Clinical Governance
Discuss about the Importance of Leadership and clinical governance in Healthcare.
Leadership and clinical governance are important attributes in any healthcare organisation, as it helps in the maintenance of high quality and safe care accessible to the people (rcn.org.uk, 2018). Also, consumer participation in the process of healthcare transformation can also incorporate accountability and development of patient-centered care (Mendes & Roseman, 2013). Through clinical governance, an environment of quality and safety can be maintained as well as foster the development of a learning culture (Phillips et al., 2017). Skills necessary for such policies can be extensively developed through health education and leadership. Analysis of my leadership skills was done using the ‘Leadership Skills Inventory’ from Leadership Theory and Practice (6th Ed) (Northhouse, 2013). The essay discusses the various factors that contribute to strong leadership and clinical governance skills, and how such skills can be developed to create an environment of excellence and competence.
Clinical governance can be understood as an ‘umbrella term’ that includes activities that allows the development and maintenance of high quality care for the patients. Through clinical governance, the healthcare organizations are able to continuously improve and maintain high quality care by fostering the development of an environment of excellence and competence (rcn.org.uk, 2018). Clinical governance revolves around 5 key themes: focus on patient, focus on information, improvement in quality, focus on staff and leadership (rcn.org.uk, 2018).
Involvement of the consumer is an important strategy to foster improvement in the quality of healthcare, as well as for improving the effectiveness of service, maintaining accountability of the organization and empower customers who might be disadvantaged (Countyhealthrankings.org, 2018; Mendes & Roseman, 2013). Consumer participation can occur at different levels like Consumer, Program Level, and Organizational level. Different strategies that can be used to involve customer participation includes the usage of narratives, surveys, focus groups, rapid improvement events, outreach activities, co-design, evaluation processes, staff training, staff recruitment, formal committees, and reporting (healthissuescentre.org.au, 2018). Two strategies that can be selected from these are the usage of customer/ consumer/ patient surveys and training of the staff to support the development of a close cooperation between patient and healthcare team, and reinforce their capacity of self care as well as helping the nurses to understand the patients better (Sahlsten et al., 2018).
Coultier (2016) suggested that patient feedback can be useful in the improvement of healthcare quality. Feedback from patients can be collected through surveys which allow patients to share their views through interviews, feedbacks or reports. Boiko et al. (2015) also supported such a view as their studies showed that feedback from patient experience surveys creates a therapeutic approach towards getting the concerns of the patients being heard by the staff, identify areas of improvement and can be used as an evidence for professional development and appraisal.
Consumer Governance Strategies
Nurses play an important role in the improvement of patient participation by acknowledging as well as facilitating patient participation in nursing activities. However, the need to incorporate safety for each participant and proper assessment of risks can complicate the role of the nurse in the process. Training of the nurses and healthcare staff can improve their skills and competencies to maintain and improve patient participation (Tobiano et al., 2015). As a registered nurse, the future practice may include taking patient feedback and indulging in training activities to further improve consumer participation.
One standard from NSQHSS:
The National Safety and Quality Health Services Standards include several standards that are incorporated in the second edition of NSHQS standards. One of the important standards among the seven standards is “Governance for safety and quality in health service organisation” (Safetyandquality.gov.au, 2018).
The importance of clinical governance in the maintenance of safety and quality of healthcare will be discussed next.
There are certain risks related clinical governance standard for the maintenance of the health and safety quality in the health service organisations which included breaching of the clinical standards, malpractices, appalling standards of care regarding infection, control, medication errors (Safetyandquality.gov.au, 2018).
-Strategy to maintain safety and quality
Phillips et al has proposed the conceptual model for clinical governance., (2017). This model is shown in the diagram below:
Figure 1: Conceptual model of clinical governance; source: (Phillips et al., 2017).
Two evidence-based strategies are selected to improve quality and safety of care from the model.
One can be education and training of the staff. The other is clinical audits for risk assessments to ensure compliance with quality and safety protocols and identify any safety or quality incidents. Education and training ensure the development of right qualifications, skills, competencies and expertise (Phillips et al., 2017). It promotes the provision of high quality and safe healthcare to patients. Cronenwett et al., (2017) also proposed that strategy of safety education as it can help to prepare the nurses with the necessary skills and competencies for the development and maintenance of safe and high quality care for the patients. Education and training can also help to develop competencies needed for patient-centred care, improve collaboration and teamwork, utilisation of evidence-based practice apart from the improvement in the quality and safety of the practice. This improvement can occur through the strengthening of knowledge, skills and attitudes of the nurses.
