Clinical Governance covers:
“everything that contributes to maintain and improve standards of
patient care”. It is a framework for organisations and staff to
support the delivery high quality care and enables “the right care,
at the right time, in the right place, for the right patient”.
Clinical Governance also incorporates
clinical audit:
“a quality improvement process that seeks to improve patient care
and outcomes through systematic review of care against explicit
criteria and the implementation of change” .
From 2005, the Royal Berkshire NHS Foundation
Trust developed an integrated framework of Clinical Governance that
incorporates and builds on the Healthcare Commission’s Standards
for Better Health (2004) , the NHS Litigation Authority standards
(2007) and more recently the Department of Health’s Vital
Signs (2008) .
Effective clinical governance remains central
to our day-to-day operation as the first choice the first choice
provider of specialist clinical services for patients in our
community. Adherence to the revised framework, a multi-disciplinary
team approach identifying major issues and active communication via
departmental minutes continues to be a vital part of safe and
successful patient outcomes.
Quality and patient safety continue to drive
development within clinical standards. The Trust’s Hospital
Standardized Mortality Ratio (HSMR) continues to be below the
England average (of 100). The HSMR is monitored on a monthly basis
and the Trust’s mortality has decreased over the years, with scores
below 100 since 2006.
During 2007, the Trust developed more
quantifiable and accurate ways of determining clinical quality and
thus strengthening our commitment to patient safety. Data have been
enhanced to provide information on quality issues such as mortality
for emergency and elective admissions and reflect events within the
Trust as they happen. These Clinical Performance Indicators
(CPIs) enable us to show improvement and provide early warning of
risk. The initial CPIs have been targeted at easily
measurable or reportable outcomes, such as mortality. Future
developments of this work will identify CPIs for length of stay and
readmissions rates and will aim to benchmark these data with other
Trusts. However, the data do not provide information in their own
right, but simply identify areas for review.
Clinicians across the Trust are using these indicators to review
patient records and provide regular assurance on quality of care
and patient safety:
- Clinical Governance –
Quality in the new NHS, Department of Health (1998)
- A First Class Service, Department of Health
(1999)
- Principles of Best Practice in Audit, NICE,
(2002)
- Standards for Better Health, Department of
Health (2004)
- NHSLA Risk Management Standards for Acute
Trusts. NHSLA (April 2007)
- Operational plans 2008/09–2010/11, National
Planning Guidance and “vital signs”
- DH/NHS Finance Performance & Operations
(Jan 2008)
Useful Contacts
Hester Wain PhD
(Clinical Governance & Healthcare Standards Manager)
Clinical Standards Directorate
Level 4 Main entrance
Royal Berkshire NHS
Foundation Trust
London Road
Reading
RG1 5AN
Tel: 0118 322 8154
Fax: 0118 322 8042
hester.wain@royal
berkshire.nhs.uk