An Introduction to Clinical Governance and Patient Safety

ABOUT THIS BOOK

• Contains short chapters on key topics so that the reader can quickly acquire information on a wide range of subjects relevant to Clinical Governance or select those which are of interest or relevant
• Includes Key Points at the start of each chapter to quickly summarise important concepts covered in the text
• An authoritative text by well-known and influential authors in the field

Clinical Governance is integral to healthcare and all doctors must have an understanding of both basic principles, and how to apply them in daily practice. Within the Clinical Governance framework, patient safety is the top priority for all healthcare organisations, with the prevention of avoidable harm a key goal. Traditionally medical training has concentrated on the acquisition of knowledge and skills related to diagnostic intervention and therapeutic procedures. The need to focus on non-technical aspects of clinical practice, including communication and team working, is now evident; ensuring tomorrow's staff are competent to function effectively in any healthcare facility.

This book provides a guide to how healthcare systems work; their structure, regulation and inspection, and key areas including risk management, resource effectiveness and wider aspects of knowledge management. Changing curricula at undergraduate level reflect this, but post-graduate training is lagging behind and does not always equip trainees appropriately for a hectic clinical environment. An Introduction to Clinical Governance and Patient Safety presents a simple overview of clinical governance in context, highlighting important principles required to function effectively in a pressurised healthcare environment. It is presented in short sections based on the original seven pillars of clinical governance. These have been expanded to include the fundamental principles of systems, team working, leadership, accountability, and ownership in healthcare, with examples from everyday practice. This format is designed to facilitate use as a 'pocket guide' which can be dipped into during the working day, as well as for general reading. Examples from all branches of medicine are presented to facilitate understanding. Contributors are taken from a broad base - from junior doctors to internationally recognised experts - ensuring issues are addressed from all perspectives.

Readership: All doctors in training, those preparing for interviews, and those in senior positions as part of their continuing professional development for revalidation. Other healthcare professionals and managers will also find it invaluable in their practice.

TABLE OF CONTENTS

1: Elizabeth Haxby and Sarah Hammond: Clinical governance and patient safety - an overview

Section 1 - Risk Management
2: Suzette Woodward: Risk awareness
3: Elizabeth Haxby and Richard Hartopp: Risk identification
4: Alison Lovatt and Mel Johnson: Risk assessment
5: Mary Lane: Risk control
6: Elizabeth Haxby: Risk assurance
7: Ruth Symons: Complaints and claims
8: Gaynor Pickavance: Risk management standards

Section 2 - Clinical Effectiveness
9: Henry McQuay: Evidence-based medicine
10: Peter Littlejohns: NICE and NSFs
11: Gillian Leng and Chris Connell: Clinical guidelines
12: David Hunter: Clinical audit
13: Paul Farquhar-Smith: Research governance
14: Carole Longson and Mirella Marlow: New interventional procedures
15: Helen Goodman: Integrated care pathways

Section 3 - Strategic Effectiveness
16: Paul Williams: The Trust board
17: Gareth Goodier: Trust strategy and strategic planning
18: Heather Shearer: Capacity efficiency and targets
19: David James: Service provision
20: Tina Ferguson: Policies and procedures
21: Heather Shearer: Quality improvement
22: Richard Connett: Performance management

Section 4 - Resource Effectiveness
23: Carole Johnson: Recruitment and retention
24: Sara Lightowlers and Andrew Rochford: Improving working lives
25: Judith Hulf and Kirstyn Shaw: Revalidation
26: Jerry Mitchell: Managing poor performance
27: Maria Cabrelli: Facilities - the hidden hospital
28: Stephen Squire: Equipment management

Section 5 - Learning Effectiveness
29: Les Gemmell: Induction
30: Lesley Bromley: Training
31: Siân Jaggar: Continuing professional development
32: Hazel Adams: Competence
33: David Greaves and Peta Jane Eastland: Knowledge management
34: Simon Finney: Clinical information systems

Section 6 - Patient Experience
35: Rachel Matthews: Patient and public involvement
36: Eve Cartwright: Patient advice and liaison
37: Jilla Bond: Patient consultation
38: Alison Wright: Patient feedback
39: Ruth Robertson: Patient choice
40: Claire Reid: Patient information
41: Deborah Trenchard: The expert patient

Section 7 - Communication Effectiveness
42: Murray Anderson-Wallace: Communicating with the public
43: Nick Hunt: Communicating with commissioners
44: Angela Walsh: Clinical networks
45: Nick Coleman: Board communication
46: Robert Craig: Staff communication
47: Elizabeth Haxby: Communicating with patients

Section 8 - Fundamental Principles
48: Edwin Borman: Accountability, safety and professionalism
49: Guy Hirst and Allan Goldman: Team working
50: Nelson Phillips: Leadership
51: Kieran Sweeney and Michael Williams: Complex systems and resilience

AUTHOR INFORMATION

Edited by Elizabeth Haxby, Lead Clinician in Clinical Risk, Royal Brompton and Harefield NHS Foundation Trust, London, UK, David Hunter, Consultant Anaesthetist & Intensivist, Royal Brompton and Harefield NHS Foundation Trust, London, UK, and Siân Jaggar, Consultant Anaesthetist, Royal Brompton and Harefield NHS Foundation Trust, London, UK

Elizabeth Haxby was a consultant adult and paediatric cardiothoracic anaesthetist for four years until 2002 but now devotes her time solely to clinical risk management, patient safety and medico-legal work. She is a member of the Improvement faculty of the NHSIII and the faculty of the Leadership in Patient Safety programme. She is also a member of the Core team for Patient Safety First with a focus on Leadership and junior doctors. She lectures widely and has a particular interest in patient safety, consent, clinical risk assessment and evidence-based risk management as well as training. Her publications include papers on safety in clinical practice, particularly fibreoptic bronchoscopy for which she was an advisor to the European Respiratory Society Working Group, clinical risk management and training in risk management. She is an honorary senior lecture at the National Heart and Lung Institute and is currently studying for a Masters in Medical Ethics and Law.

Prior to his appointment to the Royal Brompton in 2002, David Hunter was a Consultant Anaesthetist at Guy's and St Thomas', London for 7 years, the last 3 years of which he was the Programme Director of the South Eastern School of Anaesthesia. Since arriving at the Royal Brompton he has developed his interest in clinical governance and patient safety. Since 2005 he has run regular multidisciplinary courses in Sedation for Non-anaesthetists and Patient Safety open to all in the region. He acted as an anaesthetic advisor to NCEPOD from 2005-8 for the report <"The Heart of the Matter>" looking at deaths following coronary artery bypass grafting. He is currently Director of Theatres, and Clinical Governance Lead for Anaesthesia and Intensive Care at the Royal Brompton, working to improve both efficiency and patient safety by highlighting the importance of human factors in safe practice. He is an honorary senior lecturer at the National Heart and Lung Institute.

Siân Jaggar has an interest in education, particularly in changing practice amongst multidisciplinary groups, and the barriers to this in the face of adequate evidence for change. She has developed programmes involving junior doctors, paramedical staff, managers and patient safety staff addressing these issues, and lectures both Nationally & Internationally. Her publications include papers on outcome prediction following cardio-respiratory interventions. She is an honorary senior lecturer at the National Heart and Lung Institute.