CNA802 Advanced Professional Nursing Practice

Introduction

Clinical governance is considered to be the framework with the help of which the healthcare organisation is found to be accountable for improving the clinical service effectively and maintaining a high standard of practice (Mohaghegh et al. 2016). Presently, it has been observed that the framework of clinical governance is implemented in many healthcare organisations which is designed for improving the clinical practice by considering the indicators such as risk management, patient safety, use of information, clinical audits, effectiveness and performance indicator (Macfarlane 2019). The nursing and social theories such as the Patricia Benner’s theory which highlights the concept of novice to expert explains the importance of clinical practice and addresses the components of the clinical governance framework for improving the patient safety (Goldman et al. 2021). Similarly, the middle range theory, it is the responsibility of the nurses to constantly pursue the goal of patient safety by adapting effective actions and determining the need of the situation and the patient which specifies the importance of clinical governance framework (Groves & Bunch, 2018). The aim of the clinical governance program is to provide the healthcare organisation board with proper assurance of sustainable management of quality care by maintaining a proper trust. The following paper will discuss about the clinical governance and its impact upon the supporting the patient and consumer with high quality of care.

Discussion

Part A- Clinical governance

The clinical governance is considered to be one of the effective frameworks in the healthcare setting which helps in improving the patient safety and care by implementing high standard of care. The clinical governance is consisting of 7 pillars such as clinical effectiveness, risk management, public involvement, audit, education, staff management and information. The clinical governance which is applied in the healthcare setting helps in ensuring that the people receive high quality care in a safely manner, maintaining a proper environment and inspiring the professionals to take accountability for their clinical performance (Pearson 2017). One of the advantages of the clinical governance is to improve the patient experience and managing the patient in an effective way by improving the practice. A proper quality care can be implemented by involving the patient and the caregivers along with that monitoring the high standards of care is also essential in this case. The key features which is essential for improving the patient safety includes- implementing proper clinical leadership which comprises of a designated senior clinician, review of the performance, maintaining proper clinical audit, performing proper research and dissemination of the evidence about the effectiveness of clinical practice, managing and learning from complaints (Tabrizi et al. 2016). Other key features include seeking proper responses from the user and patient views and utilising the patient’s experience. Evaluating the patient experience is essential for improving the practice which will help in maintaining a routine engagement. The professionals will have a good information in monitoring the performance (Demartini & Trucco, 2017).

Clinical governance and its impact upon patient management

The implementation of clinical governance framework helps in ensuring a continuous quality of care for improving the standards of health and social care. The clinical governance will serve as a cycle of monitoring, controlling, improving the patient care by implementing high quality care (Ebrahimpour et al. 2018). It helps in shifting the performance of overall healthcare organisation to achieve the higher level of clinical standard and lowering the unjustified variations or error in the quality of care. It has been evident that previously, the medical training system is concentrated in acquisition of skills and knowledge which is also related to the diagnostic intervention and procedure. The implementation of proper risk assessment, management and implementation of evidence-based practice helps in implementing effective strategy for improving the quality of care (Price et al. 2020).  Farohkzadian et al. (2018) performed the study for determining the challenges which will help in understanding the aspects of patient safety culture. The study highlighted the fact that the safety culture is one of the essential facts in healthcare organisation and the nurses play an essential role for improving the patient safety by along with that the study also highlighted that the nurses face difficulty due to lack proper knowledge. The result of the study highlighted the fact and the barriers which is faced by the nurses in providing care and maintaining a proper cultural safety includes inadequate efforts to keep pace with international and national standards, lack of proper leadership skill and lack of proper participation in clinical practice. Hence, it is highly essential to overcome the challenges within the healthcare setting in order to improve the patient safety and maintain a high quality of care.

