Catherine Scott
Sundale Ltd
There is increasing demand for elderly care services, and the types of care are becoming more intense and complex as people live longer, have more complex co-morbidities, and expect higher levels of more advanced care. A system of clinical governance ensures all the elements that create the care and support for our residents are considered and work effectively.
But there is complexity in how the system of clinical governance works because care is delivered by teams. And teams can be unpredictable which means care outcomes can be unpredictable if there is not a system in place that supports consistency. An effective clinical governance system will increase the reliability of the care provided. An effective clinical governance system will additionally put the care recipient and the team members providing care at the centre of the system. Every other part of the system is designed to enable safe and high-quality care to be delivered.
An important part of clinical governance is to understand how the care is delivered and how it is perceived by care recipients and their families. Communication between managers and direct caregiving team members is important to ensure expectations and delivered care are aligned. Teams will work differently depending on team culture, the team’s history, and previous experiences, and how the team interacts with the environment they work in. These human aspects of teams need to be understood so the clinical governance system can adapt to ensure the delivery of highly reliable care.
The purpose of a clinical governance system is to standardise systems, processes, team member capability and continuous improvement mechanisms to increase the likelihood that in the same scenario, two different residents will receive the same level of high-quality care. A provider’s goal is to have a system of clinical governance that creates highly reliable care for all residents and participants in an aged care or in-home care community.
While team members have always had a role in leading aged care organisations, increasingly involving team members in governance processes began in the 1990s in response to a series of safety incidents in the US, UK, Australia, and Canada. Over the last two decades, clinical governance has evolved to include accountability, performance, and appropriate culture and workplace behaviour. More recently, there has been a greater understanding of the human aspects of care and the need to adapt to the different ways teams work and to respond to the preferences of care recipients. For organisations to perform at high levels these human aspects need to drive the systems that support good life and clinical outcomes.
Each provider’s system of clinical governance will look slightly different from another’s and needs to reflect their priorities identified as contributing most greatly to highly reliable care. Considering this, clinical governance will include either separately or combined the following ‘pillars’:
- Audit
- Clinical effectiveness and research
- Education and training
- Resident and family engagement
- Risk management
- Staffing and staff management and
- Using information and information technology.
*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.