Jun 30, 2023

Embracing clinical governance in aged care

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For decades, aged care managers desperate to raise the quality of healthcare have been stymied by a lack of direction, inadequate care data and limited resources for a quick transformation. [Source: Shutterstock]

SPONSORED – In a sector that will always be challenged by a lack of funding and a lack of skilled resources, clinical governance by its very nature has the ability to enhance operational efficiency and effectiveness. 

The overwhelming burden of bureaucracy has the health consumer at risk of not receiving the level of care they need or deserve. 

But clinical governance provides an opportunity for care staff and managers to constantly measure the pulse of the clinical health of their business. It is a concept that was originally defined by Gabriel Scully and Liam Donaldson in 1998 as: 

‘A system through which healthcare organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, creating an environment in which excellence in clinical care will flourish.’ 

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 workforce to raise the clinical bar. 

As a result, managers can plan effectively, intervene quickly to improve resident safety and ensure that learnings are taken on board by individuals and teams, and embedded into the organisational culture.

It becomes immeasurably more powerful when standardised data collection tools are used and aged care quality indicator data can be seen in the context of the wider health system.  

Incorporating relevant data input from secondary and tertiary care hospitals, allied health, other social care agencies, and other community services impacting the care of an individual will no doubt result in clinical outcome gains being seen across the entire health system. 

A person-centred approach

A sound clinical governance structure should always have the individual at the centre of decision-making as their safety and well-being is paramount to the clinical governance process working. 

Healthcare providers 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 of this is with regard to 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, often staff are reticent to carry out and learn from a formal assessment and because of time constraints or other priorities, they tend to rely on the convenience of incontinence products as the fall-back position. Equally, residents can often be reluctant to engage in a toileting schedule if they have limited capacity or mobility as a result of pain, a perceived loss of dignity from being hoisted or a reluctance to use a commode. 

Similarly, a resident 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, intimacy needs, death and dying that must be considered and implemented.

Working to your full scope

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. 

They are always considering 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 sets expectations around best practices and assists with the analysis of what clinical interventions work best with different residents in different situations. 

As a manager, it is important to know if 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.

An electronic clinical governance framework provides 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. 

Maintaining quality assurance

Fundamental to the clinical governance framework is a quality assurance program that clearly articulates a vision and strategy for enhancing clinical care and reducing adverse care events. 

A sound quality assurance program should be intuitive, flexible and responsive in real-time to ensure it is always focused on measuring the right data in the right way. 

Data collection should follow a logical pattern to derive information by date, by the nature of the event and the number of events, from contributing factors, anecdotal evidence, product intervention, even location both at a high level (for example care home or hospital) as well as a more specific location for example dining room or bathroom. 

As a result, you will easily be able to extract patterns and trends based on a wide range of different parameters determined by those responsible for managing clinical care outcomes. 

Assigning a clinical ‘champion’ responsible for wounds, infections, continence and falls prevention is an excellent way to get buy-in from the staff working at the coal face. The champion doesn’t have to be a manager or indeed even a registered nurse. Some of the best champions in the aged care sector have been caregivers working to the top of their scope. 

They have been able to bridge the often perceived divide between their care worker colleagues and management and have provided salient suggestions and real-world solutions completely tailored to the individual residents they know so well. 

The three ‘C’s of good governance – Collaboration, Comprehension and Communication are as relevant in a clinical setting as anywhere. Regularly checking into your clinical governance programme through monthly quality assurance meetings is needed to ensure progress is being made towards your clinical indicator goals. 

Through structured quality assurance meetings, staff can be given the opportunity to have input (Collaboration), from which data can be effectively collated and understood (Comprehension). The results then go through various channels and are disseminated to all relevant members of staff (Communication).  

An in-depth analysis of clinical indicator data, including interventions that were successful or otherwise, should come out of your quality assurance meetings. The results can then be relayed to the appropriate staff. 

Just informing the champions of what needs to be changed and not communicating to and involving all staff involved in the relevant aspect of that resident’s care will lead to a breakdown in the process and no change in the resident’s clinical outcomes. In order to ensure the effective management of all clinical risks, the entire care team needs to be rallied when and as necessary.

Digital monitoring

Clinical governance lends itself easily to an electronic program that enables staff to have high visibility of the health of a range of different quality indicators at the push of a button. 

Most electronic programs provide at least one real-time dashboard which prevents managers from having to delve into a myriad of folders and pore over excel spreadsheets to derive data. With the advent of artificial intelligence, there is now even less excuse for governors of care to not be able to identify and closely manage clinical risk.

For instance, kitchen staff need to see a real-time change to someone’s texture-modified diet but will not likely be remotely interested in the continence-related risk to a resident.

Being able to see real-time data on a dashboard or via a report means managers can circumvent worrying trends and intervene before a resident experiences an adverse clinical event and becomes very unwell. 

An electronic program will protect junior staff when issues need to be escalated, while also regularly pre-empting or preventing major adverse events from occurring. 

When senior staff members are alerted instantly and a Key Performance Indicator (KPI) dashboard provides month-to-month data sets for comparisons, there will no doubt be significant productivity and cost savings.

If nothing else a clinical governance programme will assist with identifying what problems need to be solved, whether the accountability for change sits at an individual, a team or a care home level and most importantly whether the Chief Executive Officer (CEO) has effectively communicated the vision and provided the right leadership to create a culture where clinical safety is a priority for every member of staff.

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