Clinical Governance in Nursing

Running head: Clinical Governance in Nursing
NURSING STUDY
-Clinical Governance
Name of the Student
Name of the University
Author Note

1Clinical Governance in Nursing
Introduction:
Clinical governance is an ‘umbrella term’ that refers to a system through which
healthcare organization develop the responsibility for continuous quality improvement and
maintain high quality care by fostering an environment that can facilitate excellence and
flourishing clinical care (Scally and Donaldson 2015; rcn.org.uk 2018). Clinical Governance
ensures proper care for everyone seeking healthcare, facilitates the best practice by staff,
maintenance of the best possible standards (Qotba 2018). The importance of clinical
governance is supported by the duty of healthcare organisations in the maintenance of quality
and safety of care. Because of such aspects, clinical governance has been implemented in the
UK by the National Health Service (NHS) and involves 5 key themes: patient focus,
information focus, quality improvement, staff focus, leadership (rcn.org.uk 2018). This can
be considered as a part of Total Quality Management (TQM) which is an approach towards
long term success through customer satisfaction, where the members of the organization
are involved in the improvement of the process, services or products as well as the work
culture (asq.org 2018). Such aspects of TQM have been incorporated into the HA Annual
Plan framework 2017-2018 that included three strategies: a) providing patient centered care
b) developing competency and commitment in workforce c) improve financial
sustainability (Ha.org.hk 2018). Al-Shdaifat (2015) suggested that the most important factor
in the implementation of TQM was to maintain a customer focus as the first priority,
attributed through interviews with nurses. Hong Kong uses the clinical governance model
utilized by the UK because of two reasons a) similarity in the professional training systems
between UK and Hong Kong and b) the developmental stage of the UK model allows scope
for learning through their experiences (Leng 2005)
In this essay, the importance of clinical governance will be discussed briefly, and then
the causes of the selected scenario (scenario 2) will be visualised using the Fishbone model.

2Clinical Governance in Nursing
After this, the strategies to address such causes will be discussed to identify appropriate
clinical governance strategies. In the conclusion, the key aspects of the discussion will be
highlighted.
Main Body:
Ishikawa’s Fishbone Analysis is a universal model that can be used in the
identification of cause and effects associated with a given problem and represented in a
structured format. This visual tool allows several contributing factors to be changed
simultaneously and helps to fully comprehend the identification of multiple factors associated
with a situation or problem. It allows scope for team discussions and solving problems, and
facilitates systematic discourse while maintaining focus on the problem. IN the fishbone
model, the problems are categorised into different groups like: people (the involved
personnel in the process); process (any important pasrt6 of the process); equipment (used in
the process); material used and management (evaluation of quality through evaluation of
data) and environment (Vetter et al. 2016).
Figure 1: Ishikawa’s Fishbone model; source: (Vetter et al. 2016).
Advantages of the fishbone model are:

3Clinical Governance in Nursing
 Allows a comprehensive analysis of the causes of a problem without the possibility of
overlooking any root cause
 Easy implementation of the model.
 Easy to comprehend due to the visual representation of the cause-effect relation.
 Enables focussing on the big picture in relation to the influences of the identified
factors on the problem or issue being discussed.
 It also allows identification of areas of weakness, and therefore the scope of further
improvement and rectifications.
Disadvantages of this model are:
 Complex situations, involving interrelation of several different factors might be
difficult to represent on the fish bone.
 Lack of space while drawing the fishbone can leave inadequate scope for the
exploration of cause-effect relation properly.
 The model only focuses in analysing the causes of a problem but not on any solutions.
(siteresources.worldbank.org 2018)
The Annual report on sentinel and serious untoward events- 1 October 2013 to 20
September 2014 published by Hospital Authority Hong Kong on January 2015, showed 19
cases of death of an inpatient due to suicide (that included 10 patients on home leave and 2
patients reported missing. The report showed that most of the Sentinel Events in the hospitals
were contributed by retained instruments or materials during surgery (20 events) and due to
inpatient suicides (19 events). However, the suicide cases accounted for most of the severity
of the consequences compared to other sentinel events (Ha.org.hk 2015).