Introduction
Formally, New Zealand embraced clinical governance for the first time in the year 1999. Since then, all New Zealand healthcare organisations have recommended its implementation. In New Zealand, the concepts of clinical governance are also widely embraced. Application of concepts of governance in the healthcare setting entangles the setting of frameworks through which organisations are checked for accountability through fostering continuous improvement in quality of healthcare service delivery coupled with safeguarding and provision of healthcare of high standards. This deliverable has been possible via creation and management of an environment in which care delivery can flourish.
From this fundamental approach in clinical governance, the paper focuses mainly on the role of clinical governance in enhancing cute clinical care, which leads to better control of infections in wards in New Zealand. Due to valid healthcare needs for various groups of people, the paper holds that patients’ needs in New Zealand form the primary concern of healthcare professionals for prevention of infections in New Zealand wards to materialise.
It provides an extensive analysis of the literature on the roles of clinical governance in prevention and control of infections in wards in New Zealand. It also holds that any clinical governance strategy applied to the management of health conditions of New Zealand people with valid and diverse healthcare also needs to have the concerns of the healthcare givers at heart. This plan keeps the staff motivated. It eliminates or reduces substantively cases of occurrence of burn out among healthcare staff.
The paper proposes that extensive and magnificent provision of information related to perceptions of health risks in wards can work as an incredible strategy tied within the umbrella of clinical governance for reduction of infections in wards. When appropriate risk management principles are applied within clinical healthcare settings, healthcare professional working in wards becomes aware of the risks presented by inappropriate management of an environment that would form subtle breeding grounds for infections in wards, both on healthcare professionals and on the chief client of clinical healthcare facility: patient.
Consequently, the paper infers that, while the professionals attempt to reduce or even prevent completely the risk of infections on their part while working in wards, the patients also are shielded from contracting infections. Another vital plan of reducing infections is fostering optimal resource utilisation in clinical facilities. The paper also proposes that incorporation of information technology in clinical information management can amount to a substantial aspect of quality improvement. Hence, it can incredibly aid in realisation of aims and objectives of clinical governance coupled with application of its principles in reduction of infections in wards in New Zealand healthcare facilities.
Roles and Significance of application of clinical governance in prevention of Infection in wards in New Zealand
A statutory responsibility goes to the clinical facilities to make sure that the guidelines of clinical governance deliver quality healthcare to the clients-patients. Prior to adoption of the clinical governance across New Zealand, the main concern of accountability in healthcare facilities revolved around healthcare institutions management capacity to balance financial books. A similar approach was also evident in New Zealand.
However, clinical governance altered this emphasis and focused it on the patients as the real priority (Pellowea et al, 2002, p.375). In this context, clinical governance had the immense responsibility of enhancing magnificent quality care within healthcare organizations in New Zealand (Good Hands Report 2006, p.3). Arguably, from this perspective, it is upon maintaining of high quality standards in the clinical healthcare service delivered to all patients that infections can cease taking place in wards.
The success of any healthcare infections prevention and control program is largely dependent on the capacity of all healthcare stakeholders to understand the various modes and means through which transmissions of infections can take place within clinical healthcare facilities including wards. The responsibility of control and prevention of infections transmissions in wards is a noble duty for all persons visiting and or working in healthcare facilities such as the patients, staff, caregivers and even the administrators (Ham, 2003, p.1979).
Therefore, success in reduction and prevention of infections in New Zealand wards enormously depends on ability to apply cutely various concepts of risk management in the attempt to manage both system and human factors, which have close association with person-to-person agents of infections transmission. This way, infectious agents, either which are common such as gastrointestinal virus, or even the evolving ones such as influenza among others can be managed effectively. Inculcation of measures to curb infections in wards is not an issue of not only clinical healthcare management concern, but also an issue of concern in the public domain.
This is because effective strategies of preventing infections coupled with their control is a key indicator of the quality of New Zealand healthcare delivered to patients coupled with likely indication of the capacity to provide working environments that are safe in healthcare clinical settings (Hahn, Cummings & Michalek, 2002, p.527). Application of clinical governance approaches in management of infection in wards is immensely significant upon consideration of the harm that permitting opportunities for infections to take place can cause. For instance, Beggs, Kerr, and Noakes (2008) approximate that in Australia, there are about 200, 000 cases of infections associated with acute healthcare facilities (p.253).
