Implementing Clinical Governance in a Private Wellness Service
Context: Clinical governance describes a systematic approach to ensuring the quality and safety of healthcare which has become accepted as one of the foundations of effective healthcare. This project describes the implementation of a clinical governance system in a private healthcare setting over a nine month period, in which lack of clinical governance and oversight had been identified as a significant risk.
Aim: The aim of the project was to design and implement an effective, sustainable clinical governance system to ensure the safety and quality of care delivered in a private health screening service.
Methods: The key principles and components of clinical governance, and evidence guiding effective implementation, were established through review of the literature. The HSE change model was used as the organisational development framework for the change process, including strategic analysis, stakeholder management, communication, planning and implementation.
Evaluation: The project was evaluated against seven objectives using service data, clinical audit and a stakeholder survey to measure project implementation and project outcomes. Outcome evaluation was limited by the timescale of the project.
Results: 71% of the objectives were fully achieved and 29% partly achieved. A causal link was established between the implementation approach and process change, and between process change and improved outcomes. Before-after evaluation of service data combined with clinical audit confirmed that clinical governance structures and processes were implemented and working as intended. Stakeholders perceived the change as positively affecting service safety, and the system design was seen as being fit for purpose without imposing an excessive workload. The leadership and change management approach were seen as effective, and there was evidence supporting the sustainability of the system.
Conclusions: Use of the HSE change model, with a combined top-down and bottom-up approach, in the context of a model of engaging leadership and the development of distributed leadership, provides an effective approach to clinical governance implementation and healthcare innovation. Culture was an important enabler, while resourcing and information technology support emerged as important barriers.