Literature review

Ghavamabad et al. (2021) performed a study for establishing a clinical governance model within the primary healthcare model. The study highlighted that clinical governance is considered to be a systematic approach which helps in enhancing the quality of primary health care performance by ensuring the high clinical standards, continuing the quality of care by improving the service. The result of the study highlighted that the implementation of quality care in the primary setting can be done by implementing proper risk management intervention, understanding the structural and organisational needs, implementing proper communication and assessing the resources for proper management and understanding the barriers which exist in implementing clinical governance. The study also stated that a proper suitable framework must be implemented within the organisation for implementing measures according to clinical governance within the primary health care setting. Veenstra et al. (2017) performed a study for determining the professional views upon the clinical governance. The study in this case identified 50 elements which is related to bottom-up approach of the clinical governance, teamwork, ownership, feedback and learning from the mistake and no such parameters mentioned about patient involvement and hence, proper bottom-up approach is essential in this case for improving the high quality of care and patient safety. The organisation in this case must maintain a proper relationship between the managers, healthcare professionals and patients for maintaining a high standard of practice and care. Behzadifar et al. (2019) conducted the study for determining the challenges which is associated with the implementation of clinical governance. The study highlighted that it is the responsibility of the decision-maker and policy helps in improving the quality of care by lowering the treatment cost. The result of the study highlighted that health system structure, cultural factors, person-power, information and data, resources, evaluation and education. Hence, a proper infrastructure must be maintained in this case for improving the high-quality care (Rattan et al. 2017).

National model clinical governance framework

The National Model clinical governance framework has been developed for improving the key clinical performance based upon the National Safety and Quality Health Service Standard. A proper conceptual framework needs to be implemented in order to improve the quality of care by implementing proper risk management strategy. Hence, in this case a proper leadership plan, safe environment and partnering with the consumer needs to be implemented within the organisation for improving the quality of care (NSQHS, 2022). Buja et al., (2018) performed a study for determining a new clinical governance framework for providing care for chronic disease within the primary care. The result of the study highlighted that the primary healthcare setting must be focused upon person-centred care and proper intervention can be provided to the patient by managing a proper risk management, quality assurance, resource management, oriented research and implementing a proper team building. Hence, in this case, a proper framework for clinical governance will help in implementing coordinated care within the primary care setting.

Part B

The two of the common group rules which needs to be implemented within the conference programs includes- active listening and critiquing the ideas.

It is essential to maintain a proper physical and mental stability during conference and active listening helps shows respect to the speaker and hence, it helps in developing rapport and trust between the individuals. The active listening skill in this case helps in conference which will help in understanding the patient issue and the feedback which can be discussed with the help of conference can be utilised by healthcare providers will help in improving the key performance. The active listening will help in collecting the points and evidence related to the topic and the standards can also be discussed with the help of this skill (Brescia et al. 2019). Jahromi et al., (2016) performed a study for determining the importance of active listening as a communication skill. The study highlighted that the quality of active listening helps in avoiding the chance of misinterpretation and showing interest will also motivate the employees in exchanging the ideas and implementing evidence-based practice. The idea about the clinical governance along with the skills, components and maintaining a proper body structure will help in improving the trust between the nurses and the care organisation. Attending needs the managers to comprehend that their staff and clients are significant. Similarly, a proper listening skill of the supervisor helps in enhancing the communication skills and providing effective support.

The critiquing of the evidence is essential in this case as it will help the nurses and the healthcare providers to implement new ideas. In order to implement proper ideas proper feedback is essential in this case.  The critiquing the idea will help in improving the intervention which will help in improving the patient safety by understanding the quality improvement plans. The critiquing will help in improving the care plan and the standards within the healthcare setting. It is also essential for the healthcare organisation to improve the non-clinical aspects of treatment which consists of team work, communication and implementation of collaborative care which helps in improving the care process and considering the patient’s wish helps in improving the patient management by considering the fundamental principles such as leadership, team work, accountability and ownership in healthcare which will help in improving the care standard. The implementation of proper risk assessment, management and implementation of evidence-based practice helps in implementing effective strategy for improving the quality of care (Gottward and Lansdown 2021).