Arguably, healthcare-associated infections in New Zealand entangle the most notable complications afflicting patients, especially when such patients appear in common areas such as hospital wards. Apart from giving birth to pains that are unnecessary coupled with sufferings on the part of the patients together with their families, healthcare associated infections leads to prolonged stays in hospital. Hence, they can be expensive to the entire healthcare system.
Indeed, the challenge of infections in healthcare settings does not only pose health risks to workers and patients. They can take place in any other clinical healthcare setting such as dental and even in general practice clinics without negating care facilities providing long term healthcare services. This implies that any person who accesses any New Zealand healthcare facility is at risk of infection. However, amid all this dangers posed by healthcare associated infections, such infections are significantly reducible to manageable limits by incorporation of strategies of effective control and prevention of infections as stipulated in the clinical governance strategies and principles.
Principles and objectives of clinical governance
Objectives
Clinical governance, as a concept that can proactively facilitate in reduction of infections in wards, is deeply ingrained in the foundations of the need to reorient the organisational culture to indebt in working collaboratively in enhancing quality healthcare that is subtle for forging and inducing partnerships between care providers and patients that are meaningful (Elcoat, 2000a, p.622). Indeed, clinical governance was an additional mechanism of facilitation of strategies for achievement and improvement of quality clinical care. It was vital for modernisation of New Zealand clinical services (Department of Health, 1997, p.34: Department of Health, 1998, p.13).
For realisation of the proper inclusion of the principles of clinical governance in the managerial approaches of the healthcare facilities, the objective of the clinical governance needs to be at the forefront of any program deemed substantive for delivery of quality healthcare to patients.
Firstly, clinical governance in New Zealand has the objective of ensuring that quality data is availed to aid in monitoring clinical care with regard to both the commissioned and provider services. Secondly, it endeavors to foster improvement of quality assessment processes, for instance the process of clinical audit and for taking appropriate actions with response to the feedback obtained from the users and patients. The third objective is to set priorities and indentify the myriads of education coupled with development needs of the clinical healthcare staff with the aim of ensuring that the staff is appropriately skilled.
Additionally, clinical governance has the objective of putting in place programs that facilitate professional development. In the endeavor to promote continuous quality healthcare delivery, clinical governance objects to ensure early identification of challenges of poor performance and deal with them accordingly before they escalate to higher magnitude and hence affect negatively the levels of healthcare quality delivery. Moreover, it objects to ensure promotion of fair and open-ended blame culture. This sort of organisational culture is critical since outward incidents coupled with near misses go through a precise detection and then investigation. Arising lessons can then be available among all staff followed by fostering of quality healthcare.
Principles
Upon the introduction of clinical governance, many medical scholars in New Zealand became cynical about its ability to produce change and ensure that quality healthcare goes to all patients. One of the significant counterargument was that clinical governance had numerous unwritten rules that acted only to place more emphasis on the status quo (Garratt, 2000, p.63). This means that new ideas on organisational change including New Zealand and clinical audits fell on stony grounds (Miller, 2001, p.87). On the other hand, many healthcare professionals, upon scrutiny of the principles of clinical governance disagreed with its core aims’ capacity to boost the quality of health care in clinical settings.
This is perhaps evident since many doctors, long before the introduction of clinical governance principles, had been practicing it unknowingly when they strived to deliver utmost quality care, though in fragmented, introspectively and in haphazard manner (Millward, Barnett & Thomlinson, 1993, p.219). The main principles of clinical governance constitute seven elements. These elements are education and training, clinical effectiveness, clinical audit, research and development, information management, openness, and risk management.
Education and training
After qualification, continuing education is crucial. Clinicians needs not abstain from it. This is because many of the things learned during the foundational training have the tendency of becoming obsolete. Consequently, professionals have the due duty of ensuring that they remain up to date (Squire, 2001, p.1332). On the other hand, the trust has a noble responsibility of ensuring the clinicians participate in professional development forums. Arguably, continuous education and training ensures the development of clinical governance in accordance to the complexities of differing organisations.
