Emerald | Clinical Governance: An International Journal | Table of Contents

What worked over there must be good for over here : discuss

literatinetwork@emeraldinsight.com (Nick Harrop) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Not available.

Clinical Governance Implementation: A Developing Country Perspective

Mon, 20 May 2013 00:00:00 +0100

Abstract

Purpose - To explore how the clinical governance policy and its main component, patient satisfaction, turned into practice and what they look like on the ground in the centralised health system of Iran.Design/methodology/approach - A qualitative research stance was adopted incorporating three main sources of information: face to face in-depth interviews and focus groups conducted with hospital senior managers at the teaching hospitals in Kerman city, Iran as well as documentary analysis of key policy texts. Nine hospital senior managers were purposefully selected for face-to-face interviews as well as a purposeful sample of 15 hospital senior managers for focus groups.Findings - The documentary analysis revealed how clinical policy has put into practice. The interview and focus group data analysis also disclosed four key themes with respect to how policy implementers in the Iranian centralised health system perceive nationally developed policies towards clinical governance and patient satisfaction. These include: a paper exercise; opaque, ambiguous policies; unstable policies; and separation of policy making from policy implementation.Originality/value - The study revealed a perceived mismatch between the official proposals for clinical governance and their application in practice. The findings of this research lend support to the idea that there should be no separation between policy making process and its implementation; they are inseparable and should be treated in parallel, rather than in sequence. The study further suggests more accountability of the sate towards its policies and public alike as a better governance of the health system. State-level sustainability followed by allocating proper resources to implementation fields and empowering policy implementers coupled with good systems of performance control are the keys to keep patient focus a top priority.

AUDITING SOLOMON ISLANDS’ HEALTH AND MEDICAL GOVERNANCE

literatinetwork@emeraldinsight.com (Alistair Brown) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - This paper seeks to analyse the audit findings, by the Auditor General’s Office of the Solomon Islands, of the Ministry of Health and Medical Services, Solomon Islands’ main health and medical agency that aims to coordinate the country’s health and medical services. Design/methodology/approach - Using electronic data from annual reports, audit findings on the Solomon Islands’ Ministry of Health and Medical Services are textually analysed over a six year period (2006-2011) to detect the milieu of reporting by Solomon Islands’ main health agency.Findings - Over a six year period, the Ministry of Health and Medical Services consistently found it difficult to generate accurate and timely annual reports as mandated by legislation. Critical governance issues of internal control, asset management, stock control and bank reconciliations are given short shrift by the Ministry. Research limitations/implications - The findings presented here are derived from exclusively from textual analysis rather than through the medium of open-ended questionnaires and mixed methodological techniques. However, the paper used authoritative local texts and explanations to overcome these limitations. Practical implications - In low-income countries, audit findings needs to be fully integrated in the governance of the national health and medical services. The findings presented here provide practical guidance for those considering developing or improving health and medical services in low-income countries. Originality/value - Local audit findings have the major potential for improving health and medical services in low-income countries within existing resource constraints. The audit findings presented here have relevance to the entirety of health and medical systems in low-income countries.

