Clinical Governance Strategic Planning

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Implementing Strategy for Staff Involvement and Experience

Staff Involvements in Clinical Governance

Clinical governance should contribute to the capability for patient, public and healthcare professional involvement through creating the environment for interaction, shared strategic care planning, and delivery of care based on shared goals and objectives (Porter-O’Grady, 1994; Donaho, 1984; DoH 1998). In addition, it should provide a basis for staff management, staff performance, and motivation that should be a function of structure and procedures for employee recruitment, workforce planning through training need analysis to ensure right staff identified for training and development (Sirgy and Su, 2000). The organization should demonstrate commitment to staff development through the development of policies and framework for staff education, in-house training, continuous staff professional development, provision of a psychological contract via work-life balance, and capabilities for data protection and management (Kaynak, 2003).

Clinical governance is important towards the development of framework and structures for clinical effectiveness as well as achievement of duty of care which should be supported by capabilities for clinical audit management (Rahman, 2001). In this respect, the Southern NHS Trust should also introduce as a lean operational process, review the quality and effectiveness of care, plan and monitor quality systems, invest in research and development towards determination of mechanism for quality improvement and audit efficiency of operational processes (Gutteridge, 2000; Hart et al., 2006). The clinical governance should define mechanism through which team working and workgroups are structured, enhance internal and external consultation in the healthcare, and advance the framework for promoting clinical and multidisciplinary teams (Oakland, 2003).

Communication Improvement

Lean implementation through clinical governance has capability to improve communication and flow of information material (Lewis et al, 2006), hence lead time improvement as documented by Poksinska et al. (2006)

Through staff communication, physician and nurses are able to prepare admission of a patient and preparation of patient management plan before the patient finally arrives at the concerned department which improves turnaround, lead time, decreases patient hospital length of stay and improves quality of care (Care Quality Commission, 2010). Communication improvement provides information processing that could be integrated into the patient administration system (Slater, 1997).

Staff Education: Elimination of Wastes Through Reduction of Nurse and Physician Interruptions

Lean principles could be implemented towards reduction of time wasted following physician interruption. This could be achieved through “Releasing time To Care” (RTTC) productive ward operational process that ensures nurses and physicians are not interrupted during operational processes for instance medicine administration processes. The process of improving medical administration facilitates in enhancing safety and quality of care hence improving health outcomes (The Good Governance standards for public services, 2004). Non-interruption ensures nurses have a higher time to spend with patients hence capability to provide more direct patient care. Interruptions of nurses or physician process contribute into creation of environment for making errors hence capability to improve on safety delivery of patient care (Halligan, 1999).

Process Maps

The staff ought to meet, periodically in order to review performance gaps based on operational process maps. This forms basis for continual quality improvement that enhances quality control, quality assurance and efficiencies of quality monitoring (Hogan et al, 2007). Through focus discussion, the staff is able to develop trust-wide standard processes as well as implement sharing of ideas towards improving clinical governance. Wards and departments, systems and sub-systems ought to implement reviewed standard processes. Non-interruption of staff results into quicker medicine rounds, improved turnaround and reduced chances of omitted medicines which plays role of increasing quality of care, decreasing hospital length of stay and improving quality of life (Staniland, 2009). Clinical process maps ensures capability to track patient treatment journey which ensured increased capability for departments and wards to share information and decreases patient length of hospital stay through close to real time data and information transfer.

Promoting Transparency and Disclosure Among Staff

Lean principles of management create an environment for management of staff duty handover as opposed to duty handover that is carried out of the ward without standardized procedures that result into reduction of staff in-attendance (Oakland, 2003). Managing staff duty handover ensures staff does not make independent notes or information which increases volume of notes, lead time and turnaround (Hogan et al, 2007). The healthcare facility ought to integrate RTTC productive wards towards shift handovers that are systematic, characterized by uniformity in patient notes and do not create opportunity for less staff to attend to patients which increases safety levels, ensures there is sufficient staff to attend to patient whose medical condition worsen. RTTC productive wards ensure handover is carried out inside the wards as opposed to outside the wards.