Various organisations subscribe to differing organisational beliefs, values, relationships, structure and even management styles. All these diversities should be in harmony for the caregivers to deliver quality healthcare in clinical settings. Basic education embraces the minimum standards upon which people can be gauged for placement in any clinical facility (Chambers & Boath, 2001, p.137). Indeed, it is impossible for basic education to address the diversities of every clinical facility. Consequently, on job education and training is critical for the clinicians to gain system understanding and communication processes which results in better service output.
Creation of cute system awareness is particularly significant since system awareness enable healthcare workers to come into acquaintance with the various parts of the organisation that can function uniquely or as a function of the whole organisation in the endeavor to bring about quality improvements. “System thinking identifies organisational problems and obstacles to quality improvement and encourages creative responses to these issues” (O’Neill, 2001, p.1074). Without proper understanding of the system, it is impossible for the workers to utilise all the resources available in the organisations in enhancing their delivery of quality care to the patients. Understanding of the system is only achievable through continuous education and training.
Clinical effectiveness
In the context of clinical governance, clinical effectiveness embraces a measure of extent to which certain inventions functions to enhance increased quality care delivery. Although the measure is ardently important on its own, other additional factors affect decisions to particular strategies to enhance the effectiveness of clinical service delivery to patients. Such factors include “whether a certain intervention is precise and appropriate representation of money value” (Taylor, Plowman & Roberts, 2000, p.28).
Stemming from this argument, concepts of clinical governance hold that, current healthcare services in clinical settings need being refined to reflect the emerging substantive evidence of effectiveness without negating efficiency aspects coupled with safety in healthcare facilities from the dimension of both the wider community and individual patients. Certainly, from this perspective, clinical effectiveness entails the approaches an organisation or a service institution deploys in order to both develop and make use of desired outcomes and agendas (McSherry & Pearce, 2002, p.23).
Thus, agenda setting to reflect on the patient focused model of clinical management is critical for enhancing the clinical effectiveness. On the other hand, the principle of clinical effectiveness maintains that such a model needs being porous to the traditional organisational demarcations. This is because “preventing infections is every one’s business and because microorganisms do not acknowledge such boundaries” (Taylor, Plowman & Roberts, 2000, p.30). Ideally, this means that infections control and prevention services and trusts have immense things to learn from each other and harmonise them into a single strategic plan.
Clinical audit
Clinical audit entangles “reviewing the clinical performance, refinement of various clinical practices and performance measures against the datum of accepted and agreed upon standards” (Taylor, Plowman & Roberts, 2000, p.29). Arguably then, clinical audit amounts to cyclical clinical care improvement process. For increasingly many number of year, clinical audit has constituted one of the pronounced methodology of measuring good clinical practices.
The only challenge of the traditional clinical audit is that it over-emphasised on the financial accountability and negated central consideration of the quality of care delivered to the patients in its premises. Although, systems of clinical governance such as New Zealand have included clinical audit as one of the requirements, opposed to traditional approach, clinical audit competes with other priorities vital for enhancement of quality care delivery. This means that in primary care, audit is only encouraged since its time competes with other priorities.
Research and development
Any professional practice needs to have immense supply of evidence acquired from a broad body of research. In this end, clinical governance endeavor to make introduction of shortened time lags coupled with related morbidity. This accomplished through conducting research coupled with implementation of results acquired from the research in enhancing the quality of clinical service delivery to the patients. To make this a realty, tactics such as “project management, critical appraisal of various literatures garnered from the research, and also developments of various guidelines, strategies of implementation and protocols” (Taylor, Plowman & Roberts, 2000, p.37) are akin and central to the process of creating a superfluous model of clinical governance.
Risk management
A perception of risks is one of the central and key principles of clinical governance. It involves consideration of a number of elements, which can foster quality care delivery while well balanced. Among these elements, the risk on the patients’ part is the most significant main issue for consideration. To mitigate such risks, good clinical governance policies encourages incredible compliance with statutory regulations (Department of Health, 2001, p.5). Another way of reducing risks to patients is through putting in place mechanisms for checking the conformance of the system to standards on regular basis. Where irregularities are evident, queries arise.
