Clinical Governance Safety And Quality

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Clinical Governance Safety And Quality

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Clinical Governance Safety And Quality

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Discuss about the Clinical Governance Safety And Quality.

There have been public health inquiries both nationally and internationally into the failure of the health system. It ensures delivery of safe and evidence based care. The paper deals with the investigation into the Bundaberg Base Hospital/Queensland Health. In response to the investigation, the paper discusses about clinical governance, safety, and quality.
Clinical Governance
The term clinical governance by the “Australian Council on Healthcare Standards” is defined as the health system where responsibility and accountability is shared among the governing body, clinicians, staff and mangers to minimize the risk and ensure patient safety (Jones & Killion, 2017).  The components of the clinical governance framework as per the Victorian Clinical Governance Policy framework are identified and two of them are discussed in this section
In the Bundaberg Base Hospital, the clinical governance structure was very complex. The paper specifically discusses how the following components led to system failure. 
Organisation & committee structure, systems and processes- there was a fault in the internal clinical governance system.  There was no incidence of poor clinical outcomes detected in the organization or any incidence of compromised patient care. It was the most perturbing aspect of the Dr Patel’s case. There was no consistent link found between incident reporting and the process of compliant management (Terry & Lê, 2015). There was poor management of range of clinical risks.  The external quality control team (Australian Incident Monitoring System) did not expose the hospital to the events. The incidents were also not exposed by the hospital accreditation processes. Due to the faulty structure and process of the Australian medical system, the Bundaberg Base organisation was not competent even to carry out the basic monitoring, reporting and management of medical errors (www.phcris.org.au, 2017).
Another faulty aspect of the organisation’s structure and processes was lenient OTD (overseas-trained doctors) regulatory factors.  Dr Patel joined Bundaberg Base as it was located in an AON. The same was defined under Medical Practitioners Registration Act 2001. The AON classification process was full of shortcoming (Beaupert et al., 2014). The blind acceptance of the applications by Queensland Health for AON positions from public hospitals was a big blunder. Further, there was lack of assessment of the registrants like Dr. Patel. The clinical competence of such doctors was not scrutinised. As a visiting officer, the ability to provide the surgical services at Bundaberg Base was not established. There was no rationale for promoting Dr Patel’s from Staff Medical Officer to the position of Director of Surgery. He did not even apply for this position (Edwards et al., 2016). 
Reports review and performance – Dr. Patel’s was trained in US. His practice disadvantage came from his training and education that took place in different setting. He has practiced in cultural setting that was different in level of technology, disease patterns, form of heath care delivery and treatment options, workplace hierarchies and etiquette differ markedly from those in Australia. Based on initial medical qualification of Dr. Patel in India, he was appointed as OTD in Australia. There was no additional training given for performance improvement or reviewed his activities (Terry & Lê, 2015). Although Ms Hoffman raised concerns about his practice and competence with management, staff and administration, the coroner and police but in vain. There was no further review on these complaints on his performance. Therefore, the health system failure in the Bundaberg Base Hospital is due to failure of quality assurance mechanism both at internal and external level. However, when the allegations against the doctor become public, the inquiry was lunched. 
Safety and Quality
In the Bundaberg Base Hospital, the clinical governance structure was very complex. There was no delegation of single committee to tackle the safety and quality issues. There was lack of follow up on events been occurring. In case any concerns, events, or incidents were raised there was no flow of information. The staff provided no feedback and there was no ongoing evaluation for improvement. The incident reporting system was in place but in vain. There were number of concerns raised in response to the resources available in safety and the quality unit. There was also frequent incidents where the staff complained about lack of training facilities and support followed the inquiry of Dr. Patel’s case (Chandler, 2017). Further, there was lack of aggregated data report on surveillance that will help the executive to monitor the safety and quality. There was little evidence found in regards to the departmental clinical audits, and mortality audits. The clinical audits in the general surgery were variable. However, by Monitoring and responding to complaints, this issue would have been resolved.
Monitoring and responding to complaints
If the above-mentioned risk management strategy had been in place, an immediate action would have been taken against Dr Patel. Initially MS Hoffmen, blew the whistle regarding this doctor.  The complaints regarding the incompetence and practice of Dr. Patel were neglected. She even highlighted that together with staff she hid patients from Dr. Patel (Watson, 2016). The administration was however, inactive and apparently unwilling to investigate the issue. If it was earlier monitored that a number of patients suffered serious complications after being treated by Dr. Patel, he death cases would have been prevented. Responding to this whistles early would have led to early detection of Dr. Patel’s past black records. In addition, an investigation should have been started before the public disquiet about the quality and safety of Queensland public hospital services (Wilkinson et al., 2015). 
The risk management strategy could have  prevented such disastrous consequences if following actions was taken after complaints against Dr. Patel-

