.

Design/methodology/approach

A total of 409 responses in completed form returned from self-administered structured questionnaires dispatched to 705 clinical staff members underwent the structural equation modeling (SEM)-based analysis.

Findings

Emotional intelligence among clinicians, as the data reveals, is the lever for ethics of care and knowledge-based or identity-based trust to thrive in hospitals, which in turn activate ethical CSR in clinical activities. Ethical CSR in clinical deeds will heighten clinical governance effectiveness in hospitals.

Originality/value

The journey to test research hypotheses has built layer-by-layer of CSR-based model of clinical governance in which high concentration of emotional intelligence among clinical members in the hospital catalyzes ethics of care and knowledge-based or identity-based trust, without which, CSR initiatives to cultivate ethical values cannot be successfully implemented to optimize clinical governance effectiveness in Vietnam-based hospitals.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 8 no. 1
Type: Research Article
ISSN: 1750-6123

Keywords

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