A good example of system check for conformance is through conducting critical audit events and endeavoring to gather, analyse and learn from patients and other noble stakeholders’ complaints. In this context, the system is ran through feedback mechanism in which the main plan and strategies for improving quality care delivery are derived from the consumer‘s demand requirements. Furthermore, use of medical moral and ethical standards contributes greatly in maintenance of appropriate public and patient safety. Another element of risk that is an important component of a good clinical governance program is the risks to the practitioners. Clinicians need to “be immunised against various forms of infectious diseases, should work in safe and well protected environment and are aided in getting updated with various requirements and essential elements of quality assurance” (Taylor, Plowman & Roberts, 2000, p.30).
An organisation may also be at risk. Hence, it is in the risks principle of clinical governance. One of the substantive coercion to any organisation is underprivileged eminence. Hence, the organisation needs to be mitigated from it. In this end, apart from striving to curtail risks to patients and practitioners, organisations need also to develop risks resilience. One the subtle ways of achieving risks resilience is to deploy high quality practice of employment. Such a practice encompasses reviewing and thorough scrutiny of both team and individual performance portfolios and locum procedures. Other mechanisms include designing working and favorable public involvement policies and making provisions of safe working environments.
Openness
Closed doors can serve as crucial breeding culture medium for poor practice and poor performance of healthcare organisations. Clinical governance acts to open up these closed doors to ensure openness of the health facilities’ practices for the scrutiny by the public. This happens upon considering the significance of both practitioners and patients respect of individual confidentiality. However, justification of the confidentiality in an open environment is critical element of good quality assurance under the concerns of clinical governance. Under the pillar of sincerity, as an indispensable code of clinical control, deliberations and procedures have to be crucial attributes in the organisational quality frameworks.
Therefore, any association that ardently claims that it offers good quality healthcare needs to demonstrate that it has the capacity and the will to cater for the myriad of demands of its target population. For instance “health needs assessment and understanding of the problems and aspirations of the community requires the cooperation between any relevant organisation, public health departments, local authorities and community health councils” (Scally & Donaldson, 1998, p.63). This implies that all stakeholders and interest groups in the performance of an organisation should have an opening for accessing the levels of quality of service delivered by any clinical service. This may help in determining whether an organisation embraces good clinical governance in its management practices.
Information management
Information management in the healthcare setting involves proper collection of the records of the patients’ (about their clinical information, demographic and socioeconomic information), its management, and appropriate use of the garnered information within the system of healthcare. The extent of precise accomplishment of this task, aids in determining how effective the healthcare system is in conducting its noble roles of health problems detection, priorities definition, identification of solutions that are incredibly innovative coupled with how the organisation allocates resources aimed at improving the outcomes of health interventions of the patients.
Communication of the collected information is also critical in fostering delivery of cute healthcare. Hence, effective communication of clinical information is part of the realm of the principles of information management in the clinical governance approaches. In this line, Pratt and Pellowea et al (2001) hold, “ the effectiveness of infection prevention and control practice and the potential of clinical governance to derive quality improvements largely depends on communication skills, specifically people’s ability to first understand others and then to move people from understanding to involvement and commitment” (p.332).
This insight proves that without proper enhancement of good information management through good communication, alignment of the concerns of various stakeholders of clinical healthcare organizations cannot be achieved. Hence, quality of care delivered to the patient suffers some blows.
Plan for reducing infections in wards using clinical governance principles
Objective of the plan and how achievement of the objectives can be determined
The main objective of the plan proposed in this section is to provide a theoretical proposal of strategies of preventing infections in wards in New Zealand. This plan entails making use of the principles of resource management and risks management in curtailing the spread of infections in wards. The capacity of the plan to achieve this objective can be determined through statistical comparisons of infection rates data before and after the plan is implemented.
Rationale for the plan
The rationale behind the choice of this area of concern in healthcare setting is based on the fact that, in ward, patients are always in close vicinity with each other and hence chances of spreading of infectious diseases are imminently high. Since clinical governance aims at ensuring delivery of high quality clinical care (Good Hands Report, 2006, p.2) and that the main concern of the plan discussed in this section is on enhancing quality clinical care through prevention of infections in wards, its principles are widely applicable in reduction of infections in New Zealand wards. Quality in clinical services delivery is essential for enhancing reductions of infections in wards.
