Clinical governance is about how you deliver care

Dr Melanie Tan provides her perspective as a doctor, lawyer and carer of what clinical governance in aged care means.

What does clinical governance in aged care mean? Dr Melanie Tan provides her perspective as a doctor, lawyer and carer.

Clinical governance is now firmly embedded in aged care regulation. However, clinical governance is about much more than standards, accreditation, or compliance – because it is about how we deliver care.

Clinical governance involves understanding relationships or connections with people and identifying the roles and responsibilities throughout your organisation that support those relationships or connections with people.

It is about how these roles and responsibilities, within your organisation’s framework, collectively enhance the care experience.

Everyone has their own perspective on clinical governance.

Mine comes from over 20 years as a ‘junior’ doctor – knowing what it’s like to multitask within a complex adaptive system against competing tensions – caring for several people at any one time.

I also know what it’s like to juggle the interests of disparate stakeholders – from patients and their families to other practitioners, administrators, technicians, regulators and insurers – to name just a few.

Melanie Tan (photo By Cath Leo)

My perspective in clinical governance also derives from having been a medical negligence lawyer – examining care retrospectively – and a medico-legal adviser in medical defence organisations – helping my clinical peers navigate challenging situations and manage, or reflect on, their medico-legal risk. And then I became an aged care lawyer.

Devastatingly, I have also been co-carer to my dad, who recently passed away at home after a four-year journey with cancer. Being on the receiving end of health and aged care – and covering the gaps as a carer – has given me a different, yet most profound, perspective.

Through these experiences, clinical governance is now what I aspire to – for all of us who are responsible in some way for providing care – regardless of whether it’s healthcare, aged care, disability or health technology.

As a lawyer, my approach to clinical governance was limited to identifying and mitigating risk. However, as a doctor and a carer, I understand that clinical governance is not only about risk, just as it’s not only about compliance – and it’s about much more than avoiding legal risk. Clinical governance is about constantly striving to be better.

But what does the term clinical governance mean? Why these words? If governance means to control, regulate, direct or oversee something and clinical pertains to the management of a person’s health to support optimal outcomes – then clinical governance can be understood to be about how we control, regulate, direct or oversee the management of a person’s health to support optimal outcomes.

“Aim for the moon and if you miss, you’ll sit with the stars – those five stars.”

The concept of governance includes self-governance – meaning the way that we, as individuals, conduct ourselves. Further, those optimal outcomes must encompass the person’s experience of care, even if we cannot change the end result for them.

Finally, the concept of health must be broadly understood. Any care or support can potentially impact a person’s physical or psychological health. It need not specifically be clinical care.

Put people at the centre

With all this in mind, clinical governance must start and end with the person – and their family, subject to the person’s wishes. This is also consistent with legislated requirements in aged care.

The person receiving care, and their family, will have their own unique perspective on life that has shaped their values. And remember that even a person with dementia is entitled to determine what quality care means to them, in the context of their circumstances.

We need to be authentic about putting people at the centre of care – so let’s always ask them – this means starting with a presumption of capacity for the decision at hand. Further, understanding other domains of clinical governance – as they apply to your organisation – will give you a mental framework to achieve the best possible outcome for the people you are responsible for.

“Clinical governance is about meeting an optimal standard, to promote quality of the care experience.”

It doesn’t matter where we sit within an organisation – whether we’re on the board or at the frontline – a clinical governance framework reminds us of what we need to remember. It guides us to constantly ask ourselves how we can deliver the best care we possibly can, in accordance with a person’s values, preferences and wishes. This should be any organisation’s common goal.

Aim for the moon

Continuous improvement is at the heart of clinical governance, and an expectation of the regulator. To that extent, clinical governance and compliance go hand-in-hand.

My dad was an innovative surgeon who pushed through barriers to improve outcomes for all his patients, and their families. He was always seeking to improve the care experience. We need to be doing this in aged care.

As a little girl, Dad taught me that old adage – reach for the moon and if you miss you’ll sit with the stars. This is how I see clinical governance and compliance. Good clinical governance is the moon. If we miss, we’ll at least meet our compliance obligations – the stars.

Finally, clinical governance supports our common law duty of care – which is about meeting a reasonable standard of care.

Like regulation, our duty of care sets a minimum standard of care – to avoid or mitigate the risk of harm – regardless of whether you provide clinical care or not. Clinical governance is much more aspirational.

It’s about meeting an optimal standard, to promote quality of the care experience – also regardless of whether you provide clinical care or not.

Clinical governance is therefore about doing our best, whatever our role is in the context of care provision. The better we can be at clinical governance, the more likely we will also meet our duty of care – just as it is more likely we will comply with our regulatory obligations.

Remember, aim for the moon and if you miss, you’ll sit with the stars – those five stars.

Dr Melanie Tan is an independent clinical governance and medico-legal consultant and a lawyer in health and aged care.

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2 thoughts on “Clinical governance is about how you deliver care

  1. Admirable sentiments, but in reality, they’re just aspirational.
    When you have a largely unskilled and low-paid migrant workforce at the pointy end of care delivery, even the most robust governance frameworks won’t guarantee a high standard of care. Shelves full of policies and obscure care minute targets wont (can’t) change things at the actual point of care.
    When you can still get away with staffing a night shift with two AINs and one RN to ‘care’ for 120 residents accommodated over three floors, how could they?

  2. Many thanks for your input Peter! Yes, I agree clinical governance is aspirational by its nature… we need to aspire towards something (and it should not be just compliance). A clinical governance framework is a starting point. How it is operationalised or implemented is another issue – I completely agree that shelves of policies and obscure targets aren’t the solution. They represent attempts to meet a minimum standard, but do not necessarily have real value in the quality of care.

    A robust clinical governance framework should support the workforce in an authentic manner. This can only happen by ensuring frontline staff are consulted (eg. in developing these policies – not just given them), trained up (on an ongoing basis), and appropriately resourced (which I appreciate is a challenge within the limits of funding – technology should therefore be considered as integral to safe and effective care delivery, not as a luxury – it may help those AINs and RN in a climate where workforce shortages have become the norm). Further, the entire workforce should operate in a culture where they feel safe to speak up and ask questions, and where there is some sort of positive reinforcement for their hard work. But unless all of this is somehow captured in an organisation’s clinical governance framework in the first place (which should encapsulate its values and goals), it will be inconsistent or forgotten.

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