The second strategy clinical audit ensures measurement and monitoring. It can help improve the safety of healthcare (Vincent et al., 2014). Clinical audit and risk assessment can help to analyse, monitor risks/hazards, and even learn from safety and quality information of past events and help to promote self-reflection at the board and clinical levels. Clinical audit and monitoring will help identify the system in management that are defective. It can be followed by the integration of safety and quality systems within management (Vincent et al., 2014). An audit will help promote an environment of safety and quality care while adopting best practices (Safetyandquality.gov.au, 2018).
Strategies to Increase Consumer Participation
Two evidence-based leadership skills for RN
Healthcare industry is characterised by a dynamic system in constant flux, involving legislative and economic changes. Healthcare leaders working in the managerial and administrative levels/positions need a diverse array of skills (operational, relational and analytical) (McFadden et al. 2015). The competencies and skills of the healthcare leaders can directly affect both the quality and availability of safe healthcare (utica.edu, 2018; McFadden et al., 2015). Executive leadership can affect the quality and safety environment of an organisation, and Transformational Leadership (TFL) have been pointed out to be the most effective leadership style as per McFadden et al. (2015). Two evidence-based leadership skills have been identified that are relevant to a registered nurse.
The skills identified as components of transformational leadership that are relevant for the registered nurse are values, optimism, enthusiasm, importance, morals, compelling vision, collective mission and confidence. Developing the transformation leadership skills can be effective in the personal development of registered nurse as a leader in healthcare (McFadden et al., 2015). According to Savage et al. (2014), another set of leadership skills healthcare leaders should possess as per literature evidence inter-professional teamwork skills for collaborative governance that can be beneficial for the organisation. These skills have also been demonstrated by the transformational leadership.
Key skills that can foster personal leadership abilities in healthcare organization can include: being able to act as agents of change (requiring a proactive approach, anticipating challenges beforehand and being aware of the latest trends in the industry), having focus on the bottom-line (that is the providence of safe and quality healthcare that is both affordable and accessible) and conflict managing skills (healthcaremba.gwu.edu, 2018).
Strategies to achieve the skills-
- The skills for being agents of change can be developed through leadership training and health education programs. Studies by Sheriff et al. (2017) showed that student-led trainingof the nurses on leadership can be useful to fill in any gaps in the teaching needs of the nursing students and be a vital strategy towards equipping the healthcare professionals to become future leaders of healthcare. In addition, participation in continuous professional development activities is another strategy to develop leadership and communication for change development skills ().
- to learn conflict management skills,simulation, as well as classroom-based team training, is necessary. It improves communication, collaboration, coordination, competition, and cooperation (Careau et al. 2014). Up taking such classroom-based training will foster personal development as a registered nurse and handle conflicting situations.
- Importance of leadership educationprograms for registered nurse development of transformational leadership has been implicated by Careau et al. (2014). Such education can help develop registered nurses’ competencies to focus on bottom line. Leadership education ensures delivering best clinical practices for safety and quality of care.
Characteristics of Learning Culture:
Learning culture can be understood as a set of values, practices and processes that fosters all the employees of an organisation to develop their competence, knowledge and performance in the organisation (Oracle.com, 2018). Hahn et al. (2015) suggested that learning culture can help to improve employee creativity by leading the employees to acquire knowledge and develop innovative ideas. The learning culture is a product of a culture with organisational learning. Hahn et al. (2015) proposed that organisational learning culture can positively influence exploitation, exploration and creativity. Because of such aspects, a learning culture usually have the following characteristics: a culture based on values, a culture that has support from top management, seeking feedback and information from all levels in the organization, effective communication, availability of resources, empowerment of the employees, orientation towards performance, knowledge and the willingness to learn from mistakes or failures (Jeong et al., 2017; Hjahn et al., 2015; Newton et al., 2015).
Safety and Quality
Two of the evidence-based strategies
Two of the evidence-based strategies to contribute to learning culture as a registered nurse-
- Education and training -Utilising training and development programs that has been formalised. A formal developmental plan is more likely to be taken seriously and therefore implemented (Manuti et al., 2015).
