What is Clinical Governance in Aged Care?
Clinical Governance in aged care is about how the Board, executives, managers and staff all relate, share responsibility and are held accountable for delivering safe and high-quality clinical care and services to Elders.
The essence of clinical governance is to ensure that the right things happen to Consumers more often (by making it easy to do the right thing)… and the wrong thing happens to Consumers less often (by making it difficult to do the wrong thing).
The Boards Role in Clinical Governance (2011). Australian Institute of Company Directors.
The term Clinical Governance was first introduced in the 1990’s in the National Health Service (NHS in the United Kingdom), in response to concerns about the quality and safety of healthcare. A problem was the separation between management and clinical services, and a lack of understanding about how clinical risk may cause harm. Clinical governance is now an important concept that ensures a clinical focus in all decision-making.
The term itself, Clinical Governance, has been defined as the set of relationships and responsibilities established by a health service organization between the health regulatory body(ies), own governing body, executive, clinicians, consumers and other stakeholders, to ensure good clinical outcomes.
Why is Clinical Governance Important?
Elders in aged care have more complex health care needs. This means they are more likely to be at risk e.g. harm due to a fall. This awareness of increased risk requires everyone’s focus in the course of their work. It’s important to have an overarching structure (known as a Clinical Governance Framework) to do this.
Everyone has a role in clinical governance, including non-clinical staff.
Clinical Governance Framework
The Clinical Governance Framework must be embedded into Corporate Governance. This is so the whole organisation is proactive in identifying and mitigating clinical risk. A Clinical Governance Framework provides guidance on how clinical governance is implemented across an organisation. It helps to show how risk is managed and how continuous improvement is achieved.
It ensures that everyone in the organisation is aligned with your organisation’s vision, mission and objectives.
How is it Implemented?
Good Clinical Governance in Australia in Aged Care is about having an effective clinical governance framework in place. This means having the leadership and right systems in place for delivering safe, quality clinical care in accordance with the new aged care quality standards. It requires a flow of information and reporting to the board to assist decision making. Clinical governance is one of the cornerstones of risk management in aged care.
Aged care boards have responsibilities to ensure the systems are being followed and the CEO, managers, clinical team and care workers achieve good clinical results for consumers and the organisation.
Clinical governance “pillars” help create the structure to uphold areas of accountability. All pillars overlap in their central focus on Elders, partnering with them in their care to optimise clinical outcomes.
An example of the type of pillars (structures) that your organisation may have in place that include specific accountabilities and regular reporting to the Board are:
- Governance, Leadership and Culture
- Safety and Quality Systems
- Workforce and Clinical Effectiveness
- Safe Environment, Monitoring and Reporting
How AgeWorks Helps With the Main Issues with Clinical Governance in Aged care.
How quickly does bad news travel in your organisation? In other words, when something goes wrong, how quickly do you find out? Is there transparency and a culture that supports the reporting of risk? Or is there reluctance because people fear being blamed or reprimanded? Are problems escalated and acted on as may be required?
For the most part, Boards rely on the integrity of internal reporting from their management to tell them if there’s a problem. Boards often use accreditation results to verify the quality of that reporting (i.e. reports from the regulator, now known as the Aged Care Quality and Safety Commission but more commonly referred to as the Quality Agency).
It’s been our experience that clinical issues that may lead to poor outcomes are often not detected by busy staff on the ground. Where they are identified, many cases are poorly followed up or lack a satisfactory resolution. In other words, Elders may remain at risk of illness, injury or in some cases death.
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Outcomes of Poor Reporting
Sadly, in many instances clinical risk is not reported at all, or its poorly explained so Boards fail to understand the true nature of the situation. Unless Board members have a clinical or operational background much of the area may present as quite technical and this presents a barrier. This exposes the Board to serious consequences. Evidence of this is being played out now in the Aged Care Royal Commission. The Interim Report entitled “Neglect” highlights many case studies that demonstrate poor clinical governance. 2
Poor reporting is a reason why the government has now made it mandatory for all services to provide quarterly Quality Indicator reports. Currently there are three areas (more Quality Indicators will be included over time. 3):
- Pressure injuries
- Physical restraint and
- Unplanned weight loss
What to do if Your Organisation or Board has an Issue with Clinical Governance
First off you must have a clinical governance framework that is effective. Many services have ad hoc policies and various documentation available, but in practice, their operations differ. Often the quality of communication across the organisation is poor.
If you’re not confident of the information you’re being provided or you suspect that your organisation has an issue with Clinical Governance, or you just want peace of mind, it’s vital that you investigate further. You may benefit from a third-party independent audit to verify this for you.
Support AgeWorks Provides to Rectify Issues
We review the key aspects of your business as they relate to Clinical Governance. We check systems such as incident reporting, staff practices, communication processes, quality of data and actual reports to Boards. We can also help you to interpret clinical data for better decision-making.
