Has the clinical governance development agenda stalled? Perceptions of New Zealand medical professionals in 2012 and 2017

Clinical Governance in Musculoskeletal Care-An Online Cross-Sectional Survey of What Allied Health Professionals Participate in, and What They Value

RATIONALE

Clinical governance (CG) is a systematic approach to improving care quality, ensuring healthcare organisations and professionals are accountable for safe, effective, and continuously advancing practice. Traditionally, CG frameworks follow the 'seven pillars' model: risk management, education and training, patient and carer experience, information management, clinical effectiveness, clinical audit, and staff management. However, optimal CG may also require additional elements. Despite its importance, research on CG, and clinicians' views, remains limited, particularly in musculoskeletal (MSK) care where calls for reform are growing.

AIM

To explore the views of NHS MSK Allied Health Professionals (AHPs) on CG, establishing what activities are undertaken and valued. An additional objective was to identify any differences between clinical leads and non-leads.

METHODS

This exploratory study used an anonymous online cross-sectional survey built with Qualtrics software. Questions were informed by evidence and MSK think-tank discussions, enhancing content validity. The survey evaluated general opinions as well as perspectives on the seven pillars and 23 additional CG activities, including teamwork, culture, and leadership. It was disseminated via social media (X) and Interactive CSP (iCSP) to maximise the response rate. Predominantly ordinal data were analysed using descriptive statistics, with qualitative comments examined using content analysis.

RESULTS

Data from 52 participants were analysed. 96.15% were physiotherapists, 90.38% worked in the NHS, and 53.85% held clinical leadership roles. Respondents viewed CG positively, with 73.08% strongly agreeing it was essential for care quality. Most participated in and valued both the seven pillars and additional activities. No substantial variance was observed between clinical leads and non-leads.

CONCLUSION

MSK AHPs in this study strongly supported CG and valued a broader range of activities than the seven pillars model asserts. Findings suggest current approaches may not fully reflect the scope of CG as perceived by clinicians, highlighting the need for more inclusive CG frameworks.

Lessons learnt from the implementation of new models of care delivery through alliance governance in the Southern health region of New Zealand: a qualitative study

OBJECTIVES

To explore the process of implementation of the primary and community care strategy (new models of care delivery) through alliance governance in the Southern health region of New Zealand (NZ).

DESIGN

Qualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation science theory-the Consolidated Framework for Implementation Research.

SETTING

Southern health region of NZ (Otago and Southland).

PARTICIPANTS

Eleven key informants (Alliance Leadership Team members and senior health professionals) who were involved in the development and/or implementation of the strategy.

RESULTS

The large number of strategy action plans and interdependencies of activities made implementation of the strategy complex. In the inner setting, communication and relationships between individuals and organisations were identified as an important factor for joint and integrated working. Key elements of a positive implementation climate were not adequately addressed to better align the interests of health providers, and there were multiple competing priorities for the project leaders. A perceived low level of commitment from the leadership of both organisations to joint working and resourcing indicated poor organisational readiness. Gaps in the implementation process included no detailed implementation plan (reflected in poor execution), ambitious targets, the lack of a clear performance measurement framework and an inadequate feedback mechanism.

CONCLUSIONS

This study identified factors for the successful implementation of the PCSS using an alliancing approach in Southern NZ. A key enabler is the presence of a stable and committed senior leadership team working through high trust relationships and open communication across all partner organisations. With alliances, partnerships and networks increasingly held up as models for integration, this evaluation identifies important lessons for policy makers, managers and services providers both in NZ and internationally.

Clinical governance in New Zealand: perceptions from registered health professionals in health care delivery compared with social insurance

ObjectiveEffective clinical governance can improve delivery of health outcomes. This exploratory study compared perceptions of clinical governance development held by registered health professionals employed by two different but interrelated health organisations in the broader New Zealand (NZ) health system. Most staff in public sector healthcare service delivery organisations (i.e. District Health Boards (DHBs)) are registered health professionals, whereas these clinical staff represent a small minority (5%) in social insurance organisations (i.e. the Accident Compensation Corporation (ACC)). Given these different contexts, comparison of results from three surveys of clinical governance perceptions identified key learnings for the development of clinical governance.MethodsThe Clinical Governance Development Index (CGDI) was administered to registered health professional staff in NZ DHBs and ACC, at different time points. The data were explored, compared and reported.ResultsResponses to survey items completed by NZ DHB staff and registered health professionals employed by ACC were compared. For each administration, there was a similar profile of positive responses across the seven CGDI items. The 2020 ACC survey results for one item were clearly different. This item asked about perceptions of full and active involvement in organisational processes and decision making (i.e. clinical engagement).ConclusionsPerceptions of registered health professionals working in the NZ public sector delivering health services were compared with those held by staff employed by a NZ social insurer predominantly commissioning and influencing care. The results indicated similar levels of clinical governance development. Clinical governance development in the ACC context can benefit from clear communication, building strong supporting structures and greater management-clinical provider partnerships. Clinical governance development drives health outcomes and regular measurement of developmental progress can provide momentum. There is room across the NZ health system to raise awareness and leverage clinical governance to deliver improved health outcomes.What is known about the topic?Little is known about the perceptions held by registered health professionals employed by social insurance organisations. There are no published comparative studies exploring differences in perceptions between registered health professionals across two different organisational contexts, both with a goal of improving health outcomes.What does this paper add?Effective clinical governance drives coordinated, quality systems that promote optimal health outcomes. Social insurance organisations predominantly commission healthcare providers to deliver health outcomes. Although registered health professionals employed by social insurance organisations represent a small total number of staff, their perspective on clinical governance, as reported via survey, indicated there is most to be gained in the development of partnerships between management and clinical providers. This exploratory study fills a gap in the existing clinical governance development literature and evidence base.What are the implications for practitioners?Any health organisation can leverage clinical governance to deliver improved health outcomes. Effective clinical governance interventions are targeted to specific organisational context and culture. For ACC, a clear definition, enhanced management-clinical provider partnerships and strong supporting structures or organisational arrangements can be further developed. The survey results indicated that a focus on management-clinical provider partnerships is a clear priority for ACC clinical governance development. Partnerships based in empowered collaboration require greater clinical engagement, as well as increased capability for aligning with organisational priorities. Effective clinical governance development requires attention to context and culture. It can improve delivery of health outcomes.

Mapping clinical governance to practitioner roles and responsibilities

Purpose

While clinical governance is assumed to be part of organisational structures and policies, implementation of clinical governance in practice (the praxis) can be markedly different. This paper draws on insights from hospital clinicians, managers and governors on how they interpret the term “clinical governance”. The influence of best-practice and roles and responsibilities on their interpretations is considered.

Design/methodology/approach

The research is based on 40 in-depth, semi-structured interviews with hospital clinicians, managers and governors from two large academic hospitals in Ireland. The analytical lens for the research is practice theory. Interview transcripts are analysed for practitioners' spoken keywords/terms to explore how practitioners interpret the term “clinical governance”. The practice of clinical governance is mapped to front line, management and governance roles and responsibilities.

Findings

The research finds that interpretation of clinical governance in praxis is quite different from best-practice definitions. Practitioner roles and responsibilities held influence practitioners' interpretation.

Originality/value

The research examines interpretations of clinical governance in praxis by clinicians, managers and governors and highlights the adverse consequence of the absence of clear mapping of roles and responsibilities to clinical, management and governance practice.