Critical Factors Within an Inquiry Process That Influence Positive Changes in Clinical Governance

Major failures in patient safety often lead to high profile inquiries set up to establish the facts, and to identify areas of improvement to prevent further failures. In order to learn from inquiries, we need to be able to identify if, and how, the inquiry process influences improvements. Using a case study strategy, this research study examined the impact or influence of the Douglas Inquiry on KEMH’s clinical governance systems. The research focused on two areas that were highlighted in the final Inquiry report as requiring reform. These systems deal with the clinical credentialing and performance review and the involvement of consumers in care. Several sources of data collection were employed. Firstly, document and archive analysis identified the procedures and processes employed by the Inquiry, and the changes that had occurred at the hospital. Secondly, semi-structured interviews ascertained participants’ perceptions of changes in clinical governance systems at KEMH post Inquiry, and the influence of the Inquiry on the changes that have taken place. The findings were then compared and with the literature. The study conclusions identified critical factors within the Inquiry process, which influenced improvement in the clinical governance systems examined. Absence of one of these critical factors resulted in the Inquiry reinforcing existing barriers and thus, in those areas there was no change. Lewin’s (1951) model of change specifically informed the analytic process, with the outcome resulting in the development of a conceptual model of organisational clinical governance change. This paper reports the results of this study and presents the conceptual model of change

The influence of health inquiries on clinical governance systems: A case study of the Douglas Inquiry

Major failures in patient safety often lead to high profile inquiries set up to establish the facts, and to identify areas of improvement to prevent further failures. In order to learn from inquiries, we need to be able to identify if, and how, the inquiry process influences improvements. Using a case study strategy, this research study examined the perceptions of external stakeholders in regards to the impact or influence of the Douglas Inquiry on KEMH’s clinical governance systems. The research focused on two areas that were highlighted in the final Inquiry report as requiring reform. These systems deal with the clinical credentialing and performance review and the involvement of consumers in care. Several sources of data collection were employed. Firstly, document and archive analysis identified the procedures and processes employed by the Inquiry, and the changes that had occurred at the hospital. Secondly, semi-structured interviews ascertained participants’ perceptions of changes in clinical governance systems at KEMH post Inquiry, and the influence of the Inquiry on the changes that have taken place. The document and archives were analysed using an analytic approach described by Neuendorf (2002). The Miles and Huberman (1994) framework was used for the analysis of the interviews. The findings were then compared and with the literature. The study conclusions identified critical factors within the Inquiry process, which influenced improvement in the clinical governance systems examined. These factors were the Terms of Reference (TOR) and the investigative and inquisitorial processes employed by the Inquiry. Absence of one of these critical factors resulted in the Inquiry reinforcing existing barriers and thus, in those areas there was no change. Lewin’s (1951) model of change specifically informed the analytic process, with the outcome resulting in the development of a conceptual model of organisational clinical governance change

Clinical Placement Experiences in the Highlands of Vietnam

There is a considerable body of literature which supports the value of international placements, however there is little reported in the literature where these experiences have been in remote third world countries. This presentation will present the experiences of the students and their clinical supervisors who traveled to the remote Highlands of Vietnam to provide health assessment clinics and health education in schools. The objectives were to provide the opportunity for students to develop professionally and personally through: • Experiencing a clinical placement within a health care system other than the Australian system • Working within a health care system delivering care to patient & communities where ethnicity, culture, spiritual values, economic and social factors were unfamiliar. The specific student objectives were to: • Identify similarities and differences between the Vietnamese and Australian Healthcare system • Identify strategies that facilitate the provision of nursing care and communication to patients/ families/ communities in a different ethnic and cultural context • Evaluate their clinical practice using the framework of the ANMC Competencies for RNs • Reflect and identify personal challenges and growth opportunities during the placement. To evaluate if the aims and objectives we held focus groups with the students pre, during and post experience. In these groups the students’ perceptions and expectations were explored and discussed. The students also completed a pre and post survey and as well, students were observed in the clinical context throughout their practicum

