This paper presents a critical insight on the key aspects associated with the deployment of clinical and corporate governance on an organization wide basis. The key managerial elements associated with the management or change, organization wide practices and implementation of policy guidance is presented to the reader.
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1. Organization Wide awareness and governance
Lee (1999) argues that the “Clinical governance has been defined as ‘Corporate accountability for clinical performance”. This makes it clear that the accountability of a given NHS trust can be accomplished only through an organization wide approach to the quality management process in order to ensure that the organization is not only accountable to the process of achieving quality of service in healthcare services but also in the delivery of the processes from a managerial perspective. The implementation of the framework like Total Quality Management is deemed applicable as the TQM approach is primarily aimed to nurture the awareness of quality at all levels of an organization thus leveraging commitment and operational excellence among the staff members as argued by Onion (2000). The implementation of the TQM would also require the need to review and address the key operational and strategic elements of the overall NHS management process in the given organization in order to effectively implement the quality assurance strategy devised (Onion, 2000).
The following sections provide a overview on the key tasks associated with the implementation of the organization wide quality assurance and management process at the NHS trust where the clinical incident due to the mismanagement and inefficient policy control.
2. Quality Assurance
The quality of service in the health services environment is a critical aspect associated with the management of the NHS hospitals and primary health care units attached to the each hospital (Savage, 2000). This is not only due to the need for ensuring that the patients are diagnosed successfully and critical illness or transition to critical condition avoided through prompt treatment but also due to the need for effectively managing the process of allocating the resources to the necessary locations and training the medical staff in the use of the equipments alongside communication of changes to policies and procedures. This process of clinical governance is one of the critical elements to ensure that the funds spent on the healthcare services at NHS and other primary healthcare units are realised through providing prompt and valuable services to the patients as argued by Trubek et al (2008). The implementation of the quality assurance process at the primary health care clinic and the NHS hospital to which it is attached, it is necessary to review the existing policies and procedures of the entire NHS trust that manages the portfolio of hospitals and primary health care centres along with the two that were concerned with the incident. This is necessary in order to ensure consistency in the policies and procedures which can be accomplished through implementing a common procedure to replace those that are locally managed at the healthcare centres or hospitals. This is critical for the effectiveness in the quality assurance process because of the fact that the consistency in the service rendered is the first step to achieving quality of service as the healthcare staff across the organization at a given role will be aware of the tasks and the sequence in which they must be conducted in order to provide medical care to a patient. The process of quality assurance in an organization is mainly concerned with the policies and procedures that are implemented and the extent to which they are adhered in order to deliver the effective service quality to the customers as argued by reference4. Hence it is necessary to ensure that there is consistency in the policies and procedures followed in order to successfully implement the quality assurance process at the NHS. In the light of the clinical incident, it is clear that the lack of policies and procedures for resuscitation of the patients along with the lack of awareness among the emergency response team on the operational procedures associated with the use of the recovery equipments justifies that the review of existing policies and enforcement of organization-wide policies and procedures for both emergency medical care and the day-to-day operations to achieve quality assurance.
3. Audit Control and Change Management
The process of quality assurance can be achieve successfully only when the revision of the existing procedures and policies are in place (i.e.) the changes required at each hospital and attached health care units are achieved and practised effectively. This naturally leads to the need or change control and management of change in order to ensure that changes in the infrastructure, policies or procedure related changes specific to a given care unit or hospital is not only implemented but also managed as part of the NHS trust. This is necessary because of the fact that any emergency response team that is dispatched to the specific unit can be aware of the changes before hand and the relevant personnel with the necessary expertise arrive at the scene. This is evident in the case of the clinical incident where the emergency medical staff that arrived at the primary health care centre was not only aware of the procedures at the primary care unit but also lacked knowledge in operating the equipments at the facility. This process of change management and the audit control when managed in tandem centrally by the NHS trust, can help provide the relevant information that is up-to-date on the paramedic or emergency staff’s handheld devices thus helping the staff overcome the element of surprise due to malfunctioning or outmoded equipments etc.,
The audit control process in the clinical environment as argued by Onion (2000) is deemed to become effective when the changes to the policies and procedures are incorporated as changes to the then implemented procedures and policies along with upgrades to any equipment at a given healthcare unit will be logged and monitored across the board. This process will also help in devising the training plan for the medical staff. As the emergency medical staff that arrived at the primary healthcare unit was unable to operate the equipments available at the facility because of the lack of knowledge, this makes it clear that the training is a critical part of the change management process. The audit control when enforced alongside the change management process will help achieve the desired result of training the appropriate medical staff and emergency response staff members to deliver the desired health care service at the hospitals and the primary healthcare units that are attached to the hospital.
