The NHS guidance on good governance and collaboration, released in October 2022 following the implementation of the Health and Care Act 2022, signalled a major step in the road towards integrating the health and care systems in England.
They placed a range of requirements on the stakeholders involved with healthcare, public health and social care in each area of the country in order to help them promote equality and address health challenges by working together. As such, these parties should utilise a clinical governance checklist to ensure they are contributing to integrated care systems (ICPs) in the most effective way.
Clinical governance is the process of committing to continuous improvement to achieve the best possible levels of care by creating an environment in which clinical excellence is encouraged and supported.
Purpose of a clinical governance checklist
The UK government describes clinical governance as encompassing:
- quality assurance
- quality improvement
- risk and incident management.
Therefore, the purpose of a clinical governance checklist is to ensure that your organisation takes all of the steps necessary to master these elements.
The checklist breaks down the necessary work of organisations involved with ICPs to keep them on track and able to monitor their progress towards their goals. It provides transparency and accountability, displaying who needs to complete which tasks and when in order to help the organisation meet its obligations.
The good clinical governance checklist
The guidelines set out the ultimate goals of partnerships within ICPs as “better health and wellbeing for everyone, better quality of health services for all and sustainable use of NHS resources.”
Within these overarching aims, organisations should create a series of targets in order to be able to meet them. This could include improving patient safety, improving staff safety, reducing waste, faster and more efficient decision making or any other goal that feeds into the mission to reduce inequality of care and deliver excellence.
These goals will depend on the location in which the organisation works, the demographics and challenges in that area. They are also related to the infrastructure available and the role of the organisation within the ICS and its associated integrated care board (ICB) and integrated care partnership (ICP).
Assemble a dedicated governance team
Your governance team should include a clinical governance lead who will take responsibility for oversight of all governance activities within the organisation, reporting to the CEO. They will head the team and ensure that each member understands their roles and responsibilities.
The lead should also challenge decision-makers to ensure that they create policies that work towards the governance goals, as well as analysing reports to ensure the team is delivering on its requirements.
Depending on the size and structure of the organisation, you might also want to include senior management and medical staff in the clinical governance team. However, each organisation must make a decision on how to most effectively and efficiently deliver its governance goals and guide the team that needs to facilitate this.
Create a patient safety culture
As part of a wider safety culture, focusing on developing your patient safety culture is an important aspect of meeting your governance goals. In order to deliver better health and wellbeing for patients, you must look at the current systems and processes in place and consider how to improve them to keep service users safe.
This patient safety culture should, of course, concentrate on the physical wellbeing of service users. But it should also support their mental health and offer them safe routes through which to report any misgivings that they experience.
Ways in which you can implement this strategy include ensuring patient safety is on the board’s agenda, alongside the establishment of a patient safety committee. One executive should then take responsibility for all matters relating to the safety of service users, including the patient experience and the whistleblowing complaints procedure.
Regular training for staff members and management on topics relating to patient safety also helps keep it at the forefront of people’s minds.
Establish effective communication systems
Communication is key within clinical organisations and between partners in the ICS of which the organisation is a part.
Internal communication systems keep staff informed of important details about patients and best practices, and internal, top-down, communication channels allow you to present a cohesive approach to governance and strategy by ensuring all stakeholders are aware of their responsibilities.
Within boards of healthcare bodies, using a board portal to organise meetings allows directors to communicate and collaborate outside of the boardroom. These communication opportunities facilitate a joined-up approach to strategy that helps the organisation work towards its governance objectives.
As part of the new NHS guidelines on governance, there is an expectation that partners in ICSs will share planning and decision-making information, taking shared responsibility for the delivery of services and the improvements to those services. This requires robust communications, which should be established early on.
Develop a quality improvement plan
Improving the quality of care for everyone is one of the reasons behind the establishment of the new legal structure of the ICSs. Each partner should develop a plan for how they will improve clinical quality internally and as part of their collaborative efforts.
