Assessing hospitals' readiness for clinical governance quality initiatives through organisational climate

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.

Team Resource Management Perception Under Managerial Coaching Skills and Organizational Climate: Cross-Level Analysis in Taiwan's Hospitals

There is growing recognition of the importance of teamwork and integration of resources in the health care industry. This article studied the influence of organizational climate and managerial coaching skills on team perception of team resource management (TRM) and coaching techniques in selected hospitals in Taiwan. Structural survey method was used to measure the relationship between organizational climate, managerial coaching skills, and team perception of TRM. The participants of this research were 530 administrative staff from 12 hospitals in Taiwan. Cross-level relationship between organizational climate (group level), managerial coaching skills (individual level), and team perception of TRM (individual level) was examined. The results revealed that organizational climate had a significant influence on team perception of TRM. Second, recognition of managerial coaching skills shaped team perception during TRM implementation. Third, organizational climate had a moderating effect on the relationship between managerial coaching skills and team perception of TRM. The study concluded that positive organizational climate and good managerial coaching skills contribute to effective team management and development. Thus, it is important for health care organizations to understand the importance of coaching and mentoring and create a workplace that makes learning, growth, and adaptation possible across different departments and functional teams.

Is medical perspective on clinical governance practices associated with clinical units' performance and mortality? A cross-sectional study through a record-linkage procedure

Objective:

Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units’ performance measured through mortality rates and efficiency indicators.

Methods:

This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors’ knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units’ performance indicators which include patients’ mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators.

Results:

The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units’ efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units’ mortality rates (odds ratio, −8.677; 95% confidence interval, −16.654, −0.700).

Conclusion:

The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical governance tools application on its own clinical practice.

Nursing experiences of clinical governance implementation: a qualitative study

Purpose

– Clinical governance (CG) was used as a driver to improve safety and quality of healthcare. CG implementing is a change in health system and all the stakeholders must be participating. The purpose of this paper is to study nurses’ experience about CG movement in Tabriz hospitals.

Design/methodology/approach

– A qualitative study using Focus Group Discussions (FGD) was done. Purposeful Sampling was used to select the objectives including 65 participants. Actually seven FGD’s were held. Content analysis was used to extract the meaningful themes.

Findings

– It is revealed that nurses are the focal point in CG implementation in hospitals. Low commitment of managers and lack of physicians’ contribution was experienced by nurses. However, personnel education and development and patient safety have got more attention. Blame culture and increased work stress was reported as challenges.

Originality/value

– CG as a change in healthcare system, especially in low- and middle-income countries, is faced by several challenges and its implementation would have different experiences. Nursing staff, the major group in hospitals, would be having interesting experiences through CG. Their practical opinions could guide the policy makers to employ proper plans to effectively implement CG. Considering the result of this study in practice would lead to improve CG implementation.

Hospitals' readiness to implement clinical governance

BACKGROUND

Quality of health services is one of the most important factors for delivery of these services. Regarding the importance and vital role of quality in the health sector, a concept known as "Clinical Governance" (CG) has been introduced into the health area which aims to enhance quality of health services. Thus, this study aimed to assess private and public hospitals' readiness to implement CG in Iran.

METHODS

This descriptive and cross-sectional study was carried out in 2012. Four hundred thirty participants including doctors, nurses, diagnostic departments personnel, and support staff were chosen randomly from four hospitals (equally divided into private and public hospitals). Clinical Governance Climate Questionnaire (CGCQ) was used for data collection. Finally, data were entered into the SPSS 18 and were analyzed using statistical methods.

RESULTS

Among the CG dimensions, "organizational learning" and "planned and integrated quality improvement program" scored the highest and the lowest respectively for both types of hospitals. Hospitals demonstrated the worst condition with regard to the latter dimension. Furthermore, both types of hospitals had positive picture regarding "training and development opportunities". Private hospitals scored better than public ones in all dimensions but there was only a significant difference in "proactive risk management" dimension between both types of hospitals (P< 0.05).

CONCLUSION

Hospitals' readiness for CG implementation was "average or weak". In order to implement CG successfully, it is essential to have a quality-centered culture, a culture specified by less paperwork, more self-sufficiency, and flexibility in hospitals' affairs as well as centring on shared vision and goals with an emphasis on continuous improvement and innovation.

Hospitals' readiness for clinical governance implementation in educational hospitals of yazd, iran

BACKGROUND

Clinical governance is a systematic approach to maintaining and improving the quality of patient care. This study aimed to assess some Iranian educational hospitals' readiness for clinical governance implementation through the organizational climate.

METHODS

It was a cross-sectional study that used the Clinical Governance Climate Questionnaire (CGCQ) in three educational hospitals in Yazd, a city in central Iran, in 2012. A total of 186 personnel contributed to the study. Data were analyzed using SPSS version 16. Descriptive statistics and the Kruskal-Wallis test were used for data analyses.

RESULTS

The mean scores of the clinical governance climate in Shahid Sadoughi, Shahid Rahnemoon and Afshar hospitals were 2.63±0.29, 2.58±0.32, and 2.68±0.29. The mean scores of quality improvement planning and change, quality improvement integration and motivation, clinical risk management and climate of blame and punishment, organizational learning, and training and development (T&D) opportunities for learning in the studied hospitals were 2.21±0.49, 2.80±0.40, 2.76±0.40, 2.91±0.54 and 3.06±0.72, respectively.

CONCLUSION

The results of this study showed that the educational hospitals' climate should be more supportive for successful implementation of clinical governance.

Constructing the health care system in Greece: responsibility and powerlessness

OBJECTIVES

Based on health care professionals' (HPs) and patients' interviews about work demands and quality of care in hospitals, the study explores the way that patients and HPs constructed their identities to describe and construct the health care system in Greece.

DESIGN

This is a qualitative study using a focus group (FG) design.

METHODS

Seven FGs discussions were conducted: three FGs discussions were conducted for the assessment of job stressors (1 for doctors, 1 for nurses and 1 for residents) and four FGs discussions for the assessment of quality of care (1 for doctors, 1 for nurses, 1 for residents and 1 for patients). The sample consisted of health care professionals working in a teaching hospital in the region of Thessaloniki, Greece, and patients who had at least one experience of any kind in the same hospital. Transcripts of the FGs discussions underwent discourse analysis.

RESULTS

The results showed that both HPs and patients construct the health care system based on bipolar constructions of responsibility and powerlessness. In particular, participants use these constructions to allocate the responsibility to different levels of the health care system hierarchy or to the system per se constructing, at the same time, themselves as the 'viewers' of this system.

CONCLUSIONS

The study allowed a deeper understanding of issues related to quality of care in hospitals providing context-specific information. Identity in health care organizations was inextricably linked to power and responsibility. The need to deconstruct this responsibility/powerlessness ideology is discussed.