Okay. In the previous post i mentioned about health system, its definition, function and et cetera. Today i am going to write on quality of care and how the best care possible is ensured. :) I am sure we are all concerned on the quality of materials or even services that we get no matter what we buy or where we go. Thus, i am sure we wonder about the quality of health care. So, lets look at the aspect of quality from the health system point of view.
First lets look at the word Quality. It is defined as degree or grade of excellence. There are 3 types of quality in this context which are :-
a) management quality
b) professional quality
c) service quality.
All these 3 components are important to ensure a high quality of health care. So now, lets look at how do we maintain this quality.
Clinical Governance
This was the first time i heard the word myself. Anyway after lectures and some side reading by myself i was able to understand the meaning of this word. Lets look at some definition of this phrase.
" Clinical governance is about ensuring
that patients are safe and risks are managed.
Janet Seaton, Clinical governance facilitator, NHS 24
" Clinical governance is the framework through
which all the components of quality, including
patient and public involvement, are brought
together and placed high on the agenda of
each organisation.
David Steel, Chief Exec NHS QIS
From my understanding, clinical governance is an association who are responsible for improving the standard of clinical practice. It is also mentioned in the law (UU 29, 2004) that the health care providers namely physicians have to follow the standard to ensure the quality of care. Now lets look at the governance itself.
Firstly, the AIM :
- for appropriate access and also high quality of care
- to reduce risk
The aim of clinical governance will be clearer as we look at the components of the governance. The COMPONENTS are :
1. Education - Where the physicians have to go through con tinuous education which means they constantly upgrade themselves with the new updates of interventions, drugs and etc. For example, the concept of continuous professional development. This is learning activities through which health care professionals maintain and develop their skills and knowledge. This helps in improving quality of care. However, this has been focused more on individuals rather than groups of physicians or other health care providers who work together.
2. Clinical Audit - This is where the clinical performance is reviewed. Its a cyclical process performance against standards.
- The objectives of a specific clinical audit may be developed specifically based on characteristics such as appropriateness, timeliness, and effectiveness of a treatment procedure.
- The criteria of the clinical audit are developed from national guidelines and it has to be agreed upon before use. From the criteria we develop its standard and what are the exceptions to justify when these standards are not performed.
- Next we perform data collection which can be performed prospectively or retrospectively. The data may be obtained from medical records with the help of Clinical Audit (CA) assistants.
- After obtaining the data we analyze them by the level of compliance, pattern of deficiency and with the help of some diagrams.
- The next step will be to implement changes. However to do this, first we have to determine the problem, plan of action, responsible team, timeline and also cost.
- After the specific time mentioned, we have to re-audit to determine if the changes are effective.
3. Clinical Effectiveness - This is a measure of the extent to which an intervention works. It can be measured on its own or together with the appropriateness of the intervention and also the financial aspect of it. It may be assessed using randomized controlled trials or meta analyses. The term that is closely related to clinical effectiveness is Number Needed to Treat.
4. Risk Management
- Patient risk - it can be reduced by compliance to statutory regulators and also constant review of the service and intervention given.
- Practitioners risk - we have to reduce the risk of practitioners to infections and ensure they are in a safe environment.
- Organization risk - it can be decreased by high quality employment practice and constant review of individual and team.
5. Research and Development - It is done to ensure professional practice. It may be done in ways of clinical appraisal of literature and also by developing guidelines, protocols and etc.
6. Openness - It is important for the governing team to be open to public scrutiny but at the same time respecting patients' and also practitioners' confidentiality.
With all these ways, quality of health care can be improved and IS being improved. It's a huge relief that even as i type this, there are people thinking on improving quality of health care. :)
Thats all for now,
Adios, Tc and looking forward to learning together again. :)
References :
1) Lecture Note - Briefing for Clinical Audit Practical Sessions, Prof. dr. Adi Utarini
2) Lecture Note - Quality Framework, Clinical Governance and Patient safety, Prof. dr. Adi Utarini
3) Clnical Governance - Nigel Starey Bsc MBBS, MRCGP, Director, Centre of Primary Care, Univeristy of Derby
4) Health Professions Council - http://www.hpc-uk.org/registrants/cpd/
5) Dictionary - http://www.thefreedictionary.com/free
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