A dental student’s guide to…clinical governance

A dental student’s guide to…clinical governanceClinical governance is at the forefront of many dental professional’s mind at the moment. Hannah Hook takes a closer look at what it means and what it involves.

With interviews for dental foundation training fast approaching, clinical governance is a topic to which many final year dental students will pay closer attention.

That said, clinical governance is an incredibly important aspect of dentistry. We should not overlook it. And so this article is not just for final year students, but to any dental professional at any stage of their career.

What is it?

Clinical governance is an umbrella term for various activities that help to maintain and improve high standards of patient care in the NHS.

Originally defined by Scally and Donaldson in 1998 as ‘A framework through which NHS organisations are accountable for continuously improving the quality of their services and safe-guarding high standards of care by creating an environment in which excellence in clinical care will flourish’.

Clinical governance was introduced to make sure the quality and safety of patient care is maintained. And that health care organisations, such as the NHS, are accountable for their actions.

The implementation of structures and systems therefore helps to do this. They are regularly checked via quality assurance processes to provide evidence that standards are also being upheld.

Clinical governance is divided into seven main subsections; these are also referred to as the seven pillars of clinical governance:

  1. Clinical effectiveness and research
  2. Audit
  3. Risk management
  4. Education and training
  5. Patient and public involvement
  6. Information and IT
  7. Staff management.

Clinical effectiveness and research

This pillar ensures everything carried out is designed to provide the best outcome for the patient. For example: ‘Doing the right thing, at the right time, by the right person, in the right place’ (Gray, 2005).

There are various ways in which to do this. Such as:

  • Management of patients using an evidence-based approach
  • If current practice is inadequate, then change practice. Introduce new protocols and guidelines developed based on evidence and experience
  • Making sure the implementation of national standards such as NICE guidelines to ensure optimum care
  • Enhancing the level of patient care by conducting research and adding to the body of evidence available.

Audit

Defined by Miller and Dowler (2005) as: ‘The systematic review of activity in practice against standards, in order to improve patient care’.

Clinical audit enables practitioners to continuously monitor their clinical practice. It allows practitioners to compare personal activity with the current set standards and remedy any short-comings,  therefore acting as a means of self-improvement (Hook, 2020).

Audits follow a six-step cycle. This includes:

  1. Identifying a problem
  2. Define standards
  3. Collect data
  4. Analyse data and compare against standards
  5. Implement change
  6. Re-audit.

Risk management

Risk management involves robust systems to assist in the understanding, monitoring and then minimisation of risks to patients and staff.

It promotes a blame-free environment where staff are also encouraged to admit to, share and learn from any mistakes. This therefore helps identify areas of risk, assess for their likelihood of occurrence and facilitates the development of protocols.

Examples of risk management include:

  • Complying with protocols such as radiography, discarding sharps, hand washing etc
  • Using mistakes and near misses as a learning tool
  • Making sure that any significant adverse events are then correctly reported (via critical incident forms, significant event analysis etc).

Education and training

This involves making sure that staff receive appropriate training and are also competent in their job role. And that they have the opportunity to continually develop their skills to then make sure they are up to date. This links with professional development, which is a continual learning process.

Examples of education and training include:

  • Continuing professional development (CPD) activities. Such as attending courses and conferences to develop and enhance abilities
  • Undergoing regular assessment and appraisals to help identify areas of personal development.

Patient and public involvement

This allows patients and the public the opportunity to have their say on services provided by giving feedback often via questionaries and surveys.

This information then develops the services, improves the quality of care and monitors treatment outcomes.

There are various ways in which patients can actively impact on care organisations, such as:

  • Participation in local feedback questionnaires or national surveys
  • Formerly known as patient forums, Local Involvement Networks (LINks) have been introduced as a means of supporting communities to influence healthcare services at a local level
  • Members of the local community are able to elect foundation trust board of governors. They represent the members of the public by having a say in who runs a hospital and how to run it.

Information and IT

Information and IT guarantees that all patient data is confidential, accurate and also up to date. Data is used appropriately to measure quality outcomes via audits to develop services to match the needs of the local population.

There is a designated Caldicott Guardian for every NHS organisation. This is also a senior person responsible for protecting the confidentiality of people’s health and care data. As well as ensuring its appropriate use. Caldicott Guardians make decisions or give guidance using the six Caldicott principles below.

Caldicott principles:

  1. Justify the purpose for using confidential information
  2. Only use it when absolutely necessary
  3. Use the minimum required
  4. Access is on a strict need-to-know basis
  5. Everyone must understand their responsibilities
  6. Everyone must understand and therefore comply with the law.

Staffing and staff management

This covers the appropriate recruitment and management of staff.

It identifies areas of underperformance and also facilitates ways to address these. Practices can do this via practice meetings, multi-source feedback, team building, personal development plans and regular appraisals.

It also encourages and motivates staff to develop.


References

Gray C (2005) What is clinical governance? BMJ 330: s254

Hook H (2020) A guide to clinical audit for the dental team. BDJ Team 79 (7): 34-7

Miller AG and Dowler FJ (2005) Making the most of audit. Dent Update 32

Scally G and Donaldson LJ (1998) Clinical governance and the drive for quality improvement in the new NHS in England. Br Med Jour 317: 61-5

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