The art of clinical supervision program: Its impact on nurses attitudes towards nursing students

Background: Increasing health professional student numbers in Australia, in response to looming predicted workforce shortages, resulted in a Federal Government call for action to provide clinical supervision education to health professionals. Objectives: This research aimed to develop, implement and evaluate the programme, ‘The Art of Clinical Supervision’ (ACS), designed to support nurses facilitate a positive learning environment for student nurses. Method: The ACS programme was presented (n = 199) across Western Australia as a doctoral study, with participants from both the public and private healthcare sector working in a variety of specialties. A triangulation approach of surveys, reflective entries and interviews was utilised to determine its impact. Results: The data indicated that participants improved their understanding of supervision and attitude towards students and supervision after attending the ACS. Conclusions: Health service managers are encouraged to evaluate their staffs’ knowledge and attitude towards students with findings used to facilitate a positive learning culture. Impact Statement: The Art of Clinical Supervision The purpose of the research was to develop, implement and review a new education programme that could support the development of clinical supervision knowledge and attitude to support student nurse learning. This occurred in an environment of increased student numbers as a strategy to correct a predicted looming workforce shortage. The study findings determined that the programme improved both participant knowledge about how to provide effective clinical supervision (teaching) in the clinical environment, and improved staff attitudes towards students and their place as a learner in the clinical areas. The type of impact was therefore within the domain of quality by improving student learning through effective education strategy. As a result of the doctoral research, involving 200 participants, a Federal Government grant of approx. $500,000 was received to facilitate the training of additional educators to provide the programme across the state of Western Australia. This grant was a partnership between the programme author (researcher) and the Western Australian Government Department of Health. This involved four educators presenting the programme to over 3,000 health professionals in a 3-year period. Despite the cessation of funds with the closure of HWA the programme continues to be delivered through The University of Notre Dame Australia School of Nursing and Midwifery, with only a cost recovery charge

Perceptions of External Stakeholders Regarding the Development of Clinical Governance: A Western Australian Perspective

The current context of healthcare delivery is one that emphasises patient safety and high quality care. This focus on patient safety within the health industry has lead to the widespread adoption of the term clinical governance. Clinical governance has two aspects. Firstly, this term describes the systems and processes that a health agency has in place to detail accountability and responsibility for patient safety. Secondly, the term clinical governance also encompasses the mechanisms used to monitor and measure patient outcomes to ensure optimum quality care (Balding, 2005). The growing awareness of the vulnerability of patients to safety related incidents was highlighted in an Australian study by Wilson and colleagues in 1995. This study retrospectively audited patients\u27 notes to identify the incidence of patient events that occur because of errors in care. Because of this study, they estimated that 18,000 deaths and 17,000 permanent disabilities occur each year to patients in Australian hospitals because of preventable errors. This study focused political attention on the issue of patient safety and increased pressure on health care agencies to demonstrate processes that protected patients

Do Inquiries make a difference or are they a waste of time?

Government inquiries into system failures are expensive, time consuming and have an enormous impact professionally and personally on those involved. They are set up to investigate systemic failures in healthcare delivery. Such major failures are different from a single event failure that may capture media attention or be the focus of a coronial inquest. Health system failures that result in an inquiry are distinguished by the scale and magnitude of the breakdown in care. The timescale of the events may stretch over months or years, and there are a number of different occasions where poor patient outcomes (including patient deaths) have occurred as a result of inadequate or unsafe care. In 2000 the Douglas Inquiry was established by the Western Australian Premier and Minister of Health to inquire into the provision of obstetric and gynaecological services at King Edward Memorial Hospital (KEMH). The final report from the Inquiry detailed 237 recommendations for action to improve patient care and safety. Inquiries of this type tend to be highly politicised and very visible to the general public The act of the inquiry itself can be viewed by politicians and the community as the remedial action for the problems being investigated. The reality however, is that an Inquiry in itself does not “fix the problem”. Rather, it is the actions and changes that occur subsequent to the Inquiry that will improve an unacceptable situation. There is very little examination given to this aspect .When changes are examined, the focus is inevitably on reporting changes in policies and procedures, management structure or accountability processes. While structure and process changes are vital, they do not necessarily translate into differences of how care is being delivered at the coalface. There is very little reported on the outcome aspect of changes. So, the question of whether an Inquiry has actually made a difference to patient safety or patients’ perception of their care is not addressed. The paper reports the results of a study undertaken to examine whether there have been significant changes in the clinical governance systems and processes in line with the recommendations of the KEMH post inquiry. Further information about this conference may be accessed at: http://www.aaqhc2009.org.au

