Chief Medical director Dr Alex Smallwood discusses how clinical governance provides multiple opportunities to improve client outcomes in rehabilitation.  He explores why it holds the key to excellence, trust and best value for every stakeholder.

It is true that many organisations struggle with the culture that excellent clinical governance requires.  However, through careful and pragmatic evaluation of existing practices, whilst being mindful of the ever-developing healthcare environment, a nimble and responsive organisation can stay ahead of best practice, and learn proactively, rather than responsively. This culture of success in clinical governance can be a driver to vertical integration within a healthcare organisation. It transcends any perceived hierarchy as the success or otherwise of an organisation depends on the transparent inclusive input of its staff at all points within the care pathway, to the best possible outcome for the client.

As such it is helpful to break clinical governance into a series of manageable areas.  The brief discussion below only scratches the surface of the possibilities.

Ultimately, a person (rather than problem) centred approach, through the patient journey enables care to be delivered within the context of the individual, rather than a ‘one-size fits all’ program. Some models of care allow for purely algorithm delivered care, but providing a care package that is problem-focussed in the context of the person results in much better outcomes. As such, a true skill (of which the measure of benefit is more than the ‘measurable’) is to be able to contextualise the patient’s needs, whilst taking into account other factors that may affect their rehabilitation. Getting it right from the ‘patient’s perspective’ goes a long way, and reduces the chances of multiple negative endpoints.

Providing rehabilitation imparts with it an obligation to achieve as much as possible for the patient, whilst providing the best value for the purchaser – be it insurer, solicitor, statutory body and so on. As such the ‘customer focus’ is essential in ensuring that HCML provides ‘more’ for every £1 spent, compared to spending it elsewhere. As a consumer, we expect everything to be right, first time, in a timely fashion, and with SMART goals, this is no different. By keeping a careful focus on each patient journey, and the outcomes, we are able to evidence the expectations we impart to our customers, and, that we have met (and exceeded) those expectations on a recurring basis. Aspiring towards complaint free, seamless, responsive, individualised and non-dependent service is far from a laudable goal, as with good governance, each step of every path can be revisited and tweaked on countless occasions, without squeezing the flexibility of the patient journey. Purchaser satisfaction is, by and large earned by the perception of patients’ needs being exceeded, and the reputation that this instils in both HCML and their customers.

A natural by-product (but not in isolation) of the above is to be safe, and effective – clear pathways help staff to identify escalation points, and patients that need urgent care, whilst facilitating contemporaneous care without delay. It is often difficult to separate what is necessary from what is desired, and the skill of well-trained teams is a natural and responsive ability to identify need, whilst at the same time de-escalating pre-conceived ideas (often gleaned from the internet, which in some cases may be more harmful) in a constructive way that takes the client with them to the point of recovery. Having impeccable frameworks, to make sure that suppliers are following best practice is essential, and using the feedback garnered from patients to help inform our services, and aid personal development of our staff.

Well trained and confident staff provide better care, and as such, continually well informed and updated professionals inspire confidence in both customers and clients alike. Providing opportunities for ongoing learning, that isn’t just responsive to learning needs is vital, as is protected time to complete learning. Peer review and benchmarking also helps staff to learn and grow, and those with broader skills provide better organisational robustness, and ultimately continuity. Staff that are provided the opportunity to self-determine learning needs through professionally led CPD – such as through a professional association – are more likely to enjoy their work, and develop a curiosity-led special interest. Where possible, supporting individual staff with niche skills to use them strengthens an organisation and improves customer satisfaction.

Not a day goes by at the moment without hearing about clinical information governance – in particular the DPA, subject access requests, the right to deletion and latterly, GDPR. The digital revolution has made the duty of the information guardians to be vital in ensuring that we can be trusted to look after the client, and their information. Breaches of information, be it giving more information that one should do (proportionality), loss of information, inappropriate disclosures, disclosure of harmful information and so on, are regarded as a very serious problem by the professional healthcare associations as well as the ICO, and patients. Robust procedures and policies surrounding the holding, using, processing and disposing of personal information need to overarch an organisation. Good information governance enables an organisation to provide information to care providers accurately and swiftly, whilst maintaining absolute clarity around the responsibilities held, and explicit consent to share. It also enables service improvements, and helps to identify trends early, to promote excellence, and educate.

Meeting and exceeding national and professional standards, is a visible way for an organisation to champion the services it provides.  Most guidelines and ‘best practice’ documents describe the ideal solution, but often in the statutory sector. Where opportunities exist to exceed, these should be taken, as improved outcomes and quicker recovery are recognised benefits. By developing, and adhering to internal standards within HCML, we are subscribing to not just a standard, but to an aspiration, which is pinned to the values the HCML holds, and the value that it adds for clients and customers. Newer standards, such as ISO 9001, as held by HCML, clearly champion the quality management principles within the organisation.

Finally, it wouldn’t be possible to ensure the clinical governance of an organisation without ongoing audit – the cycle of continual improvement, identifying any and all possible improvements on a regular basis, making the necessary changes, and checking that they have had the expected outcomes – which is vital at proving that our quality claims are robust. Allowing staff, through a supportive culture to raise concerns whilst respecting their confidentiality, facilitates operational and service improvement, and allows for better scrutiny of delivery at every point in the care cycle. Audit represents an opportunity to identify and compare with best practice, and in due course, set the standard for it.

Clinical governance is a multi-faceted opportunity to prove excellence, identify opportunities for improvement, and build trust. Providing a robust and supportive culture for it to flourish is an invaluable and achievable goal.

Alex Smallwood, Medical Director, Feb 2018