The major barriers to the change management is the funding and the availability of resources as the implementation of a quality assurance process with consistency in the equipments being used across the hospitals and attached healthcare units will require commitment of resources and funds to procurement of the infrastructure as well as training of the staff as argued by Onion (2000). It is also critical to appreciate the fact that not only the change control, but also the need to realise sustainable return on the investment in specific piece of hardware at a given healthcare unit naturally requires the need to ensure that the change process to achieve quality assurance does not affect the existing investments at the facilities managed b the NHS trust. This makes it clear that the effective delivery of the services at the NHS must be accomplished through introducing the change management process as part of the infrastructure upgrades being conducted but ensure that the policies and procedures for the emergency response and day-to-day medical operations are implemented. As the change management and audit control are expected to govern the managerial elements of the operational and strategic business of the NHS, the aforementioned must be managed effectively. This process itself will help provide the relevant information to the emergency staff in order to effectively respond to a given medical emergency. The aforementioned also includes the process and procedure associated with the dispatch of the emergency medical staff as the failure of the dispatch team to send the staff to the correct location in the first instance resulted in delays to the medical care given to the patient at the primary healthcare unit.
The setting of the policies and their implementation can be achieved successfully once they are reviewed and the senior management along with the operational staff are in agreement with the policies/procedures prior to their implementation. This is necessary because of the need to ensure that the staff members are aware of their duties in the light of the new policy thus avoiding potential errors associated with the dispatch of emergency medical staff to the wrong location, lack of training to the staff member at any given facility as well as sending emergency response medical personnel who do not have the relevant training in operating the equipments at the given facility. This makes it clear that the implementation of an organization wide policy would leave the paramedic to be concerned with the equipments at the facility alone. This is because the former when standardised will be the same across the facilities at the given NHS trust thus overcoming the barrier of lack of information or misinformation.
4. Clinical Failures and Lessons Learned
The case of clinical governance at Greater Manchester NHS Trust (Clinical Governance Support Team) is a classical example for this case where the clinical governance implementation changed the attitude of the staff towards incident reporting and clinical failures. The positive approach to handling the critical incidents through avoiding disciplinary on the staff involved and encouraging the process of taking collective responsibility to the case justifies that the clinical governance is a major element that attributes to the effective use of the lessons learned process and knowledge transfer across the organization in the NHS trusts of the UK. The change in the attitude of the staff towards reporting incidents with the outlook of realizing benefits to the organization through the information gathered in the critical incident in order to help address policy related issues and fill the gaps in the expertise and training required at the Greater Manchester NHS Trust further justifies that personnel management at the NHS trust is the major element that must be addressed as part of the policy and procedure review to implement quality assurance and TQM within a given NHS trust.
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In case of the primary healthcare unit incident, it is clear that the implementation of the aforementioned would not only encourage the staff to learn from the incident but also avoid potential incidents in future through drafting the best practices that can be implemented organization wide to achieve clinical governance.
From the research presented above, it is clear that the review of the existing policies and procedures must be conducted at the NHS trust on a organization wide basis in order to revise and implemented the policies along with audit control change management to ensure best practices are devised and adhered to effectively.
 Clinical Governance Support Team (2002/2003), Communicating the need for change: getting better following untoward incidents. Online Resource [URL: www.cgsupport.nhs.uk]