The Development of Staff Governance Committee

Each NHS Boart must have a staff governance committee headed by non-executive members. This committee will be accountable for the providing assurance of efficient and consistent clinical governance and insuring patient safety and quality of health care delivery. The committee also plays a crucial role in establishing the high-quality standards and ensuring that those standards are strictly adhered (DoH, 2000; DoH, 1999). Therefore, the members of the clinical governance committee should take control of the way the health care professionals fulfill their responsibilities and demonstrate high level of performance and adherence to the safety and quality of services. The actual implementation of clinical governance strategies is also included into the part of the committee’s duties (Bunch, 2001, p. 535).

With regard to the clinical staff, the committee should primarily focus on the improving the quality of services, enhance the clinical effectiveness, introduce effective risk management strategies and create a favourable environment for advancing professional performance (Bunch, 2001, p. 537). Hence, the quality improvement should be premised on a number of activities aimed at ensuring quality improvement, including the participation into the work out of clinical audit programmes, introduction of evidence-based practice and research, and producing accurate records of clinical information (Koc, 2007; Scally and Donaldson, 1998).

Clinical effectiveness consists in demonstrating and insuring the high outcomes of the established goals in terms of treatment strategies and application of experience to the recently issued research on nursing and clinical expertise (Kotter, 1995). The committee should monitor each practitioner’s level of competence and awareness of recent innovation to the field of nursing and health care. They should also be able to implement the acquired information into practice (Bunch, 2001, p. 537). Finally, the performance problems of the clinical staff should also be taken into the deepest consideration. This will definitely involve a sensitive analysis of the personnel department to define the climate within the organization and identify the risk factors and zones. The clinical staff must know that they can disclose their concerns connected with the work and the organizational environment in general.

Clinical governance contributes into documentation of roles and responsibilities of nursing staff (UKCC, 1992a, 1992b, 1992c). this is vital towards breeding discipline in the sector, through nurse requirement to demonstrate professional competence, performing tasks and responsibilities based on nursing principles of practice, adherence and conformity to nursing ethics of practice, enforcing team player attitudes and advocating for patients at risks hence capability to provide healthcare that is safe, patient supportive and free from abuse (UKCC, 1992a, 1992b, 1992c).

Implementing Sustainability: Shared Governance Model

Clinical governance strategy gains value through shared governance where healthcare staff holds focus meetings and healthcare organization provides nursing staff opportunities for career maturation (Porter-O’Grady, 1991; Jones et al., 1999) through investment in clinical supervision, governance and effectiveness which should meet needs of values of professional competencies. Through shared governance, excellence in healthcare is defined, evaluated and monitored towards achievement of sustainable quality of care (Wan et al., 2009). This has capability to ensure healthcare pathways and protocols are adhered to and complied with which ensures healthcare systems abides by national recommendations and guidelines for clinical governance strategy (Care Quality Commission, 2010; DoH, 1999). Adoption of multi-disciplinary approach in governance ensures system modification could be carried out based on benchmarking analysis and recommendations.

The Lean Management

Lean management is based on capability to implement order winner strategy through structured quick response times, increased lead times, low product cycle times, introduction of new competitive products, reliability of supply chain and delivery (Holweg, 2007). This creates foundation for flexibility of operational processes, quality of outputs and capability to gain value from customization strategy. Lean management utilizes order qualifiers that are characterized by adoption of attribute that enhance competitive advantage. This is subject to adoption of operational processes like functionality, customization, speed, costs and quality, operational process choices, work flow, rate of order processing and capacity management (Jones et al, 2000). Lean management depends on competencies of lean concepts like value stream mapping, 5-S model, Just-In-time strategic tools, Total quality management, six-Sigma model and capacity management. Implementation of Just-In-Time (JIT) should be structured towards waste elimination and continuous improvement by improving on lead time, cycle times and inventory and effectiveness of the supply chain

