Quality Improvement in Healthcare Services

The assignment content discusses the importance of clinical governance in healthcare services, particularly in regards to patient outcomes and quality improvement. The report highlights the significance of governance and management in improving healthcare quality and addresses issues that inhibit clinical governance. A personal reflection is also included, where the author shares their experience as a healthcare recipient and reflects on the importance of integrating patient involvement and experience into healthcare service frameworks.

Running Head: HEALTH GOVERNANCE AND MANAGEMENT1
Health Governance and Management
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Contents
Introduction:...............................................................................................................................3
Origin and Relevance:................................................................................................................3
Governance and Management for Quality Care:.......................................................................5
Issues with governance:.............................................................................................................7
Personal reflection:.....................................................................................................................8
Conclusion:................................................................................................................................9
References..................................................................................................................................9

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Introduction:
Clinical governance is widely recognized as a resource for public health organizations
to improve the quality and safety of services in the services provided by the staff, facilities
and contractors. The integration of a common clinical governance framework in health
organizations refer to the mandatory requirement of a consistent organizational structure. The
interpretation of recent incidents in which the aspects of clinical governance has been widely
considered by healthcare organizations for inducing long term improvements in the delivery
of healthcare services. However, the effectiveness of clinical governance in modern
healthcare is often mired in controversies on the basis of its classification as an abstract
concept.
On the contrary, the contemporary healthcare scenario is characterized by dynamism
leading to unprecedented changes and health system failures. Hence, the changes are
responsible for inducing subsequent reforms in the clinical governance systems which could
be complemented by the involvement of clinicians (Baba-Djara, Conlin&Trasi, 2016).
Therefore, it is imperative to consider undertaking a comprehensive review of the origins and
changes in clinical governance followed by a critical analysis of principles and frameworks
pertaining to governance and management (Clark & Beatty, 2016).
The following report aims to present a critical review of the origins and relevance of
clinical governance in healthcare alongside the significance of governance and management
in the improvement of quality care. The report would also illustrate the probable setbacks in
governance and their relevant implications on clinical governance. The concluding section
would comprise of personal reflection on a specific experience as a recipient of healthcare
which would be helpful for drawing recommendations to improve quality of healthcare
through clinical governance framework (Dickinson, et al., 2015).
Origin and Relevance:
Clinical governance emerged in 1997 in the form of an abstract concept by the NHS
for improvement of the quality of care. The reasons for the emergence of clinical governance
could be explicitly anticipated in the wide range of incidents which indicated the failure of
NHS. One of the examples of such incidents which led to the proliferation of clinical
governance concept could be observed in the case of the Bristol Royal Infirmary Inquiry in
2001 which investigated 23 deaths (Dimitropoulos& Thompson, 2014).

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The investigations revealed that the patients suffering from cardiac surgical paediatric
afflictions were subject to unwarranted variations in clinical practices as well as undesired
outcomes. Other notable incidents such as the case of the GP Harold Shipman and the Royal
Liverpool Children’s Inquiry were also responsible for inviting widespread political and
public concern thereby increasing the emphasis on realizing the potential of clinical practices
for causing harm to individuals. This factor could be used to perceive the necessity of clinical
governance. Furthermore, the necessity for clinical governance was also responsible for
developing concerns among health professionals for inducing major reforms in delivery and
management of healthcare services on the basis of critical analysis and comprehensive
reflection.
Quality healthcare is one of the major concerns of every individual and is often
accounted as the determinant of an individual’s perception about their life (Fattore&Tediosi,
2013). The lack of coordination among the general practitioners, primary care professionals,
nurses and managers could also be accounted as a significant necessity for establishing
clinical governance frameworks. The implementation of clinical governance can be
accounted as a remedial measure for addressing the issues that were observed in patient
outcomes. Clinical governance could be effective for realizing outcomes such as improve
health outcomes of a considerable share of population, enhancing quality standards,
development of services and commissioning different hospital services (Ferlie, et al., 2017).
Even though it is clear that the NHS adopted the concept of clinical governance to address the
sudden increase in number of incidents related to discrepancies in provision of quality care,
the apprehension of the reason for which the issues increased unprecedentedly is necessary.
Therefore the scope for reforms in existing healthcare service delivery frameworks
could be largely derived from the concerns of inquiries into healthcare incidents as
observed in the case of different examples of incidents that led to the proliferation of
clinical governance. It can also be aptly perceived that the origin and relevance of
clinical governance has a comprehensive association with the inquiries into healthcare
system failures, thereby validating the dynamic nature of the clinical governance
concept.
Some of the factors could be explicitly apprehended in the rising costs of healthcare
which are complicated further with the impact of macroeconomic factors such as lack of
public funding or ageing populations. These factors are responsible for drastic changes in the
delivery of healthcare services which could also be affected by the trends in purchasing

