Clinical governance
patient can be translated to the provision of service for many. It is clear that one of the major challenges for health professionals is that, regardless of whether they are very good at their job, they are very often constrained by the systems and processes that support them.
Person-centred services A sound clinical governance structure should always have the resident or patient at the centre of decision making. The safety and wellbeing of the healthcare consumer is paramount to the clinical governance process working. It is not enough to just determine what clinical intervention needs to be administered to circumvent an adverse event from happening to an individual. With the exception of providing lifesaving emergency care (and even then, best practice would dictate some form of advance planning and consent), services must be person-centred – meaning that the resident and/or their family must be party to all healthcare decisions that affect them. Person-centred is the extent to which the service involves the person and their family in a truly culturally sensitive way to accommodate all of their needs, desires, and values. This should take into account access to the service and equity of service provision, how safe and effective the service is, and, from an organisational perspective, how efficient it is. Healthcare providers often need to carefully manage conflicting priorities with regard to managing risks and providing interventions. What may be a realistic mainstream intervention on the part of the care home may be viewed as completely unrealistic from the perspective of the individual receiving the therapeutic intervention or care. A good example is continence
management. In most cases, it is completely appropriate to regularly toilet an incontinent resident to prevent moisture lesions or incontinence-related dermatitis. Staff can learn a lot about the resident’s fluid input and output through a three day assessment from which a documented schedule can be developed. However, staff may be reticent to carry out and learn from a formal assessment, and because of time constraints or other priorities they may tend to rely on the convenience of incontinence products as the fall-back position. Equally, residents can often be reticent to engage in a toileting schedule if they have limited capacity or
March 2023
www.thecarehomeenvironment.com
mobility as a result of pain, a perceived loss of dignity from being hoisted, or a reluctance to use a commode. Similarly, a resident and/or their
family may request a specific therapeutic intervention that may challenge the specific value set of staff or compromise others living in the home. There are a number of specific cultural and religious practices centred around meeting sexuality and intimacy needs and also death and dying that must be considered and implemented with sensitive accommodation and understanding.
Training and education
There is a concept I often share with colleagues which describes staff ‘working to the top of their scope’. This concept embodies the ability of staff to think outside of just completing a ‘task’ to tick a job off a list. When staff work to the top of their scope they are required to use their knowledge, skills, and experience to provide some robust critique to the therapeutic interventions they are carrying out and hence by default are always considering
A sound clinical governance structure should always have the resident or patient at the centre of decision making
whether the solutions they are providing for the resident are the most appropriate given the circumstances. Clinical governance provides an important framework for managers to foster and develop clinical leadership across all levels of the organisation. Such a framework is able to set expectations around best practice, assist with the analysis of what clinical interventions work best with different residents in different situations, and to easily report on outcomes. An electronic clinical governance framework goes one step further in providing real time analysis and vivid transparency as to the level of staff intervention and involvement in clinical care. Whether the determined solutions are directed at an individual resident or the care home as a whole, visibility provides managers with peace of mind and encourages critical thinking across the staff base regardless of role. As a manager, I want to know if my staff interactions are benefitting or hindering the resident and whether they are solving the right problem in the right way at the right time with the right resources. Clinical governance requires the analysis
of a range of quality indicator data – in aged care, this encompasses falls, infections, wounds, and continence interventions, to name a few. This provides a perfect vehicle for managers to drive professional development initiatives across their
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