The 5-S model could be implemented through Sort such that there is elimination of operational processes that could not create value to the quality of product. The organization could ensure that operational processes are supported by systemic arrangement which ensures required materials are easily assessed which also reduced risks and fast personnel movement, reduces time spend searching for components and increases lead time. Lean management (Jones et al., 1999) provides basis for visual controls which creates opportunities for staff to visually identify movement of inventory throughout the manufacturing process. Through visual controls, lean management provides environment for application of error and mistake proofing techniques. This ensures employees are involved in product design process, supply-chain process, production process and delivery process which contributes into capabilities for achievement of quality at the source (Sirgy and Su, 2000). Lean management (Holweg, 2007) is vital towards set-up reduction through determination of individual steps that are involved in set-up processes. It provides capability to diagnose potential to reduce and eliminate equipment downtime. This is based on lean thinking that set-up doesn’t add value to the manufacturing operational process (Slater, 1997). Jones et al (1999) advanced argument that set-up reduction has impact of resulting into decreased throughput, reduction of lot sizes and achievement of consistency of production flow. Lean management provides basis for constraint management which further enhances throughput and strategic yield improvement. As a result, lean management is vital towards utility of process control buffers that reduces constraints in operational processes by reducing bottlenecks in operations. This ensures supply chain efficiencies hence non-delay or possible customer dissatisfaction (Wan et al., 2009).

Six sigma is vital towards determination of operational processes that are responsible for process variations towards achievement of reliable and quality individual operational processes. Employees ought to be trained on lean manufacturing technologies in order to develop competencies in application of six sigma model. Lean management plays a leading role towards strategic tool engineering which results into capability to design and build operational process tooling that is independent of employee. This ensures continuity and consistency of qualified process that pave way for quality products and customer satisfaction. Lean management based on Slater (1997) results into elimination of waste in operational process through determination of inventory that does not add value to a process at a given time or at a given product cycle. This ensures non-value inventory doesn’t create customer dissatisfaction through throughput delays. The capability to identify and eliminate waste ought to be considered as a lean management attitude.

The Reflection Section

Reflective Statements

My experience of working in team for presenting clinical governance strategy was a great challenge for me because I need to conduct researchers and propose solution to the NHS trust with people of different cultural background. While facing different cultural and ethnical context, it was quite difficult for me to conceive the specifics of the UK health structure. However, I have realized later that organizational improvement is just about the same because its main purpose to adjust some new purposes and methods aimed at the improvement of the organizational performance and quality of standards. In this respect, I will divide my experience into negative and positive one.

Positive experience involves:
- I received an opportunity to be engaged into clinical expertise and information analysis with people from different cultural and social backgrounds;
- I had a chance to understand the way people with different social status approach the problem as well the way it influence the final outcomes of the strategy implementation.
- I have found much interesting and helpful information about NHS, their quality standards, which has considerably broaden by experience and understanding in terms of what can be changes and implemented;
- I have learned to negotiate and prove my point view to people with different outlooks, though it was a real challenge for me.
- Collaborative working is a great contribution to my experience. I have realized that working in team is much more effective than individually because each member of the team is accountable for a particular strategy that can be further negotiated and improved.
- I have had a chance to learn more about effective strategies for risk management, patient safety assurance, and the importance of clinical audits.
- Finally, I have found out that that patients’ treatment and health care delivery in general should be overviewed from the perspective of cultural diversity and social background, which can contribute greatly to the advancement of staff performance.
Negative points:
- Because I was involved into discussion with people from another cultural dimension, I felt a bit isolated from the planning and implementation. Lack of cultural and social awareness prevent me from effective communication and decision-making;
- It was quite difficult to meet with my group for building the strategy because the members live in different cities. Therefore, we had to establish online communication, which is not so effective;

Aims and Objectives

This essay reports on lessons learned, challenges encountered, opportunities observed, outcomes of the clinical governance strategy, policy implications and future prospects on clinical governance strategy adoption and implementation

Lessons Learned

After completion of the portfolio on clinical governance strategy that could be adopted towards improving lead times, quality, elimination of system wastes and employee involvement, engagement and participation in clinical governance, I learned that clinical governance is important towards derivation of capabilities of a healthcare organization to improve on quality, reduce costs, eliminate wastes through visual controls, implement management reviews on quality control and quality assurance and improve on turnaround that results into capacity for achievement of task flexibility, and efficient resource utilization through capacity management. I learned that implementation of clinical governance requires adoption and designing of a shared governance model and collaborative model, that ensures all employees demonstrate professional accountability towards continuous quality improvement of healthcare, capability to deliver sustainable quality clinical care and realization of cost reduction.