Each organisation will differ in its approach to quality improvement, given the variety of circumstances, but creating a quality improvement framework in order to guide your efforts is beneficial.
It involves deciding on your priorities and using these to guide the direction of your improvement strategy. Look at the principles of quality and see whether they apply to your service’s procedures. Are they safe, timely, effective, efficient, person-centred and equitable?
If not, this gives you the opportunity to improve, as well as put in place special training and development sessions, new processes and other solutions.
Ensure effective implementation
NHS England has developed a series of oversight metrics to help organisations understand how they are performing in terms of clinical governance. Once you have implemented your governance strategy, you can use these measures to track your progress.
This includes using staff survey results to understand the perception of the leadership team and the organisation achieving a Care Quality Commission (CQC) well-led rating.
This framework helps you understand where you are succeeding and where there are governance gaps that may require additional effort to close.
Ensure you perform a risk analysis and create mitigation strategies for the most likely and most potent threats to your organisation and its patients. Governance and risk do not stand still, so it is important to be prepared for issues in the future.
Perform regular clinical audits
Clinical audits are an effective way to ensure that your organisation is providing the expected level of service and is delivering for all stakeholders. Carry out regular audits to find out where your strategy is in need of more attention.
Roles and responsibilities in clinical governance
Clinical governance does not just affect the leadership of an organisation. Other stakeholders play their roles within the framework too. Here is how they fit into the picture:
|Stakeholder||Role and responsibilities|
|Role of management||Management leads the culture of the organisation and can contribute to clinical governance by creating an environment that focuses on safety and rewards quality performance.|
|Role of clinical staff||Clinical staff should act in accordance with ethical guidelines when working with patients and be committed to continuous improvement.|
|Role of non-clinical staff||Clinical staff can have a major influence over patient experience and should be committed to making interactions as easy and straightforward as possible.|
|Role of patients and their families||Service users and their families can help clinical governance by giving feedback on their experience and outcomes, as well as through reporting of anything they felt was amiss. This helps leadership gain an eye on the ground and uncover issues before they become insurmountable.|
What demonstrates good clinical governance?
Good clinical governance is demonstrated by high standards of patient care, regular audits and risk management processes. This includes transparent and efficient communication, adherence to evidence-based clinical guidelines, a culture of continuous learning and the prioritisation of patient safety.
How often should a clinical governance checklist be reviewed and updated?
A clinical governance checklist should ideally be reviewed and updated annually. However, it may be necessary to conduct more frequent reviews in response to significant changes in regulatory requirements, healthcare practices or the occurrence of serious incidents. This ensures the checklist stays relevant and supports continuous improvement.
What are some common mistakes healthcare providers make in implementing clinical governance?
Common mistakes include a lack of leadership commitment, ineffective communication, failure to create a patient safety culture and insufficient training. Additionally, not updating or reviewing governance policies, not involving patients in their care and disregarding feedback can also hinder effective clinical governance.
How can small healthcare providers implement effective clinical governance?
Small healthcare providers can start by developing a clear clinical governance framework that aligns with their specific needs. This includes establishing policies, roles and responsibilities. It should enable them to create a culture of safety and quality through regular training based on audits and patient feedback.
What are the consequences of not adhering to a strong clinical governance framework?
Not adhering to a strong clinical governance framework can lead to poor patient outcomes, increased healthcare costs, legal implications and a damaged reputation for the organisation.
How can technology be utilised in implementing a clinical governance checklist?
Technology can streamline the implementation of a clinical governance checklist through digital record-keeping, real-time reporting and data analysis. Electronic health records (EHR) improve patient care and online training platforms can support continuous learning. Board meeting portals for organisations in healthcare streamline the work of the board, making the governance process more efficient.
This clinical governance checklist will hopefully help you understand the tasks involved in meeting the NHS governance guidelines. Important points to highlight include the development of a culture from the top that values safety and quality performance, as well as utilising solutions to increase efficiency and make the most of resources, as demanded by NHS England.
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