If there was monitoring to identify if Director of Surgery position was an AON position. Verifying the qualification was necessary before appointing OTD
Monitoring the licensure certificate of OTDs- to identify any incidents that reflect the doctors incompetence. It will help identify any restrictions being imposed on the license
The application documentation should be more stringent to sought information on practice history
Queensland authorities should be strict in detecting any absence of attachment with the applications.

Under this strategy there is  need of monitoring the

mortality rate if it appeared higher than predicted
Comparison of aggregated data from the peer group hospitals
Continues outcome with an EWMA chart- an effective risk adjustment mode for the analysis. It helps monitor the patient’s outcomes in intensive care unit. This chart helps identify change in observed compared with predicted mortality over time. It is possible using data submitted to the “Australian and New Zealand Intensive Care Society Adult Patient Database” (Pilcher et al., 2010). 
Incident reporting system in place and instant actions on complaints

Beaupert, F., Carney, T., Chiarella, M., Satchell, C., Walton, M., Bennett, B., & Kelly, P. (2014). Regulating healthcare complaints: a literature review. International journal of health care quality assurance, 27(6), 505-518.
Chandler, J. (2017). Bundaberg Hospital Recommendations Are A Priority. Statements.qld.gov.au. Retrieved 17 August 2017, from https://statements.qld.gov.au/Statement/Id/41552.
Edwards, M. S., Lawrence, S. A., & Ashkanasy, N. M. (2016). How Perceptions and Emotions Shaped Employee Silence in the Case of “Dr. Death” at Bundaberg Hospital. In Emotions and Organizational Governance(pp. 341-379). Emerald Group Publishing Limited.
Jones, A., & Killion, S. (2017). title Clinical governance for Primary Health Networks.
Pilcher, D. V., Hoffman, T., Thomas, C., Ernest, D., & Hart, G. (2010). Risk-adjusted continuous outcome monitoring with an EWMA chart: could it have detected excess mortality among intensive care patients at Bundaberg Base Hospital?. Critical Care and Resuscitation, 12(1), 36.
Terry, D. R., & Lê, Q. (2015). Challenges of working and living in a new cultural environment: A snapshot of international medical graduates in rural Tasmania. Australian Journal of Rural Health.
Terry, D. R., & Lê, Q. (2015). The Anglo-Celtic construction of national identity in Australia and the acculturation of the ‘other’doctors. International Journal of Innovative Interdisciplinary Research, 2(4), 62-76.
Watson, J. (2016). Incident management in Bundaberg during the 2013 Queensland floods. Incident Management in Australasia: Lessons Learnt from Emergency Responses, 17.
Wilkinson, A., Townsend, K., Graham, T., & Muurlink, O. (2015). Fatal consequences: an analysis of the failed employee voice system at the Bundaberg Hospital. Asia Pacific Journal of Human Resources, 53(3), 265-280.
www.phcris.org.au. (2017). Health Systems’ Failures & Redemptions: Cases of the Roles of Clinical Governance and their policy implications. https://www.phcris.org.au. Retrieved 17 August 2017, from https://www.phcris.org.au/phplib/filedownload.php?file=/conference/2005/presentations/tuesday/sharp.pdf

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