I learned that clinical governance strategy requires ongoing review in order to determine status of the clinical governance and mechanism governance and leadership supports goals, standards and legislative framework on clinical governance. I learned that implementation of clinical governance strategy is important towards achievement of capability to safeguard standards of care, staff compliance with principles of nursing and duty of care hence capabilities towards achievement of environment that could foster excellence in clinical care practice. I learned that through implementation of clinical governance, it becomes possible to identify deficiencies in quality of care, through quality monitoring, quality control and quality assurance.

I learned that implementation of clinical governance strategy plays a leading role towards improving patient-public-healthcare personnel relationship that enhances patient engagement in healthcare delivery, patient involvement in care planning and patient participation towards determination of quality of healthcare through patient healthcare system satisfaction surveys. I learned that clinical governance strategy provides framework for patient interaction, capabilities to institute shared objectives and goals within the hospital system, sharing of data and information on patient across wards and capacity to deliver care based on strategic goals laid down by NHS trust. I learned that clinical governance should be supported by sufficient planning, communication structures to support strategic planning and structured arrangement of governance and creation of an environment for a learning culture. I learned that clinical governance should provide basis for staff management, staff performance and motivation that should be a function of structure and procedures for employee recruitment, workforce planning through training need analysis in order to ensure right staff identified for training and development. I learned that the organization should demonstrate commitment to staff development through development of policies and framework for staff education, in-house training, continuous staff professional development, provision of psychological contract via work-life balance and capabilities for data protection and management.

My Current Clinical Governance Skills

My current clinical governance skill is at hierarchy leadership level four with ability to carry out system diagnosis, determination of constraints in governance and leadership, development of a leader-governance strategy for healthcare organization, development of governance strategy, ability to identify right quality improvement tool for clinical governance strategy development , implement and develop structure for a web-based information transfer, data management and ability to carry out quality control, quality monitoring through quality improvement tools and development of quality assurance standards. I am able to carry out training needs analysis that is important towards employee professional development. I have governance knowledge to implement right quality controls, implement constraint management and utilize relevant models and theories towards implementing sustainable clinical governance strategy.

Challenges Encountered

I encountered different challenges in conducting the clinical governance strategy planning. For instance, I did not understand clinical governance affects patient hospital length of stay but through information flow and anticipation of a patient into a given ward, the staff can prepare for the admission of the patient which ensures treatment for the patient is planned early enough which reduces patient-nurse contact hours.

Opportunities Identified

Healthcare organizations should develop and implement a clinical governance strategy and planning, implement quality monitoring, quality control and quality assurance towards realization of benefits of clinical governance strategic planning that could contribute into continual quality improvement. The organizations ought to develop structures and frameworks for integrating clinical governance strategies with other organizational strategies. The development of clinical governance strategy needs participation of all stakeholders in order to reduce opportunities for conflicts of interest or failure of the governance strategy.

Outcomes of My Project

The portfolio on clinical governance strategy planning determined that governance strategy should be aligned and structured based on capacity to achieve a quality management system which ensures easier adaptation of quality management system improvement tools, use of lean concepts and lean principles as well as lean based theories and models on governance and leadership. The portfolio identified benefits of governance strategy towards improving quality of care, improving turnaround time, hospital length of stay, patient-nurse relationship and capacity to create environment that can foster principles of nursing practices, duty of care and ethics of nursing. The portfolio determined that participation of employees is important towards clear understanding of governance policy, through communication of variation of governance policies, status of governance policy and strategy and potential to ensure governance strategy is communicated to nurses and employees for implementation.