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behaviour of customers. The minimal emphasis of the healthcare service providers on quality
of care services as well as the implications of patient demands according to modern scenario
refer to potential reasons for which the issues related to variations in patient outcomes were
escalated drastically all of a sudden.
The lack of precise guidelines for patients and regulations for their privileges in terms
of preferences for engagement in healthcare framework could also be accounted as profound
reasons for the rise in issues related to patient outcomes (Fletcher, 2016). Another explicit
factor which could be observed in context of the rise in issues related to patient outcomes is
the lack of transparency of processes and information for patients which served as a major
influence on quality of the outcomes.
Clinical governance was also required to inhibit the formidable setbacks delivered by
superficial investigations in poor patient outcomes. The feedback delivered by patients was
not appropriately documented nor was it processed appropriately to identify the sources of
error in delivery of healthcare services. It is also essential to observe that the lack of any
profound patient advocacy groups in the 1990s reflected on minimal pressure on healthcare
providers and organizations for considering the quality of outcomes in the clinical practices
(Gill &Benatar, 2017). Therefore, it can be aptly perceived that the healthcare services that
were facilitated without clinical governance were not centred on the demands of customers
which could be assumed as a major reason for the observed pitfalls.
Governance and Management for Quality Care:
The apprehension of the distinct structures involved in the healthcare service
provision framework could be used for addressing the significance of governance and
management in delivery of quality care. Thereafter, it is essential to observe the individuals
responsible for establishing the different structures involved in a healthcare service
framework as well as the rationale for design of the structures (Greaves & Greaves, 2017).
Requirement for understanding governance and management could be
addressed effectively through the investigations into healthcare incidents. The
significance of the investigations could also be observed in the form of improved quality
of healthcare services. The interpretation of the significance of governance and management
in provision of quality care should also comprise of references to the factors determining the

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necessity of governance and management in healthcare frameworks and the issues which
arise in terms of quality improvement (Kickbusch, 2016).
Governance and management could be considered as primary attributes for the
induction of awareness among public health organizations to be consistently inclined towards
improvement of quality of health care services as well as preservation of high standards in
healthcare. The aim of governance in such cases could be observed in the creation of a
favourable environment in which research and excellence pertaining to clinical care could be
promoted effectively. The inquiries into healthcare incidents not only provide an
impression of the immediate causes and sources of issues but also a precise illustration
of the context which lead to the issues.
The implications of governance structures could be identified in the effectiveness of a
systematic approach to realize the objectives of promotion and maintenance of quality
care(Klaedtke, Chable&Stassart, 2016). The structures for governance and management in
healthcare could be considered as crucial and mandatory additions in order to assure the
highest possible quality of care provided to patients. One of the formal reasons to apprehend
the presence of structures in health could be identified in the favourable outcomes that can be
obtained from systems of accountability and formal reporting.
The limited empirical research on structures of health in context of governance in
clinical practices could be addressed through the anticipation of the generic interpretation of
structure of clinical governance. The key components involved in structure of clinical
governance reflect on the significance of foundations of the components as well as the
underlying philosophies which are largely dependent on quality care and patient centric
approaches. The structure of clinical governance was developed by the NHS for interactive
involvement of patients in the healthcare process as well as the empowerment of patients
(Kuhlmann, Batenburg&Dussault, 2016). The necessity of integrating these structures in
healthcare provision could be perceived as a crucial initiative for addressing contemporary
trends in the domain of healthcare. The impact of inquiries into healthcare incidents could
be ascertained from the aspects of obtaining valuable insights for academic research
which can be assumed as a viable opportunity for inducing credible reforms in future
service delivery models. It is also imperative to understand that inquiries into incidents
involving healthcare issues could also provide the opportunities for development of
clinical governance model.

