Governance In Healthcare
Gap analysis between governance in Egypt and in UK
Reham Mokhtar Rashwan
MBChB, MScs ,CPHQ, LGBSS

What is clinical governance?
• “A framework through which NHS organisations are accountable for continually improving the QUALITY of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.”

Corporate Governance Vs Clinical Governance:
• It addresses those structures, systems and processes that assure the quality, accountability and proper management of an organisation's operation and delivery of service • It applies only to health and social care organisations, and only those aspects of such organisations that relate to the delivery of care to patients and their carers;

Corporate Gov.

• Term emerged to refer jointly to the corporate governance and clinical governance duties of healthcare organisations.

Clinical Gov.

Intergrated
Gov.

How it started?
• Clinical governance became important in health care after the Bristol heart scandal in 1995, found the high mortality rate for pediatric cardiac surgery at the Bristol Royal Infirmary

More and More suffering for lack of Governance!!!

“Medical error is the third most UK: blunders Britain frequent cause of death in by after cancer 40,000 doctors killand heart a disease…….kills four times more yearall other types people than die from of accidents.”
Sunday Times, 19 Dec 1999

WAY OUT !!!

SO;

Clinical Governance is “About quality and how it can be achieved and guaranteed through our service to our patients “

(Royal College of Nursing, 2003:9).

Effective Risk Management components:

Clinical Audit :
• Clinical audit is a way that healthcare professionals can measure the quality of the care they offer. • It allows them to compare their performance against a standard. • As well as individual audits carried out by individual members of staff, University Hospitals (NCEPOD) and the Healthcare Commission's National Audit Program

Stages of Clinical Audit:

Education and Training:
• It is vital that staff caring for patients have the knowledge. • It is for that reason that they are given opportunities to update their skills . • The Medical Education, Nurse Education, Clinical Skills, Medical Devices Trainer and Practice Development teams all work together to ensure that the staff have all the skills.

Clinical Effectiveness/Evidence-based care : • Care for patients should be based on good quality evidence from research. • The National Institute for Health and Clinical Excellence (NICE) is responsible for providing national guidance . • The Clinical Effectiveness Manager monitors the Trust's compliance with NICE guidance.

Risk management:
• Risk management is about minimizing risks to patients by: • identifying what can and does go wrong during care Patient • understanding the factorsPractioner that influence this • learning lessons from any adverse events • ensuring action is taken to prevent recurrence • putting systems in place to reduce risk

Organization

Research and Development:
• Good professional practice has always sought to change in the light of evidence from research. • Techniques critical appraisal of the literature, project management and the development of guidelines, protocols and implementation strategies are all tools for promoting implementation of research evidence

Openness:
• Poor performance and poor practice can too often thrive behind closed doors. • Processes which are open to public . • while respecting individual patient and practitioner confidentiality. • Open proceedings and discussion about clinical governance issues should be a feature of the framework. • Glass ceiling.

Organizational Structure :

Practically : How to Apply clinical governance in the field?!!!
• If clinical governance is to truly function effectively as a systematic approach It also requires a systems and people to be in place to promote and develop it. • The system is so called “ Trent Accreditation Scheme ” base their system upon NHS clinical governance concepts. • Adopted by hospitals in Hong Kong and Malta.

"Hospital Accreditation“ Accreditation has been defined as a “system of external peer review for determining compliance with a set of standards.”

Globalization: New Programs started :
• Accreditation Canada International (formerly "The Canadian Council on Health Services Accreditation", or CCHSA) • Joint Commission International (JCI), in the USA • The Australian Council on Healthcare Standards, or ACHS • QHA Trent Accreditation (UK)

Egypt and Governance:

Is there any Accredited Hospitals in Egypt?

Grants and Trials to apply Governance :

Recommendations:
“crossing the gap”
1. Split ownership from management and define a corporate governance structure for every organization . 2. Split between buyers of services and service providers (irrespective of type of owner) . 3. Split between capital investment to create infrastructure and operational costs to run the facility

Recommendations:
“crossing the gap”
4. Introduce the concept of governance and transparency within the healthcare industry 5. Independence of representative bodies 6. Clear strategy for Corporate Social Responsibility and Sustainability