Academic journal article Australian Health Review

From Quality Assurance to Clinical Governance

Academic journal article Australian Health Review

From Quality Assurance to Clinical Governance

Article excerpt

Abstract

Clinical governance is seen as a relatively new concept; but a long history of health care quality improvement sits behind it. Over the last 20 years, a number of approaches have been tried and discarded, with some inadequately implemented and others poorly adapted from other industries. Quality programs have evolved slowly, hampered by a conservative and complex health care culture and a lack of focus, data and resources. Despite the advent of clinical governance, driven by a patient safety crisis, many of these issues remain unresolved, and are impacting current clinical governance implementation. Reflecting on the quality journey clearly demonstrates that the potential of clinical governance cannot be realised without the leadership, commitment and support of governing bodies and executives.

Aust Health Rev 2008: 32(3): 383-391

What is known about the topic?

Clinical governance has evolved from a long history of quality programs in health care and is now the dominant approach to health care quality improvement. Despite widespread support for this model, implementation is slow and problematic for many health services.

What does this paper add?

This paper builds on the clinical governance overview provided by Braithwaite and Travaglia1 to explore some of the reasons behind the difficulties associated with clinical governance implementation. The paper provides one perspective on the evolution of health care quality in Australia over the last 20 years to illustrate some of the background to the transition from quality assurance to clinical governance, with a view to learning some lessons to better shape the future.

What are the implications lor practitioners?

An understanding of some of the barriers and drivers involved in the Australian quality journey may prove useful for governing bodies and executives charged with clinical governance, especially those who are meeting resistance or experiencing slow progress.

THROUGHOUT AUSTRALIA health service governing bodies and executives are looking for practical ways to meet their clinical governance responsibilities. In their article "An overview of clinical governance policies, practices and initiatives"1 Braithwaite and Travaglia described the components of effective clinical governance. Their purpose was to examine clinical governance policies and practices in Australia and internationally with an emphasis on the need for active participation of executives and boards if the goals of clinical governance are to be achieved. They noted that there is much work to be done before all health services have successfully implemented the detailed clinical governance model.

Why is this? Members of governing bodies and executives will be familiar with aspects of organisational resistance to enacting their clinical governance responsibilities, but may not understand the genesis or context of these problems. This makes it difficult to develop effective solutions to implementation issues. While Braithwaite and Travaglia1 describe clinical governance as a relatively recent phenomenon, a long history sits behind it, involving cultures, complexity, champions, blind alleys and roadblocks. A greater understanding of this journey on the part of governing bodies and executives may be useful in formulating responses to the implementation struggles likely to be encountered.

Where we've been shapes where we're going

Every year, millions of people interact safely with the Australian health care system and receive good quality care. But the increasingly diverse and complex nature of the system means that the delivery of health care will always involve some risk. Things can, and do, go wrong. Health care is a complex and high-risk industry, with many steps and people involved in the simplest care episode.2 Add to this the explosion of new technologies, medications and medical devices, and the constant growth in knowledge through research, and it is not surprising that we struggle to contain the potential for error. …

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