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From a critical perspective on the incidents of inappropriate patient outcomes, the use
of governance and management structures is imperative. The application of governance
structures in health could enable the systematic recognition of sources and impact of the
issues through clinical audit (Mattei, 2016). The need for governance structures could also be
validated on the grounds of the integration of research, reflective practice and consistent
professional development which leads to comprehensive review of the situation. Furthermore,
it is imperative to apprehend the various challenges which are faced by governance
frameworks in improvement of the quality of primary healthcare. The estimation of the
different reasons is liable for providing a credible impression of the possible measures which
could be implemented for reforms in the structures of healthcare governance and
management.
The different reasons which validate the efficiency of governance in the improvement
of quality of care could be assumed as motivation to deal with the issues pertaining to quality
improvement. Some of the key issues could be identified in the proliferation of clinical
leadership, dedication of staff members, emphasis of strategies on systems and evidence
based developmental approaches. The improvement of quality could be ensured only through
implementation of reasonable reforms according to the observations from the incidents which
characterized unfavourable patient health outcomes. The critical reflection on poor patient
health outcome incidents with respect to the theoretical and empirical research pertaining to
clinical governance could enable the proliferation of feasible insights into the potential
contingencies that can be implemented in quality improvement initiatives. The barriers of
uncertainty regarding the pace of change and substantial volume of work involved in
realizing a new quality improvement framework in a conventional setting could be accounted
as primary issues for quality improvement (Nikogosian&Kickbusch, 2016).
Another potential factor which is related to the inhibition of quality improvement in
healthcare settings could be apprehended in culture conflicts which inhibit the promotion of
information sharing and learning. The approaches followed by a healthcare organization for
quality improvement could be subject to ambiguities due to the variations in different levels
of healthcare, financial resources and information technology competence.
It is also mandatory to perceive the different counter effects that could be drawn
from quality improvement as derived from the outcomes of inquiries into healthcare
incidents. The recommendations from the inquiries could take substantial variants of

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time periods for completion which may not be possible for all organizations. These
factors could lead to detrimental consequences for clinical governance initiatives alongside
depicting formidable references to the outcomes such as steeper learning curve, prolonged
rime for absorbing and comprehending multiple initiatives complemented with longer
working hours. Another potential issue that arises for quality improvement is observed in the
form of confusion related to development of role of managers and leads (Rahman, 2016). The
emphasis on the significance of the clinical governance lead, emotional impact of the role on
the individual as well as long term uncertainty associated with governance in healthcare
settings could also be accounted as issues hampering quality improvement.
Issues with governance:
The understanding of the potential issues that can be observed in the case of issues
with patient outcomes in modern healthcare settings could be clarified with an illustration of
the primary drivers of governance and the responsibilities of individuals in charge. The issues
could also be clarified with an impression of the reasons for which clinical staff has to be
aware of the implications of governance alongside the need for continuous quality
improvement (Raipa&Čepuraitė, 2017).
The major drivers of governance that can be identified in the domain of healthcare
could be classified into three categories. The first factor which is responsible for driving
governance could be identified in the environment characterized by the change. The second
factor involves references to the individuals responsible for implementing governance while
the third factor refers to the professional users of the governance frameworks. The
environment of change in governance is characterized by the involvement of the architects of
clinical governance as well as the environment in which the governance framework would be
implemented (Rotar, et al., 2016).
The individuals that are associated with the tasks and responsibilities for
implementing the necessary changes in governance could be accounted as leaders of change
and are significant influences on the reforms in clinical governance approaches. The
professional users of the governance framework could be accounted as major drivers of
governance since they would be liable for integrating the governance framework in their
daily routine which is observed as a mandatory concern for all staff involved in the domain of
healthcare.

