Clinical Governance and Risk Management

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Clinical Governance and Risk Management have become increasingly important over the last decade in the various fields of nursing. The development of the concept of clinical governance will be discussed and how it can be facilitated into practice with relation to learning disabilities nursing. Clinical Governance was first introduced in the White Paper ‘The New NHS: Modern, dependable’ (DoH, 1997). Donaldson (1998) viewed clinical governance as the vehicle to achieve, locally, continuous improvements in clinical quality, which will aid the government’s agenda for modernisation of the NHS. This modernisation includes improving services such as clinical audit, clinical effectiveness programmes and risk management. Donaldson was among many authors in 1998 that contribute to literature, which supported the need for clinical governance at a time when the standards and quality of healthcare provision were in decline. Risk management and assessment will be discussed in relation to learning disabilities to include disabled children in the child protection system. High quality risk assessments and risk management strategies are essential for children and adolescents with disabilities. It will be shown that barriers faced in the assessment process often lead to disabled children being discriminated against in the child protection system.

To understand the development of clinical governance, we must firstly gain knowledge of its origins. During the early 1990’s, government documents and a series of high profile medical disasters such as the National Health Service (NHS) failures in bone tumour diagnosis and in paediatric surgery in Bristol helped to bring quality improvement to the top of the White Paper agenda (Nicholls, S et al 2000). The Patient’s Charter (1992) and The Citizen’s Charter (1993) are documents that drew the publics attention towards the quality and standards of care been delivered by the NHS. Both these charters gave rise to informing and empowering patients to the standard of care they found acceptable. Upon the deliver of these charters, healthcare professionals and the public became better informed and educated, thus demanded a higher quality of healthcare. The decline in the quality and standard of care by the NHS was now made public. The government had to act upon this.

As mentioned, the term clinical governance became prominent following the publication of the first White Paper report, in which the government set out its agenda for the modernisation of the NHS. Succeeding this a year later was a new White Paper report, A First Class Service – Quality in the new NHS (DoH, 1998) which defines clinical governance as ‘A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’. The evolution of clinical governance, promoted the various sectors of the NHS to embrace and define this new system to their specific field. Dewar (2000) suggests that the official definition has deliberately been left incomplete so that health professionals can define their own systems of clinical governance in their own way. An explosion of clinical governance definitions were circulated through the health sector in relation to specific fields such as, doctors, GPs, nurses, physiotherapists, pharmacists etc. The Royal Collage of Nursing (1998) defines clinical governance as ‘a framework, which helps all clinicians including nurses to continuously improve quality and safeguard standards of care’. McSherry and Pearce (2007) argue that even though the majority of healthcare professionals welcomed the initial definition, individuals have interpreted, internalised and transferred the meaning of clinical governance to their specific profession. The definitions supplied by the individual sectors, are in agreement that this is a framework, which pulls all the ranges of...
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