sonya preston - clinical governance within a community child & youth health nursing context
DESCRIPTION
A presentation given by Sonya Preston at The Journey, CHA Conference 2012, in the 'Delivering Safety & Quality: Innovations in Clinical Governance' stream.TRANSCRIPT
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Clinical Governance within a Community Child
and Youth Health Nursing Context
Presentation by Sonya Preston
on Wednesday 24 October 2012
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Sets out the fundamentals of a framework
Provides guidance on establishing the systems, processes and behaviours
Reference: Queensland Health. 2012. Clinical Safety and Quality Governance Framework in Hospital and Health Services. State of Queensland (Queensland Health).
Clinical Safety and Quality Governance Framework
in Hospital and Health Services
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Four High Level Elements Planning for Safety and Quality
Action for Safety and Quality
Balanced Monitoring for Safety and Quality
Appraisal, Learning and Action for Safety and Quality
Reference: Queensland Health. 2012. Clinical Safety and Quality Governance Framework in Hospital and Health Services. State of Queensland (Queensland Health).
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Planning for
Safety and Quality
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Planning for Safety & QualityClinical Governance Plan developed, implemented & monitored
Operational plan reflects safety & quality objectives
90 Day action plans include quality initiatives and risk mitigation strategies
KPI’s measure quality & safety processes and outcomes
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Planning for Safety & Quality
PAD processes monitor implementation of safety and quality objectives.
Service agreements are inclusive of safety & quality processes
Clinicians engaged in determining the safety & quality priorities for the service through monthly processes that identify local risk priorities.
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Planning for Safety & QualityAll services are supported by IHW to ensure culturally safe services & facilitate consumer engagement leading to future planning processes.
Clinical governance implementation progress is tabled quarterly utilising traffic light system.
Investment in safety culture through implementation of quality & safety training initiatives such as Caps, (Communication and Patient Safety) PRIME CI & CF (Patient Risk Information Management and Evaluation Clinical Incident & Consumer Feedback), TMS (Team Management Systems)
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Planning for Safety & Quality
Identified the key service challenges within strategic plan by monitoring trends through safety & quality reporting systems.
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Action for
Safety and Quality
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Action for Safety & Quality
Each role description includes duties, responsibilities & accountabilities that reflect a safety culture.
Organisational structure supports delegation of accountabilities associated with quality & safety.
Safety & Quality Committee established with a comprehensive committee structure.
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Action for Safety & QualityImplementation of a clinical incident management process.
Application of the clinical service capability framework
Consumer feedback & complaints management process
Implementation of clinical audit & review process
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Action for Safety & Quality
Registration, Credentialing & Scope of Practice processes for regulation compliance.
Mortality & morbidity review
Critical incident review committee
Clearly defined delegations regarding safety & quality decision making within service
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Action for Safety & QualityService agreement clearly identified responsibilities for safety & quality.
Safety & Quality Committee effectiveness is reviewed annually
Key performance indicators are reported monthly utilising traffic light process
Key performance indicators are identified through service re-design processes.
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Action for Safety & Quality
Identified integrated risk management procedure
All project plans, business cases and issues papers include a risk management plan.
All staff have access to training on risk management
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Balanced Monitoring for
Safety & Quality
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Balanced Monitoring for Safety & Quality
Actively monitor key performance indicators and compare against other like service benchmarks.
Measurement of clinical quality is achieved through the implementation of clinical performance assessment tool
Formalised case conferencing and peer group supervision is undertaken within each service
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Balanced Monitoring for Safety & Quality
Ensure compliance with accreditation bodies and National Standards.
Internal clinical auditing including scheduled and spot audits.
Clinical practice reviews undertaken and service intervention based on scientific knowledge.
Waiting timeframes monitored and minimisation strategies implemented.
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Balanced Monitoring for Safety & Quality
LEAN thinking strategies implemented at all service levels
Both lead and lag indicators are identified to determine risk management processes
Review of data collection and auditing processes to ensure usefulness of data.
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Balanced Monitoring for Safety & Quality
Targeted clinical audits that are meaningful to the clinical service provision
Ensure appropriate sampling and data measurements.
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Appraisal, Learning and Action
for Safety & Quality
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Appraisal, Learning and Action for Safety & Quality
Monitor compliance against the Hospital & Health Service readiness report in 12 months.
Thoroughly investigate potential areas of concern such as issues identified in practice reviews, complaints and risks.
Implementation of education and training
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Appraisal, Learning and Action for Safety & Quality
Cultural practice training by Aboriginal & Torres Strait Islander consumer
Escalation for reporting outcomes and risks
Implemented plan do check act cycle to ensure actions & priorities are incorporated into planning cycle
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QUESTIONS