Our independent audit report gives you very important feedback and analysis that will not be contained in agency reports or your own internal audits. Via a colour coded traffic light system you can easily check the health of your Clinical Governance.
Our report will also provide you with important information relating to the new standard 8, Organisational Governance. We can also provide you with an action plan of what to do and how to do it.
Depending on our time with you, our goal is to educate and work with all key staff across the organisation so they are aware of their key accountabilities and why they are so important.
A periodic independent audit may help to reduce the cost of your insurance premiums.
The Biggest Mistake Aged Care Boards and Individuals Make with Clinical Governance
One of the biggest mistakes that boards and individuals make with clinical governance is to rely on internal audits and reporting. Many organisations are sold or invest in systems where there’s an expectation that it will guide them, providing the magic bullet. As most systems rely on the input from humans, the system is only as good as the quality of that information. Boards and individuals fail to check how well systems are being implemented as well as the quality of those systems, processes that impact Elder’s care and overall operations and compliance.
When we have worked with clients in serious difficulty or under sanctions, invariably there’s been an issue where the Board has put too much trust in a single individual, only to find out too late that they have overestimated that person’s capability. While that individual’s poor performance may lead to their termination, it’s the Board, that is ultimately held accountable. The board must then quickly address major problems affecting their service or even face closure. (Research by the insurer AON has found that people-related risks regularly rank as the top key five risks across industries). 4
When you know better, you do better.
Many Boards, especially from rural services, fear upsetting their CEO or key staff. They fear by asking too many questions that key staff may leave. They may worry about the ability to find a suitable replacement in that event. Many managers on the other hand feel they should know. They may find it difficult to admit “I don’t know”. Most Boards, management and staff benefit from some simple education around clinical governance and reporting.
The Interim findings of the Royal Commission into Aged Care has highlighted repeated cases of poor clinical governance. Might the outcomes have been different had there been an effective Clinical Governance Framework in place, an organization in alignment, greater transparency and timely reporting to the Board?
Why Choose AgeWorks for Clinical Governance Advice?
Everyone’s job in aged care is so important. While individuals may be on different pay scales, all jobs are vital to the quality of life for Elders, ranging from Lifestyle staff, cleaning and maintenance staff to the Chairman of the Board. In reality, in the aged care space, no job is more important than another.
But many services, not just in aged care, operate as silos. Often folk work hard in their respective areas, but unless there is clarity about their accountability for clinical risk, they don’t necessarily have the same sense of priority and may fail to act. For example, a receptionist who notices a wandering Elder trying to abscond or a strange person who comes in off the street.
Risk Management in Aged Care
Corporate consulting group, McKinsey, found in their risk management research that crises continue to emerge when organisations fail to manage frontline attitudes and behaviour of staff. These are the organisations first line of defence against risk. This is otherwise known as its risk culture. 5
Dealing with problems is an everyday occurrence for all aged care operations. It’s important to develop a healthy workplace culture that understands this and that things will go wrong. Leadership must be proactive in analysing the root causes and doing something so risk is mitigated. Staff must be educated to report and escalate risk where outside their expertise. Open disclosure is now expected as part of the new standards. Clients sometimes need our consultancy services to get to the heart of problems and provide independent advice.
Unfortunately, in many organisations, when problems arise, it becomes a blame game rather than a lesson learned. As long as cultures remain fearful, then staff may shy away from identifying clinical concerns, worried that they will be blamed or isolated by others.
AgeWorks thrives on helping services to focus on what’s most important and get into alignment. We communicate with all stakeholders for enhanced mutual understandings and to enable a healthy workplace culture to develop. We’re great at alleviating tense environments so organisations can move forward. We also thrive on engaging individuals to work in teams, a shared sense of responsibility to create synergy.
In the busy, sometimes crazy world of aged care we’re expert at helping staff identify what they do well. As independent consultants, clients and families may also confide in us about their most pressing clinical concerns. In a consumer directed world, this consumer feedback may prove to be timely business intelligence and vital to understanding a changing market.
We believe that most people in aged care have a vocation and are driven by empathy and compassion. Unfortunately, the aged care system at the present time is broken, as highlighted by the Royal Commission into Aged Care. The current aged care system is reactive, full of distraction and does not bring out the best in people.
Our mission is to restore Board, Management and staff’s confidence and competence to better understand Clinical Governance in challenging times and take correct action as may be required.
For more related information, check out the services and assistance we offer for aged care standards and non-compliance.
References
- The Boards Role in Clinical Governance (2011). Australian Institute of Company Directors.
- Aged Care Legislation Amendment (Quality Indicator Program) Principles 2019
- Interim Report: Neglect (2019) Royal Commission into Aged Care Quality and Safety
- Krivkovich, A. & Levy, C. (2013) Managing the People Side of Risk. Retrieved from www.mckinsey.com/~/Risk
- Ibid., 3
Call AgeWorks today for a confidential chat about clinical governance in aged care.