Transitional Care to Adult ADHD Services in a North West England District

literatinetwork@emeraldinsight.com (Michael Oladipo Ogundele) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - We aimed to analyse the transitional care of adolescents diagnosed with ADHD in childhood into adult specialist ADHD services in a local district. We also reviewed current practice and designed a multi-disciplinary transitional care pathway to adult services for adolescents with complex health needs based on best practice and available clinical guidelines.Design/methodology/approach - Adolescents diagnosed with ADHD from childhood who were eligible for transition to adult ADHD services and who reached the age of 16 years over a period of two years consecutively (July 2009 to June 2011) were studied by a retrospective analysis of their clinical records. Our current transitional care pathway was reviewed and revised.Findings - Out of 504 patients on the specialist ADHD database, 104 adolescents were eligible for transition to adult services. 19 patients (18%) were referred to CAMHS. 68 adolescents (65%) were discharged from the paediatric services following voluntary discontinuation of medications and non-attendance at follow-up clinics. Only 16 patients (15%) were successfully referred to the specialist adult ADHD services (3 discharged). A multi-disciplinary transitional care pathway to adult services for young people with complex health needs and learning difficulties and information for the carers and young people have been designed and adopted in the local city borough, agreed by all the stakeholders. Practical implications - A total of 73% of eligible patients were either discharged or lost to follow-up. There must be some flexibility in the referral pathway to the adult ADHD services to allow some of the adolescents who were previously lost to follow-up to be re-referred by other primary or secondary care healthcare professionals if the need arises in the future.Originality/value - There is a high rate of discontinuation of medications, loss to follow-up and a remarkably low rate of successful transition to locally commissioned adult ADHD services among adolescents diagnosed with ADHD in childhood.

It’s good to talk: Auditing clinicians' interactions with patients in a primary care setting

Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - This study analysed the effect on clinical practice of auditing doctors, advanced nurse practitioners and pharmacist consultations within an out of hours primary care organisation and the resultant effects this may have on clinical practice and the quality of care provision. Design/methodology/approach - The study utilises a multi method time series case study approach using the results from the Royal College of General Practitioners (RCGP) audit tool analysis, alongside focus group analysis and participant observation. Findings - The results demonstrated there is a clear link between implementation of a clinical audit strategy within a wider clinical governance framework and improved standards of all clinician’s work. This study also demonstrates how the analysis can inform a definition of quality. Research limitations/implications - The definition of quality is limited and is one of the limitations of the study since it is related to out of hours primary care only. Practical implications - Results may be extrapolated to other care providers both out of hours and in traditional GP practices. Originality/value - This case study demonstrates how the time series analysis of audit results can assist in assuring commissioners of health services of the quality of the services they appoint.

INTRODUCING AN ACUTE GYNAECOLOGY DASHBOARD AS A NEW CLINICAL GOVERNANCE TOOL.

Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - Risk management is an essential cornerstone of any effective unit. The maternity dashboard has been found to be an efficient governance tool, but there is no such scorecard in gynaecology. Our aim was to conceptualise and implement an acute gynaecology dashboard in a teaching hospital over a period of 2 years and review the changes brought in practice as a result of the dashboard. Design/methodology/approach - This acute gynaecology dashboard was designed in line with the existing maternity dashboard. Goals and benchmarks were determined on the basis of available national guidelines, expert opinions and local policies. The dashboard was prospectively implemented, updated monthly and presented in the relevant forums. A retrospective overview of the changes brought in our practice is presented in this paper.Findings - Through the use of the dashboard significant problems related to workforce, training and clinical activity were identified. A number of changes were subsequently executed to improve patient management, service provision and training. This paper provides empirical insights about how positive changes in clinical practice could be brought in by the implementation of acute gynaecology dashboard. The acute gynaecology dashboard was found to be a valuable governance tool to monitor performance and improve training and patient care.Practical implications - The acute gynaecology dashboard can be used as an effective clinical governance tool to monitor performance and lead to improvement in clinical practice in other acute gynaecology units. Originality/value - Though the maternity dashboard is widely in use, there has been no previous description of an acute gynaecology dashboard and this is the first paper in this area. With the increasing demand of acute gynaecology services, the dashboard becomes an essential tool for clinical governance.

