Posted: October 8th, 2021

The Seven Pillars of Clinical Governance in the NHS: Ensuring High Standards of Care

The Seven Pillars of Clinical Governance in the NHS: Ensuring High Standards of Care

References:

Scally G, Donaldson LJ. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ. 1998;317(7150):61-65.

National Institute for Health and Care Excellence (NICE). Clinical Guidelines. Available from: https://www.nice.org.uk

National Health Service (NHS). Clinical Audit Handbook. Available from: https://www.england.nhs.uk

General Pharmaceutical Council (GPhC). Continuing Professional Development (CPD). Available from: https://www.pharmacyregulation.org

Walshe K, Shortell SM. When things go wrong: how health care organizations deal with major failures. Health Aff (Millwood). 2004;23(3):103-111.

Department of Health. An Organisation with a Memory: Report of an Expert Group on Learning from Adverse Events in the NHS. London: The Stationery Office; 2000.

Clinical governance is a powerful, new, and comprehensive mechanism for ensuring that high standards of clinical care are maintained throughout the NHS and the quality of service is continuously improved. [1] It represents a systematic approach to maintaining and improving the quality of patient care within health care systems. The above is an example of a definition that has been used to describe the term clinical governance; there are a number of different definitions that have been used to describe the term. The term itself covers a number of factors that clinicians must be involved in, in order to uphold and improve the quality of care provision for patients in the NHS.

Clinical governance can be broken down into seven different areas, traditionally known as the ‘seven pillars’, these are the seven aspects of clinical governance that clinicians are involved in. These pillars provide a structured framework for health care professionals to deliver safe and effective care. The seven pillars include; clinical effectiveness, clinical audit, risk management, education and training, patient and public involvement (PPI), use of information and IT, recruitment and staff management.

Clinical effectiveness means ensuring that everything you do is designed to provide the best outcomes for patients. [2] It is encouraged through the development of guidelines for particular diseases. In pharmacy, it can involve changing ways of practice, such as altering procedures and developing new guidelines based on evidence of effectiveness. This can arise if current procedures are proven to be inadequate or ineffective. An example of this is the implication of and adherence to NICE guidelines, with the overall aim of improving the standard of care provided to patients.

Clinical audit can be defined as, ‘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.’ [3] It is a process where clinical performance is reviewed, and if necessary, clinical practices are refined in order to attempt to improve performance, which is measured against a set of agreed standards. Regular audits help identify gaps in care delivery and ensure that best practices are consistently followed.

When managing health provision there are a number of different risk factors that have to be taken into consideration. There are not only risks for the patient, but also for the practitioner and the organisation providing the health care service. One of the aspects of clinical governance is risk management, and it is put in place in order to minimise and reduce the likelihood of errors, and help staff to learn from mistakes and near misses. This has particular importance in pharmacy and is extremely relevant when we consider the risk of dispensing and dosing areas. It is therefore vital that pharmacists are aware of and take an active role in risk management.

In pharmacy, risk management can involve a number of things such as following protocol. This is important for a number of day-to-day aspects of work such as counseling patients, dispensing medicines, handling of controlled drugs, and dealing with returned and out-of-date drugs. For each of these, there are certain procedures that pharmacists must follow. It is also important to learn from near misses and mistakes, to understand why they occurred, and then implement the necessary changes in order to prevent them from happening again. This can be as simple as educating staff members in the pharmacy as to the consequences of an error, and training staff to help with avoiding errors in the future.

With regards to providing healthcare, it is important for all practicing professionals to continue their education and training after they become qualified, this includes pharmacists. This is because a lot of what is learned during the qualification period becomes outdated over a short period of time. For a pharmacist, this involves undergoing continual professional development, known as CPD. CPD can be defined as ‘a range of learning activities through which health professionals maintain and develop throughout their career to ensure that they retain their capacity to practice safely, effectively and legally within their evolving scope of practice’ [4].

CPD involves undergoing training activities such as attending courses, reading journals, or it can be work-based training. These must then be recorded in a personal CPD portfolio. This portfolio can then be assessed at random and it must be submitted with evidence to support it. The portfolio must consist of a summary of practice history covering the previous two years, a statement of how CPD standards have been met, and evidence to support this.

CPD helps to ensure that health care professionals continue to further their education, and stay up to date with the latest advances and changes in the health care system. It is therefore a key component of clinical governance.

It is important to take into consideration the opinions and feelings of patients and the public, after all, these are the people that health care provision is aimed at and they are the ones receiving the service. Patient and Public Involvement is an aspect of clinical governance. PPI takes this into account and it helps to ensure that the services provided for patients are suitable, and it uses patient feedback to improve services.

Questionnaires and patient surveys are used in order to gather feedback and help improve the service to the public. Community pharmacy can provide an excellent opportunity to gain feedback from the public, as the patients have the opportunity to speak to the pharmacist one to one, in an informal environment. Patients have the opportunity to talk about their medication, if it has helped them, dosage, and adverse effects. It is important for a pharmacist to take on board this information and sometimes act upon it, for example, in the case of an adverse effect of a new drug, which the pharmacist must report.

As the level of information held about patients increases with the increased use of IT systems in health care it is important to ensure that patient information is accurate and kept up to date. In pharmacy, this relates to the patient database. Information such as addresses, new medical conditions, and new medication must be kept up to date. This can improve the quality of care provided to the patient. It is also important that this information is kept confidential.

In order to provide a high standard of health care it is important to have a strong team of staff working to provide quality service. Employees must be appropriate for the environment in which they are to work in. Performance should be monitored and steps taken to improve it if necessary. In pharmacy, this can involve continuous training of staff and for the pharmacist, CPD. The workplace should also provide an appropriate area for staff to carry out their work safely and effectively, in pharmacy, this should be a clean, professional environment with the appropriate equipment, such as tablet counters, and protective clothing such as gloves, if necessary.

It is important that all of these aspects of clinical governance are adhered to, in order to improve the standard of health care available to the public. It is also important that health care professionals, such as pharmacists employ clinical governance appropriately, and that it is relevant to their line of work.