Clinical Governance - Auditing

Clinical Governance is the NHS's focus on constantly improving care through research and audits. The NHS have an obligation to account for the quality of their services through systematic and critical analysis of the standards of their clinical care. They are accountable to fix any deficiencies within the NHS.

There are elemental differences between research and audit which we'll now look at.

Both research and audit start with a question, use formal data collection through appropriate methods and designs, and then expect the answer to influence practice. Both improve professionalism and define good practice.

Research

Research is a fundamental aspect of providing evidence based practice, to ensure that the practice Healthcare professionals undertake is relevant, it is crucial to continuously advance professions and the protocols we adhere to, in order to provide optimal patient care. Research is usually one off, it can allocate patients into random treatment groups which can use placebos or new treatments, and can disturb the patient beyond their clinical treatment.

Audits

Audits, however, are on-going and doesn't disturb the patient at all. Audit provides development of professional education and regulation within the NHS, it increases care, accountability, motivation, inter-professional working and clear assessment of need. Audits support our status as autonomous professionals.

Structure

1. Set out a clear criteria 
2. Clear standard assessment
3. What's it's relevance to clinical practice? (reference to literature to justify) *Why?
4. Preparation and planning *How? *What? *Who?
5. What are the proposed changes?
6. How successful was the audit?
7. How successful were the changes?
8. What did you learn?
9. Where does the department go from here?
10. REPEAT



 Audits are not about performance appraisal, needs assessment, research, competition between departments/professionals, statsitics or disciplinary actions. Audits just assess

"What should be happening?

"Is this happening?

"Why not?

"How can we improve this?

Within your departments there should be clinical governance and audit committees which meet regularly and have high numbers of participants (according to the RCR)

Continue reading →

Radiography Structure and Roles

The Four Tier model in Radiography states there are four main roles within a Radiography Department since the Agenda for Change enforced pay-band changes (Employees were to be paid according to their skill and competence, rather than their professional status).

Assistant Practitioner - Undertakes specific roles under supervision from a registered professional

Practitioner - Undertakes a wide-range of tasks and has professional accountability, Continuously develops practice (CPD)

Advanced Practitioner - Autonomous in clinical practice within a defined field and defines scope of practice for others - CPD

Consultant Practitioner - Clinical, professional leadership through research, education and development in practice within a specific field. Partakes largely in Interprofessional Working as their role crosses over other's roles also (must partake in MultiDisciplinary Team Meetings), 50% of their time must be clinical practice - undertaking (and reporting of) procedures - CPD 

According to the Department of Health the Four Tier structure betters patient outcomes, develops career opportunities (such as Consultant Radiographers), develops workforce, retention of expertise and improves leadership. It improves Clinical governance (audits, protocols, CPD), patient pathway and national policies.

Although the Four Tier framework allows for clearly defined roles, Constultant Practioners must overlap roles and work together in order to provide a more efficient, patient focussed NHS. 

We must all go the extra mile. Just put in that little bit more time and make someone else's life easier. You never know when you'll need their help.

Continue reading →

Structure and services of the NHS

The structure of the NHS is so that service users are at the centre of everything we do.

There's the Governmental sections:

Department of Health - Creators of policies, legislation, law 

Parliament - Passes these laws

The Non-Departmental and Regulatory Bodies:

NHS England - Set out from the Health and Social Care Act'12

 runs the day-to-day life of the NHS including finances and budgeting

 Care Quality Commission - Regulate all NHS services through inspection 

to ensure they meet protocol, law and legislation 

 Monitor - Regulate all Foundation Trusts through inspection

 to ensure they meet protocol, law and legislation

 Health Research Authorities - Regulates research within the NHS to protect patients,

 ensures evidence based practice.

The National Organisations: 

Clinical Commissioning Groups - Commission Any Qualified Provider 

for patients to choose their care from.

HealthCare Professions Council - Provide protected-title registration for

 Healthcare Professionals who meet their standards.
Healthwatch England - Local health groups which raise awareness
of patient's concerns to the CQC 

The Local Services:

Primary Care providers - Provide prevention, advice and

 initial treatment (GP's, Dentists)

Secondary Care providers - Provide acute treatment (Emergency Departments)

Tertiary Care providers - Provide care for chronic illnesses (Oncology departments)

Finally, the most important:

Service Users - Patients, Carers, Family and Friends.

The White Paper'10

The NHS has committed to constantly improving it's services to provide the best care possible, best value and better efficiency. The White Paper (2010) set out the NHS to become more efficient and less bureaucratic. The White Paper changed Primary Care Trusts to Clinical Commissioning Groups of general practice, who are responsible for choosing and buying health services from AQP's. £80 billion of the NHS budget will be held by GP's (who need to be trained in financial and managerial aspects of commissioning). CCG's allow for more user involvement when planning service delivery and allow the patients to have a better choice of care. Also, by allowing healthcare services to be commissioned away from the NHS, it increases motivation within departments to be better, so that the patient would choose their service.

The Patient Advice and Liaison Service (PALS)

PALS provides general advice to patients about their care, but also is platform for patients to raise concerns and complaints about the care they have received. Every hospital must have a PALS department, and must advertise it's existence and encourage it's usage. 

Continue reading →