Conclusion

The above paper discussed about the clinical governance and its implementation in healthcare setting. There is total 7 pillars which helps in ensuring the quality of care provided to the patient includes clinical effectiveness, risk management, public involvement, audit, education, training and information. The clinical governance will serve as a cycle of monitoring, controlling, improving the patient care by implementing high quality care. It helps in shifting the performance of overall healthcare organisation to achieve the higher level of clinical standard and lowering the unjustified variations or error in the quality of care. Lastly, the study highlighted about the National model clinical governance framework.

References

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Brescia, V., Indelicato, A., Chmet, F., Maglio, P., Muraca, L., Mazzei, A., Laura, G.M., Cardona, R., Bisogni, K. & Notarangelo, M., 2019. Multidisciplinarity in the Treatment Process: An Essential Element in Clinical Governance.

Buja, A., Toffanin, R., Claus, M., Ricciardi, W., Damiani, G., Baldo, V., & Ebell, M. H. 2018. Developing a new clinical governance framework for chronic diseases in primary care: an umbrella review. BMJ open, 8(7), e020626.

Demartini, C. & Trucco, S., 2017. Are performance measurement systems useful? Perceptions from health care. BMC health services research, 17(1), pp.1-15.

Ebrahimpour, H., Lotfi, S.A., Afrooz, R. & Lotfi, S.E., 2018. The Effect of Clinical Governance on the Nurses’ Performance. Journal of Health, 9(2), pp.172-181.

Farokhzadian, J., Dehghan Nayeri, N., & Borhani, F. 2018. The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses. BMC health services research, 18(1), 654.

Ghavamabad, L. H., Vosoogh-Moghaddam, A., Zaboli, R., & Aarabi, M. 2021. Establishing clinical governance model in primary health care: A systematic review. Journal of education and health promotion, 10, 338.

Goldman, J., Smeraglio, A., Lo, L., Kuper, A. & Wong, B.M., 2021. Theory in quality improvement and patient safety education: A scoping review. Perspectives on medical education, 10(6), pp.319-326.

Gottwald, M. & Lansdown, G., 2021. Ebook: Clinical Governance: Improving the quality of healthcare for patients and service users. McGraw-Hill Education (UK).

Groves, P.S. & Bunch, J.L., 2018. Priming patient safety: A middle?range theory of safety goal priming via safety culture communication. Nursing inquiry, 25(4), p.e12246.

Jahromi, V. K., Tabatabaee, S. S., Abdar, Z. E., & Rajabi, M. 2016. Active listening: The key of successful communication in hospital managers. Electronic physician, 8(3), 2123–2128.

Macfarlane, A.J.R., 2019. What is clinical governance?. BJA education, 19(6), p.174.

Mohaghegh, B., Ravaghi, H., Mannion, R., Heidarpoor, P. & Sajadi, H.S., 2016. Implementing clinical governance in Iranian hospitals: purpose, process and pitfalls. Electronic physician, 8(1), p.1796.

NSQHS. (2022). National Model Clinical Governance Framework. Retrieved 28 February 2022, from https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Model-Clinical-Governance-Framework.pdf.

Pearson, B., 2017. The clinical governance of multidisciplinary care. International Journal of Health Governance.

Price, T., Tredinnick-Rowe, J., Walshe, K., Tazzyman, A., Ferguson, J., Boyd, A., Archer, J. & Bryce, M., 2020. Reviving clinical governance? A qualitative study of the impact of professional regulatory reform on clinical governance in healthcare organisations in England. Health Policy, 124(4), pp.446-453.

Rattan, R., Chambers, R. & Wakley, G., 2017. Clinical governance in general dental practice. CRC Press.

Tabrizi, J.S., Pourasghar, F. & Nikjoo, R.G., 2016. Primary health care governance pillars and components in developed countries, a systematic review. International Journal of Pharmacy and Technology, 8(4), pp.24045-24059.

Veenstra, G. L., Ahaus, K., Welker, G. A., Heineman, E., van der Laan, M. J., & Muntinghe, F. L. 2017. Rethinking clinical governance: healthcare professionals' views: a Delphi study. BMJ open, 7(1), e012591.

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