- Feedbacksessions and pools can be conducted to evaluate the efficacy of the training program and identify scope for further development (Watling et al., 2014).
The importance of education and training in the development of learning culture has been emphasised by several authors. Maldi et al. (2016) proposed that through education clinical reasoning skills of healthcare professionals can be improved. Sheriff et al. (2017) also emphasised the importance of student-led training programs in the development of skills and competencies of the professionals, which can foster the development of a culture of excellence and continuous learning.
Taking feedbacks as a registered nurse will help in acquiring and sharing knowledge in the organisation (Manuti et al., 2015). Learning occurs when nurses demonstrate good practice, share their knowledge through communication and discussion and also provide feedback to the learners. Such type of interactions can only occur when positive leadership practice fosters trust and rapport between the staffs or the administrative team provides sessions to the learners or the staffs regarding the handling of the patient. After taking feedback, a formal structure can be developed to overcome drawbacks in system. Thus, it is processed for acquiring and sharing knowledge in the organisation (Manuti et al., 2015).
Professional Practice for Registered Nurses
Professional practices define the behaviour and practice of midwives and nurses are: code of conduct, standards for practice and code of ethics. The professional practice can incorporate seven standards as outlined by the Nursing and Midwifery Board of Australia: critical thinking, engagement in professional and therapeutic relationships, maintenance of the capacity for professional practice, conducting comprehensive assessment, developing nursing plans, providing proper (safe, responsive and appropriate) practice and evaluation of the outcomes that can help to inform the nursing practice (Nursingmidwiferyboard.gov.au, 2018). The diagram below shows the interrelation between the seven standards:
Figure 2: Registered Nursing Standards; source (Nursingmidwiferyboard.gov.au, 2018).
Impact upon the registered nurse
In the professional field, the nursing standards shape the professional practice by promoting nurses to fulfil the responsibility of conducting practice with accountability and responsibility which is informed by evidence and exhibited through competence. These standards ensure continuous development of registered nurses competencies. It positively impacts the ability to use clinical enquiry and nursing processes to plan for care, demonstrate the usage of evidence for informing and developing practice and competency, identify any limitations in knowledge and skills and work within the limitations, taking personal responsibility for professional conduct, reposting unsafe practices/incompetency/professional misconduct, demonstrate the ability to act as a mentor, and demonstrate an ability to safeguard the work environment (Crnm.mb.ca, 2018).
Leadership and Management
The negative impact on registered nurse is the role ambiguity and role conflict due to lack of knowledge of the professional practice and responsibilities. It has joint effect on the performance. Having unclear roles about registered nurses practice, leads to conflicting set of expectations, incompatibilities or disagreements based on difference, consequently disturbing the working relationships. It decreases the work productivity (Fong, 2016).
Use of Dorothea Orem’s self care theory- thatprovidesan efficient model for the development of patient’s ability for caring for own health, and revolves around the theories of self care, self care deficit and nursing system. Here self-care is explained as the activities individuals initiate and perform for their own selves to maintain the health and well being of themselves. The important self-care needs are termed as universal self-care requisites which include the maintaining sufficient intake of air, water food; care for elimination and excretory processes, balancing activity and rest, balancing solitude and social interaction and avoidance of hazards. A registered nurse is able to fill this deficit by guiding and supporting patients, promoting an environment that facilitates personal development and teaching or educating them about illness and adherence interventions. The Orem’s model comprises of three steps: Assessment, Nursing diagnosis and Plans and Evaluation & Implementation. As a registered nurse implementing this theory, will minimise care deficits in patient holistically. Self-care also helps patients to rejuvenate himself/herself and helps to get back to the normal pace of the healthy life (Wong et al., 2015).
Evidence-based care plan- research-based decisions for getting control of the life. The profession of nursing can be extremely stressful due to repeated hospitalisations, increase in workload which can cause stress and burnout in the nurses. Miscommunications can cause medical errors. Evidenced-based practice helps to reduce the medical errors and misdiagnosis. Physical and the emotional burden created while caring for chronic patients will decrease. Use of evidence-based treatment plan has been successful in treating illness while reducing repeated hospitalisations and length of stay (Eaton et al., 2015).
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