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The assignment of responsibilities to the leaders of change could be identified as a
promising initiative for fostering the environment of excellence especially through
establishment of realistic targets and standards. The responsibilities of the people in charge in
a clinical governance framework could also be identified in terms of monitoring the
governance contracts with recipients of governance benefits and users of clinical governance
(Roy, Litvak&Paccaud, 2013). This enables the users and recipients to obtain a credible
impression of the transparency that is evident in the healthcare system thereby improving the
opportunities for their involvement in the clinical processes and practices. For examples,
users could obtain proactive information regarding use of penalties in context of clinical
governance in order to ensure their support in valid scenarios.
The necessity for awareness of staff regarding clinical governance could be validated
on the grounds of their objectives. The awareness of staff members is required for
apprehending the time available for reflective practice and consistent quality improvement as
well as funding for implementing governance initiatives (Santos &Giovanella, 2014). The
awareness of staff regarding clinical governance could also be validated on the grounds of the
prevention of conflicts among national and regional regulations pertaining to quality of
healthcare.
The necessity for improvement of quality in healthcare services could therefore be
validated on the grounds of opportunities to create precise frameworks that provide
substantial privileges for users of healthcare services to be involved in the governance
framework. The improvement of quality in healthcare could also be perceived as a necessity
due to the emergence of wide range of afflictions and the growing ageing population. The
implementation of frequent inquiries into healthcare incidents could therefore be
considered as a feasible source for addressing the issues of inappropriate healthcare
governance frameworks.
Personal reflection:
The observation of varying aspects of clinical governance such as its origin and
relevance alongside the structure of clinical governance with respect to a personal experience
could facilitate reasonable impression of the opportunities for quality improvement.
The personal experience involves my visit to a public health hospital due to the
affliction of viral fever which validates my impression as a recipient of care. I was admitted

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for two days and was subject to the care facilities in the hospital. However, I was able to
observe that my stay at the hospital was associated with the concerns of improper hygiene
which occurred probably due to an unprecedented error in the assignment of janitors for
cleaning my cabin. While my cabin was supposed to be cleaned four times a day, the cleaning
personnel came only two times a day which led to an unhygienic atmosphere (Toh, et al.,
2016).
The event made me consider quality since the unhygienic atmosphere caused due to
lack of cleanliness could be assumed as a profound impact on the excess of viral pathogens in
the surrounding. Furthermore, the psychological impact of an unclean surrounding during
recovery also affected me the most and made me consider the quality of care being provided
to me. Therefore it is imperative to integrate a promising component from the clinical
governance framework in the concerned personal experience to resolve quality issues. The
dimension of patient involvement and experience could be integrated in the healthcare service
framework for obtaining a wider range of functions such as clinical audit alongside
accomplishing a first-hand impression of the patient’s experience (Santos &Giovanella,
2014).
I was able to reflect from the experience that the involvement of higher authority
in investigation of the healthcare incident. The healthcare incident comprised of lack of
appropriate cleaning and hygiene services which could be addressed through the
remedial action taken by the inquiry personnel. The action would also ensure the
establishment of novel guidelines in order to prevent any such discrepancies in the
future.
Conclusion:
The report presented a formal illustration of the origins and relevance of clinical
governance in contemporary scenarios involving issues with patient outcomes. The primary
objective of the report was to respond to the query of whether inquiries into healthcare
incidents are responsible for inducing reforms in the clinical governance frameworks.
Then the discussion on the significance of governance and management on the improvement
of quality in healthcare was also included in the report which was followed by the depiction
of notable issues that inhibit clinical governance.

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The final section of the report depicted critical reflection of a personal experience as a
healthcare recipient along with plausible recommendations for reforms in clinical governance
framework to accomplish desired outcomes.
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