Question

As the owner of a successful private practice you want to employ a dietitian for a new clinic commencing next month. The most experienced applicant has recently moved to Australia from England and has over 20 years dietetics experience at a large teaching hospital.

What are the clinical governance issues raised by this scenario and what strategies would you use to guide your decision making.

Answer 1

The standards of proficiency for dietitians

Registrant dietitians must:

• 1. be able to practise safely and effectively within their scope of practice

• 2. be able to practise within the legal and ethical boundaries of their profession

• 3. be able to maintain fitness to practise

• 4. be able to practise as an autonomous professional, exercising their own professional judgement

• 5. be aware of the impact of culture, equality and diversity on practice

• 6. be able to practise in a non-discriminatory manner

• 7. understand the importance of and be able to maintain confidentiality

• 8. be able to communicate effectively

• 9. be able to work appropriately with others

• 10. be able to maintain records appropriately

• 11. be able to reflect on and review practice

• 12. be able to assure the quality of their practice

• 13. understand the key concepts of the knowledge base relevant to their profession

• 14. be able to draw on appropriate knowledge and skills to inform practice

• 15. understand the need to establish and maintain a safe practice environment.

  What is Clinical Governance?

  Clinical governance is more and more involved in health-care.

  clinical governance is that it is a quality assurance process to maintain and improve standards of care for patients, with full accountability of the system towards patients.

  The main components of clinical governance

• Risk management. Risk management is about minimising risks to patients by: ...
• Clinical audit. ...
• Education, training and continuing professional development. ...
• Evidence-based care and effectiveness. ...
• Patient and carer experience and involvement. ...
• Staffing and staff management.

  What are the benefits of clinical governance?

  It provides a system through which clinicians and managers are jointly accountable for patient safety and quality care. The purpose of clinical governance is the promotion of safety and quality, which digital health, in addition to other capabilities in your practice, can improve. Clinical governance ensures that everyone – from frontline clinicians to managers and members of governing bodies, such as boards – is accountable to patients and the community for assuring the delivery of health services that are safe, effective, high quality and continuously improving.

  Clinical governance includes patient safety, risk management and quality improvement.

  It refers to the set of relationships and responsibilities established by a healthcare service between its executive, workforce (clinical and non-clinical) and stakeholders (including patients/clients). It provides a system through which clinicians and managers are jointly accountable for patient safety and quality care.

  The purpose of clinical governance is the promotion of safety and quality, which digital health, in addition to other capabilities in practice, can improve.

• Corporate governance provides a structure through which corporate objectives (e.g. social, fiscal, legal and human resources) are set and achieved, and performance is monitored.
• Clinical governance is a system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.

  Effective workforce

  Ensuring that the staff you employ have the appropriate skills and knowledge to perform their duties and fulfil their roles within your practice is paramount. Processes should be in place to support recruitment, training credentialing and maintenance of clinical standards. Strategies include:

• the health workforce has appropriate qualifications
• quality and continuous development activities are planned and scheduled
• expectations for clinical standards are clearly identified and communicated to all staff.

• Risk management

  Clinical risk management is part of the broader enterprise risk management system that includes strategic, financial and operational risk management. The key aspects of clinical risk management include:

• investigation and root cause analysis of incidents
• development of a culture that supports open communication of, and a system of learning from incidents
• implementation of a system to manage complaints or concerns of a clinical nature in the practice

• Other states have slightly different guidelines on clinical governance (see links), however all are designed to encourage accountability in clinical standards and patient safety.
  
  It is important to provide a framework for a clinical risk management approach to improving safety and quality in health care that places special emphasis upon identifying circumstances that put patients at risk of harm and then acts to prevent or control those risks.
  
  Clinical risk management has a dual aim - to improve the quality of care for patients and to reduce the cost of business risk for health care providers. These are complementary processes to the activities that ensure the quality of health care provision.
  
  A well-defined process should be available within the practice to identify, analyse, evaluate, manage, monitor and review risks. This will include key policies, guidelines and practices to ensure optimal outcomes for patients and staff.

  Improving your practice

  Key components of the clinical risk management process should include a data collection system, integration of data, clinical risk reviews and regular meetings.