In this context, clinical governance may be the concept that revolves around improving the quality of healthcare delivery in clinical settings. In this section, principles of clinical governance are in terms of prevention and control of infections in wards discussed as a specific area of application of the principles of clinical governance in nursing practice.
The role of staff
A plan of incorporating the principles of clinical governance in practice entails the deployment of concepts of risk management coupled with cute resource management as two subtle mechanisms of reducing infections in wards. To realise this plan, the professionals must play their roles in making the principles of clinical governance practical. This is because “If clinicians are to be held to account for the quality outcomes of the care that they deliver, then they can reasonably expect that they will have the powers to affect those outcomes” Good Hands Report, 2006, p.3. This implies that staff must get empowered to aid in setting the direction for the myriads of services they deliver; make decisions on the resources used in clinical facilities; and to make decisions on various people with high probabilities of being exposed to infection risks in wards.
The plan
Effective resource utilization
In order to make the principles of clinical governance practical, splendid consideration of effectiveness of resource utilisation to curb infections in wards is necessary. This responsibility mainly falls under the basket of the clinical facilities leadership. Since high quality services are predominantly resource effective, and clinical governance is all about hiking the quality of services rendered in clinical facilities, effectiveness in utilisation of resources is of paramount importance. This follows because “waste and failure of poor quality can add up to 10 percent to 35 percent to the costs of healthcare (Elcoat, 2000b, p. 880).
For example, for the case of New Zealand, adverse effects that harm patients costs it about two billion pounds every year with about 400 million pounds paid for clinical negligence claims every year (Department of Health, 2000 a, p.17). Arguably, infections in wards entangle one of such expensive adverse effects that occur in clinical facilities. Juran (1964) likened quality to “gold situated in mines” (p.79). The concept can also incorporate infections prevention and control strategy in the wards. One can explain the manner in which this concept may help in improving quality in wards and hence contribute in infections control and prevention by an example of application of clinical governance in England and New Zealand.
For instance, in England, health associated infections cost New Zealand about one billion pounds every year (Plowman et al, 1999, p.103) with 15 percent to 30 percent of the infections being potentially preventable (Department of Health, 2000a, p.23). In case people get it right for the very first time in subsequent times (Donaldson and Gray, 1998, p.41), it is possible to save about 150 to 300 million pounds every year. Such saving depicts that resources are purposely used appropriately for the good cause.
This argument points at basing the effectiveness of resource utilisation on the existing evidence of mechanisms of saving funds that can in turn be utilised in handling other critical conditions that may favor spread of infections in wards. Such conditions include poor hygiene and ventilations without negating the efforts to facilitate availing of protective gadgets and devices to the caregivers who handle differing patients and in the cause of doing their work, they may end up acting as subtle agents of spreading infections. Focusing the intervention of infection control and prevention on evidences of effectiveness of resource utilisation is one major avenue leading to achievement of high quality clinical care with the cost factors bared in mind.
Unfortunately, in the field of clinical care, in many interventions, such evidence is normally widely non-existent and if available, it is weak. Consistent with this line of thought, Masterton and Teare (2001) argue, that “even when good evidence is available, practitioners remain unaware of it and thus fail to incorporate it into clinically effective practice” (p.25). However, specialised practitioners for instance, IPCP normally undertake initiatives to acquire evidence on effectiveness of clinical care service delivery. Consequently, they act as enormous resource to other practitioners. Therefore, the plan of effective utilisation of clinical healthcare resources for the utmost good of the patients can reach every practitioner. Hence, the plan can greatly aid in reducing infections in New Zealand wards.
Use of health surveillance systems
Apart from looking at the effectiveness in resource utilisation from the dimension of cost saving so that to have optimal service delivery, surveillance systems can also play proactive roles in aiding to monitor the patterns of health associated infections in wards. The decision to install such systems lies squarely on the clinical facilities leadership and management. Hence they are the ones charged with this aspect of the overall plan of reducing infections in New Zealand clinical healthcare wards. In particular, health-monitoring system may significantly aid in inculcation of feedback approached in handling the concerns of patients in wards.