Health Inquiries: Do we ever learn?

Health system inquiries are established for a variety of reasons. They can be politically motivated to establish the facts, to identify accountability and responsibility and to identify areas that can be improved to prevent further failures. Inquiries have a profound personal and professional impact on those involved. This can only be justified if some positive effect results from the inquiry. The Douglas Inquiry (2000) was established to inquire into the provision of care at King Edward Memorial Hospital (KEMH) in Western Australia. The final report from the Inquiry detailed 237 recommendations. Using a case study strategy this research study examined the perceptions of external stakeholders in regards to the influence of the Douglas Inquiry on the clinical governance systems at KEMH. The research focused on two area of the final Inquiry report. These were those that dealt with medical credentialing and consumer involvement in care. Documents, archives and semi-structured interviews were used to provide data for the study. The paper reports two aspect of the study. Firstly, the results of the document and archive analysis in regards to identifying changes that have occurred post Inquiry will be presented. Secondly, these results will be compared to external stakeholders’ perceptions of changes that have occurred in the areas of the study focus

Patient Safety: An Essential Guide

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Are Registered Nurses who act as preceptors to students in the Kimberley receiving adequate support for their role?

Background: Anecdotal evidence suggests that Registered Nurses (RNs) who act as preceptors in the Kimberley take on the role with minimal support The literature identifies that the preceptor plays a pivotal role in the quality of the clinical experience for students when on practicum. As well, it is identified that the preceptor is fundamental to the development of capable and competent health professionals. Thus, adequate support mechanisms need to be in place to ensure that RNs who undertake the role of preceptors are prepared adequately for their role. The study: Initially a literature review was undertaken to identify the elements of a best practice model of preceptor support. A survey was then developed for completion by the different health sites in the Kimberley to allow comparison between current practice and best practice in terms of preceptor supports and preparation. Finally recommendations were developed that could be included in the development of an effective model of preceptor support for use in the Kimberley. Discussion: This paper will report the findings of the study including the current supports and the unique challenges which inhibit the preparation of preceptors for their role in the Kimberley. An overview of the recommendations that were developed to inform a new model will also be presented

Do inquiries into health system failures lead to change in clinical governance systems?

Aim: This paper reports the first part of a case study investigation to examine the changes at King Edward Memorial Hospital (KEMH) following an inquiry established to review the quality of obstetric and gynaecological services. Background: Common findings from a range of health inquiries in recent times include that there have been inadequate adverse event reporting systems, the absence of transparent systems for staff and patients to report concerns about quality of patient care, and an ineffective medical credentialing and performance review system. The similarity of findings from many health inquiries raises the question of whether an inquiry does lead to changes to improve patient care and safety. There has been very little reported in the literature about this. Method: Using a case study strategy the areas of medical credentialing, performance review and involvement of consumers in care were chosen as the KEMH clinical governance processes to be examined for changes post inquiry. Documents, archives and interviews were used as data sources for this case study. Documents were examined using a normative analytic approach and the Miles and Huberman framework was used for data analysis of the interviews. Findings: There were significant changes in the area of credentialing and performance review evident in analysis of all sources of data. There were some improvements in the processes of involving consumers in care, but deficits were identified in regard to the provision of training and upskilling for clinicians to improve their communication skills and interactions with patients and families