Clinical governance in aged care

What is clinical governance?

In aged care we are constantly referring to clinical governance, but what do we actually mean by that? 

The Aged Care Quality and Safety Commission (ACQSC) defines clinical governance as an integrated set of leadership behaviours, policies, procedures, responsibilities, relationships, planning, monitoring, reporting and improvement mechanisms to support consistent, safe, high-quality clinical care and good clinical outcomes for each aged care consumer. 

Clinical governance is of equal importance to the financial, risk and other business components such as human resources, legal etc. 

The purpose of clinical governance

At the heart of clinical governance lies a purpose to support the workforce to provide safe, quality clinical care as part of a holistic approach that is based on the needs, goals and preferences of the consumer.

Clinical governance is integrated into corporate governance when a culture of openness, partnership, learning and continuous improvement is fostered. 

The role of the governing body

The governing body and executives are responsible for building a culture that supports and promotes consistent, safe, and high-quality consumer-centred care for every consumer. 

They are also accountable for:

• Clinical quality and safety performance
• Setting strategic direction
• Understanding risks
• Monitoring Performance
• Leading action to promote and improve clinical quality and safety

From December 1 2023, obligations and reforms will be introduced whereby unless exempt,  the governing body must have a majority of independent non-executive members and at least one member with experience in the provision of clinical care.

What is a Clinical Governance Framework?

A clinical governance framework describes the overall organisational approach to ensuring clinical quality and safety for consumers.

Details about specific strategies and actions that will be taken to achieve this should be included in organisational policies, procedures, strategic, operational, and continuous improvement plans and risk registers. 

A Clinical Governance Framework should include: 

• A statement from leaders about organisational culture and commitment 
• An overview of how the organisation applies clinical governance
• Organisational structure with defined roles and responsibilities
• High level strategies and actions for implementing clinical governance
• Measures of success against the effectiveness of clinical governance 
• Processes for reviewing the clinical governance framework 
• References to plans, policies and procedures, as well as any other documents that support the Clinical Governance Framework and the achievement of safe, high-quality clinical care

The core elements of clinical governance

Leadership and culture

Transparent strategic, operational and improvement plans that encompass common goals to innovate, collaborate and transform the sector with consumers at the heart. 

Consumer partnerships

Co-design approach with consumers.

Understanding of Dignity of Risk and balance this with the duty of care providers have. Clinical needs, goals and preferences of consumers are recorded in consumers' care plans which guide the delivery of clinical care and are regularly reviewed and updated with consumers and representatives. 

Organisational systems

Key clinical areas of risk such as antimicrobial stewardship, the use of restrictive practices, open disclosure, end if life care and deterioration in mental, cognitive and physical health are known and addressed in policies and procedures that also align to the Aged Care Quality Standards. 

The workforce is aware of these key policies and procedures and operate within them. 

Monitoring and reporting

Clinical quality and safety measures are monitored to ensure that effective clinical governance has been established and maintained by analysing and actioning clinical risks through incident reporting, National Quality Indicators Program (NQIP) reports, benchmarking service reports as well as feedback/surveys measuring overall wellbeing and the experience of consumers regarding clinical care. 

Effective workforce

Workforce strategy includes detailed roles, responsibilities and accountabilities and ensuring the workforce have appropriate qualifications and experience to provide clinical care.

Orientation and training programs outline clear goals and expectations for the quality and safety of clinical care to be delivered. 

Identifying if staff are confident in performing their clinical care role by undertaking regular training needs analysis, surveys and performance appraisals.

Communication and relationships

Sound structured templates to share information when consumers are transferred to or from external healthcare providers.

The workforce is supported and encouraged to raise concerns about quality and safety. 

When things go wrong, open disclosure processes are utilised to communicate with consumers and their representatives. Continuous learning and improvement is incorporated to improve systems, processes and practices.  

Reviewing your Clinical Governance Framework 

Clinical Governance Frameworks should be reviewed at least every two years.

Reviews should be undertaken more frequently if a service or consumer profile changes over time, risks change or emerge, there are changes in the leadership of a service or other significant staffing arrangements. 

The review should record how the framework has been promoted, staff awareness of it, do staff operate within it and have there been any changes. 

Clinical governance in home care 

There are a number of unique obligations and accountabilities of being an approved provider of home care in relation to access, funding and reporting.

While the governing body and executives of home care providers will adopt similar governance processes and practices to residential aged care organisations, a range of differences bring unique risks for home care providers, as well as for their workforce and consumers within the home care environment. 

For example, there is less control of the service delivery environment, less oversight of the service delivery and less interaction with the consumers.

Governing body members and executives need to ensure that safe quality care is being delivered and they are meeting their obligations and accountabilities by ensuring that the organisation's systems, policies, and processes support the service delivery context and there is a separate risk profile for their home care services.