Through such an approach, health care providers become motivated to carry out thorough investigation of situations that run out of control. Armed with the information garnered, plausible interventions and remedies are instituted. This way, infections can be controlled and prevented in wards. One way of doing this is deploying charts of process variations. These charts have proved infective (Curran et al, 2001, p.15). The argument here is that any effective approach of curtailing infections in New Zealand wards needs amicable information and evidence on the effectiveness of other possible approaches that can also be deployed to yield similar results. Arguably, this argument is significant since clinical governance essentially deploys bottom-up approaches in the effort to achieve quality health care.
In such an approach supply of information from the ground- clinical wards, is vital as the information garnered aids the managerial arm to make appropriate decisions and put in place the right measure to curtail undue conditions that may lead to more pronounced infections. This is opposed to the authoritarian approach in that authoritarian managerial approach results to dissonance and is largely unforeseeable.
In this context, Robinson (2002) posits, “trying to police so many different teams and professionals would require huge resources” (p.23). Consequently, the plan of effective resource utilisation as a key way of reducing infections in ward becomes impaired. From this perception, monitoring of progress of the programs put in place to enhance quality service delivery in wards at both teams and departmental level coupled with at individual level is critical in enhancing the effectiveness of professional caregivers in ensuring appropriate incorporation of strategies of reducing the dangers infection risks in wards.
Deployment of risks mitigation strategies
This plan stems from the realisation of the fact that the current health care systems are predominantly complex. Hence, mistakes occur emanating from the organisation, human errors or even technological errors. For instance, physical equipments that help in ventilation and or in air circulation within a ward may fail. This may amplify the risks of infections. Therefore, risk management concepts are central to infection control and prevention in healthcare settings including wards. Every person who has accessibility to clinical wards has the noble responsibility of ensuring that he or she acts in a manner that would reduce chances of being infected. In actual sense, all people in clinical facilities are charged with implementation of this plan in one way or another in New Zealand.
Failure to control and manage risks may result to consequences that are disastrous to not only the organizational but also even the patients (Taylor, Plowman & Roberts, 2000, p.87). Risk management process deserves being a continuous process entangling incorporation of proactive measure to assess and evaluate risks. Various methods of controlling such risks can then be employed. To curtail situations providing subtle breading culture of infections in wards, a system of reporting errors and adverse situations and near misses effectively (Taylor, Plowman & Roberts, 2000, p.89) need to come in the process of identification of various risks coupled with differing responses to risks of infections in wards.
Most paramount to note is that, in health care interventions, risks are real. For instance, according to Meers et al (1981) “the prevalence of healthcare associated infections has hardly declined in the New Zealand hospitals over the last decade, affecting approximately 9 percent of all hospitals in-patients” (p.7). In case the number of patients suffering from infectious diseases is reduced, the risk of infection in wards can also be reduced significantly.
For this reason, health surveillance programs can incredibly reduce healthcare associated infections and hence risks to both in-patients and their healthcare providers in wards. Indeed, majority of the risks of infection can immensely get reduced through employment of strategies for safety and quality healthcare theories including; methodologies of quality improvement as stipulate by the guidelines of clinical governance, creation of culture of safety in wards and also through incorporation of system thinking culture. Therefore, for success of these theories, any endeavor to reduce risks of infections in wards needs being ardently derived from information arising from the health surveillance systems (Skoutelis, Westenfelder & Beckerdite et al, 1994, p.212).
According to Centre for Diseases Control, health surveillance system entangles “the ongoing, systematic collection, analysis, interpretation and dissemination of data regarding a health related event for use in public heath action plan to reduce morbidity and mortality and improve health (2001, p.43). Considering the immense role of surveillance in reducing healthcare associate infections, it is evident that surveillance can lead to embracement of effective interventions that can lead to reduction of infections in the healthcare wards.
For example, through monitoring hygiene, compliance coupled with bloodstream infection rates (Cosgrove & Carmeli, 2003, p.885) and then ensuring that the information goes across the entire health facility, improvement of hygiene practice is achievable. The repercussion is better management of infections with healthcare facilities including wards. Infections risk in wards call for use of technological interventions to solve them. Thus, technology encompasses an additional plan for helping to reduce the risks of infections in wards in the endeavor to improve the quality of healthcare delivery as postulated by principles if clinical governance.