Project Policy Outcomes

The portfolio on clinical governance strategy planning provided opportunity to determine weaknesses of clinical governance, identify right quality improvement tools for instance lean concepts and lean principles that could help guide governance strategic planning as well as rationale for continual clinical governance improvement through continuity of monitoring, quality assessment and performance reviews. The portfolio will help healthcare organizations to review their clinical governance strategies, identify deficiencies in clinical governance strategy planning and develop appropriate measures to improve their governance strategic planning. The portfolio will help academic community determine mechanism through which Southern Healthcare NHS trust has implemented clinical governance and determine its competencies and capability to be used as a benchmark for clinical governance analysis.

Future Prospects

I look forward to conducting case studies on effectiveness of clinical governance in public and private settings, conduct case controlled studies and retrospective studies on mechanism through which effective clinical governance planning could be implemented in different work-settings. I would seek to determine if similar healthcare providers could implement similar clinical governance strategies and if different wards for instance pregnant women wards, children wards or general wards require implementation of same clinical strategy hence impact of having different strategies for different hospital departments on quality, cost reduction, elimination of wastes and service delivery times and other benefits for instance decreased length of stay, quality of life and quality of care.

I need to develop my clinical governance capabilities so that I could have ability to work as consultant in leadership, leadership policy development, governance and governance policy development.

How to Apply This Strategy to My Workplace

As I worked as a staff nurse for 4 years, I became a nurse educator using my previous experiences. My primary focus was on providing healthcare for patients and educating the ne nursing staff and students. I was not engaged with any meeting and nursing projects with regard to patient feedback and, therefore, I knew little about the actual needs of my clients. In this respect, the development of clinical governance strategy allowed me to gain new understanding of the way the organization should work as well as what strategies it should implement to promote quality standards.

I have also learnt about the concept of human factor, which is often neglected in the reports provided in my organization. I also had written reports when working as a staff nurse and I noticed that had often been questioned about my report, which constituted as the major measure of information security. Certainly, I realized that strict hierarchy often prevents from transparent communication between the health care professional and the patient; at the same time, information security should also be of the top priority. Therefore, the presented project provide me with more understanding concerning which steps should be taken to strike the balance between data transparency and confidentiality.

As I came to the UK from a different country where people did not get used to complaining to the courts when the nurses neglected patients’ rights and needs. But in the UK everything is completely different because the government expresses greater concern with the patients’ rights and welfare. Certainly, the proposed strategy is quite complicated to apply to my nursing environment due to my low position, people’s reluctance to introduce changes and financial problems. Therefore, before resorting to radical changes, small shifts should be introduced first. I think it would be more reasonable to present a summary of suggestions that could be applied to my working environment and that possible to implement in the nearest time:

Place a suggestion box with questionnaires and pens for patients and the staff to feedback the proposed solutions;
Making information more available and transparent for patients. For example, nurses should disclose in detail the stages of treatment for patient to be more confident in receiving the desirable outcomes;
Introducing leadership support and engagement in widening the information exchange between the staff and the patient;
Creating staff governance committee with the specific standards, as presented below:
- Appropriate training programs for the staff;
- Safe working environment;
- Information transparency and exchange;
- Active decision making and collaborative working;
- Increased responsibility for the quality of services;
- Introduction of evidence-based practice
- Introduction of the sustainability model is indispensable for improving the organizational performance because it can provide a solid platform for introducing changes and implementing effective plans.

Conclusion

I was able to determine rationale for developing a clinical governance strategy, strategic planning that can support clinical governance, constraints that affect clinical governance, rationale for elimination of wastes in clinical settings, and nature of leadership strategy and leader strategy that can support clinical governance planning. I determined that lean principles and lean concepts are applied in clinical settings and contributes to realization of similar benefits like improved quality of service, reduction of costs, improvement of lead management and turnaround time and elimination of wastes through information flow.

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