Hospital service quality and its effects on patient satisfaction and behavioural intention

literatinetwork@emeraldinsight.com (MUSLIM AMIN, SITI ZAHORA NASHARUDDIN) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - Purpose – The purpose of this study is to investigate hospital service quality and its effect on patient satisfaction and behavioural intention. Design/methodology/approach - Design/methodology/approach – A convenience sampling technique was used in this study. A total of 350 questionnaires were distributed and 216 were returned (61.7 percent response rate). Findings - Findings – The results confirm that the five dimensions – admission, medical service, overall service, discharge and social responsibility – are a distinct construct for hospital service quality. Each dimension has a significant relationship with hospital service quality. The findings of this study indicate that the establishment of higher levels of hospital service quality will lead customers to have a high level of satisfaction and behavioural intention. Research limitations/implications - Research limitations/implications – This research examined the concept of hospital service quality, patient satisfaction and behavioural intention from the perspective of patients. However, this study did not explore the perspective of service providers. This is a limitation in as much as it only considers the patients view, which might be different from the providers view. Practical implications - Practical implications – The results indicate that managers should use the perceived service quality and customer satisfaction as mechanisms for exit strategy that will increase loyalty among the present customers. Originality/value - Originality/value – This study would enable hospitals to have a better understanding of the effects of service quality, which will lead to patient satisfaction and behavioural intention in order to build long-term relationships with their patients.

Unraveling a Web of Confusion

literatinetwork@emeraldinsight.com (David Birnbaum) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - To describe state of the art in broadcasting the quality of care at different hospitals.Design/methodology/approach - Narrative review. Findings - The American federal Agency for Healthcare Research and Quality recently conducted a funding opportunity in recognition that the science of public reporting was insufficiently understood, which underlies relatively weak impact to date of public information websites on hospital quality and safety. Whether the fundamental purpose of such websites is to inform consumer choices or to stimulate facility leadership toward accelerated quality improvement, which relates to which metrics would be the most appropriate, and whether public audiences perceive concepts of evidence-based best practices differently from professional audiences, all remain in question. Whether reporting physical harm of adverse events is the best metric, or whether damage to dignity and trust should be included, or whether more holistic measures of institutional culture would be even more meaningful remain in contention. While it is premature to set standards unifying how and what hospital performance measures should be displayed on public information websites, there are existing efforts to ensure developers can learn from the natural experiment afforded by the current abundance of independently developed North American reporting programs, league tables and public information websites. Practical implications - Developers of public policy and of electronic health information systems can benefit in terms of efficiency and effectiveness by capitalizing on recent work of several interdisciplinary teams. They can benefit from the generic approach used by some who are attempting to harmonize the broad range of public health reporting programs’ data flow into one use case model capable of accommodating all reporting streams, and from others who are applying evidence-based criteria to rank public information websites while also evaluating performance of scoring criteria they are developing from broad principles acquired from various cited sources.Originality/value - Public trust in healthcare facility quality and safety has fallen into mistrust, and the information websites developed to address that consumer issue are known to have problems in ease of use, believability and helpfulness. This paper describes recent North American projects that acknowledge those problems but also provide potential paths toward solving them.

Clinical Governance Review CGIJ 18.3

literatinetwork@emeraldinsight.com (Fiona MacVane Phipps) — Fri, 19 Jul 2013 00:00:00 +0100

Abstract

Purpose - The purpose of this review is to enable busy health professionals to gain a rapid overview of the content contained in the current issue of CGIJ.Design/methodology/approach - The design is a review, providing a brief summary of each of the major papers contained in the current issue of CGIJFindings - Clinical Governance continues to be an important facet of healthcare in the UK and around the world. In some developing countries however, implementation of clinical governance continues to be a work in progress with some senior managers expressing concerns that it is merely a 'paper exercise' in their areas. Areas where components of the clinical governance agenda have been used to improve services in the UK include an acute gynaecology dashboard developed for an EPAU in London, prevention of sudden death in epilepsy (SUDEP) and evaluation of an out-of-hours GP service where some GP consultations are now done by ANPs and pharmacists. Finally, adopting a clinical governance approach to accountancy auditing has led to improvements in the island nation, Solomon Islands where geographic spread and low per capita income add challenges to national healthcare management.Research limitations/implications - NAPractical implications - NAOriginality/value - The value of this review is that it enables readers to quickly identify articles of interest to them which they can then read in their entirety.