Investment in IT
For success of the capacity of clinical governance to facilitate in reduction of healthcare associated infections in wards in New Zealand, it is crucial that investment in technological development is considered. This is because dependence on unrewarding and laborious data collection and cases review is largely not sustainable. However, this does not mean that substantial investment in healthcare management systems has not been incorporated in the healthcare facilities. In fact, “fully integrated patient management system already exist in many general practices and are being introduced in most hospitals in the near future” (Cosgrove & Carmeli, 2003, p.884).
The proposal here is that such opportunities needs being embraced with both hands in the endeavor to speed up the decision making processes coupled with implementation of strategies of reducing hazardous situations in wards. Although, in the modern day practices there is an incredible volume of information being feed in computer data bases in the endeavor to pace up the rate of analysis of information and hence the rate of decision making, more work needs being done in improvement of both validity and consistency in coding information upon collecting it. Consistent with line of view, Pratt, Pellowea, and Wilson (2007) posit, “Key indicators should be agreed by individual teams and departments for regular feedback of performance” (p.65). By doing this, quality indicators can be derived.
While the practitioners attempts to comply and perhaps surpass the preset quality indicators, utmost mitigation of risks of infection can be realised. Accessibility to clinical information at high speed is also critical in enhancing prevention and control of infections in wards. Many situations, upon diagnosis, patients and caregivers are not immediately acquainted with the health conditions of the patients. During the periods of admission to diagnosis and immediately before results are acquired chances of infections are eminently high. Technology can reduce these times by great extent. Hence, it is anticipated that chances of infections can also be reduced by equal or even greater magnitudes.
In this context, information technology contributes to improvement of accessibility of clinical information prompting appropriate action in the shortest time possible. In fact, knowledge databases can directly link with the libraries of clinical rooms and wards in the network. Consequently, before the caregiver offers help to the patients no matter how needy such help may be, it is possible to access the clinical information of that particular patient.
The caregiver would then offer aid bearing in mind the extent and level of risk encountered in the due cause of offering the service on the part of other patients and him/her. Recognition of perceived risks is in this context vital since the practitioner, under normal circumstances, would make decision that would minimize risks on his or her part first. Consequently, other patients likely to get the attention of the same practitioner are placed and milder risks of infection.
Conclusion
Based on the expositions made in the paper, it is evident that clinical governance is a subject that the health sector needs to give attention. Without proper governance in the field of clinics, then the target people, patients, are at risk. Therefore, establishment of a strategy that boosts this area is crucial if patients are the main agenda in the field of clinics. Quality of healthcare is the focus of the clinical governance principles. The paper reveals how the application of various concepts of clinical governance revolves around establishment of frameworks for checking the accountability of a healthcare organisation in terms of delivering quality health care to the chief client: patient.
Quality healthcare is realised when the culture of providing high standard healthcare is embraced and sufficiently safeguarded. This is possible via creation and management of an environment in which care delivery can flourish. Additionally, the paper argues that the principles of clinical governance embrace seven critical elements or pillars. They include education and training, clinical effectiveness, clinical audit, research and development, information management, openness and risk management.
However, before discussing of the principles and how they can be applied in reduction of infections in wards, an attempt was made to scrutinise the objectives of clinical governance. The paper recognised that, in wards, risks of infection are real. Consequently, it proposed the plan of reducing risks of infection in wards through deployment of information and technology in the management of patients’ clinical information, and optimal resource utilisation coupled with the plan of reducing infection through surveillance system and creation of risks awareness.
Reference List
Beggs, B. Kerr, G., & Noakes J. (2008). The ventilation of multiple-bed hospital wards: review and analysis. Journal of Infection Control, 36(4), 250–259.
Centre for Diseases Control. (2001). Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR, 50 (2), 1–51.
Chambers, R., & Boath, E. (2001). Clinical Effectiveness and Clinical Governance Made Easy. Oxon: Radcliffe Medical Press Ltd.
Cosgrove, E., & Carmeli, Y. (2003). Studies of bloodstream infection outcomes: reading between the lines. Infection Control Hospital Epidemiology, 24(12), 884–886.
Curran, T, Benneyan, C., & Hood, J. (2001). Controlling methicillin resistance to Staphylococcus aureus: a feedback approach using annotated statistical process control charts. Infection Control and Hospital Epidemiology, 23(1), 13-18.
Department of Health. (1997). The New NHS Modern, Dependable. London: Department of Health.
Department of Health. (1998). A First Class Service: Quality in the new NHS. Department of Health. London: Department of Health.
Department of Health. (2000). An Organization with a Memory. London: Department of Health.
Department of Health. (2001). Controls Assurance Infection Control Standard. London: Department of Health.
Donaldson, J., & Gray, M. (1998). Clinical governance: a quality duty for health organisations. Quality in Health Care, 7(2), 37-44.
Elcoat, C. (2000a). Clinical governance in action Part 1: Key issues in clinical effectiveness. Professional Nursing, 15(10), 622-623.
Elcoat, C. (2000b). Clinical governance in action Part 5: Resource effectiveness. Professional Nursing, 16(2), 880-881.
Garratt, B. (2000). The Learning Organisation. London: HarperCollins.
Good Hands Report. (2006). Transforming Clinical Governance in New Zealand. New Zealand: Task Group.
Hahn, T., Cummings, M., & Michalek, A. (2002). Efficacy of high-efficiency particulate air filtration in preventing aspergillosis in immune-compromised patients with hematologic malignancies. Infection Control Hospital Epidemiology 23(9), 525–531.
Ham, C. (2003). Improving the performance of health services: the role of clinical leadership. Lancet, 361(9373), 1978–1980.
Juran, M. (1964). Managerial Breakthrough. New York, NY: McGraw-Hill.
Masterton, G., & Teare, L. (2001). Clinical governance and infection control in the United Kingdom. Journal of Hospital Infection, 47 (3), 25-31.
McSherry, R., & Pearce, P. (2002). Clinical Governance: A Guide to Implementation for Healthcare Professionals. Oxford: Blackwell Science.
Meers, D., Ayliffe, A, Emmerson, M., & Leigh, A. (1981). Report on the national survey of infection in hospitals 1980. Journal of Hospital Infection, 2(1), 1-11.
Miller, J. (2001). Clinical Governance. NT Monographs No. 56. London: Emap Healthcare.
Millward, S., Barnett, J., & Thomlinson, D. (1993). A clinical infection control program: evaluation of an audit tool used by infection control nurses to monitor standards and assess effective staff training.” Journal of Hospital Infection, 24 (3), 219-232.
O’Neill, S. (2001). Clinical governance in action Part 8: Systems awareness.” Professional Nursing, 16(5), 1074-1075.
Pellowea, M., MacRae, D., Loveday, P., & Reid, P. (2002). The scope of guidelines to prevent healthcare-associated infections. British Journal of Community Nursing, 7(7), 374-8.
Plowman, R. (1999). The Socioeconomic Burden of Hospital acquired Infection. London: Public Health Laboratory Service and the London School of Hygiene and Tropical Medicine.
Pratt, R, Pellowea, M., & Wilson, A. (2007). National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection, 5(3), 65-81.
Pratt, R., & Pellowea, M. (2001). The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections. Phase 1: Guidelines for Preventing Hospital-acquired Infections. Journal of Hospital Infection, 47 (3), 332-339.
Robinson, B. (2002). “A PEST analysis of the role of clinical governance in hospital infection control. British Journal of Infection Control, 3(1), 22-25.
Scally, G., & Donaldson, J. (1998).Clinical governance and the drive for quality improvement in the new NHS in England. Oxford: Oxford Press.
Skoutelis, T., Westenfelder, O., & Beckerdite, M. (1994). Hospital carpeting and epidemiology of Clostridium difficile. Journal of Infection Control, 22(4), 212–217. Ownership. Professional Nursing, 16(9), 1332-1333.
Squire, S. (2001). Clinical governance in action Part 11: Encouraging a Sense of Taylor, K., Plowman, R., & Roberts, J. (2000). The Challenge of Hospital Acquired Infection. London: National Audit Office.