MSc Nursing: Clinical Governance Pillars and Patient Care Analysis

This report delves into the multifaceted realm of clinical governance within healthcare settings, concentrating on two pivotal pillars: clinical audit and staffing/staff management. It elucidates the framework of clinical governance, emphasizing its role in enhancing service quality and patient safety. The report meticulously defines clinical audit, detailing its significance in assessing clinical practices against established standards and fostering continuous improvement. It explores the rationale behind conducting clinical audits, highlighting their function in identifying skill gaps, mitigating risks, and promoting a culture of quality. Furthermore, the report examines the critical relationship between clinical audits and patient safety, emphasizing their role in ensuring services meet quality standards and identifying areas for improvement. The report then transitions to the critical aspect of staffing and staff management, underscoring their impact on patient care quality. It discusses the consequences of inadequate staffing levels on patient safety, including increased risks of adverse events, and emphasizes the importance of appropriate staffing ratios and skill mix. The report provides a detailed overview of the steps involved in clinical audit programs, including planning, criteria selection, performance measurement, and improvement implementation. It also highlights the significance of risk management as an integral component of clinical governance, emphasizing its role in identifying and preventing potential risks to patient well-being. This comprehensive analysis provides valuable insights into how clinical governance, through clinical audit and effective staffing practices, significantly influences the quality and safety of patient care in healthcare settings.

Running head: CLINICAL GOVERNANCE
CLINICAL GOVERNANCE
Name of the student:
Name of the university:
Author note:

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Contents
Introduction:....................................................................................................................................2
Clinical audit:...................................................................................................................................2
Reasons for undertaking clinical audits:..........................................................................................3
Clinical audit and its association with that of safety and quality care to patients:..........................4
An example about how I can manage clinical audit:.......................................................................4
Steps of clinical audit that I would be following:............................................................................5
Risk management:...........................................................................................................................6
Staffing and staff management:.......................................................................................................7
Impacts of low staffing on the quality and safety of patient care:...................................................8
Nursing skill mix and impact on the patient safety:........................................................................9
Ways I can ensure effective staffing:.............................................................................................10
Conclusion:....................................................................................................................................11
References:....................................................................................................................................11

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Introduction:
Clinical governance is a framework by which different types of NHS organizations are
found to be accountable for continuously improving their quality of their services towards
patients and also safeguarding high standards by developing an environment which influences
the flourishing of clinical care. Seven important pillars mainly act as the foundation of clinical
governance in the healthcare centers and this is seen to include clinical effectiveness, audit, risk
management, using information and information technology, education and training, staffing and
staff management and also patient and public involvement (Van et al. 2018). Studies are of the
opinion that clinical governance helps in ensuring that every service users should get the right
care at the right time from that of the right person and that the best care is provided at the first
time only (Veenstra et al. 2017). Clinical governance is the responsibility of every member of the
staffs that include doctors, nurses, radiographers, physiotherapists, laboratory staffs, cleaners,
porters and also different administrative staffs (Olds et al. 2017). This assignment would be
mainly focusing on two important pillars of clinical governance like staffing and staff
management and also clinical audit. It would discuss the importance of these pillars in providing
safe and quality care for the patients and also for the other staffs in the healthcare centre.
Clinical audit:
The term clinical audit can be used for describing the procedure of assessing the clinical
practices against the standards. It can be defined as the clinically led quality improvement
process that helps in improving patient care as well as patient outcomes through the systematic
review of care against explicit criteria and also to take actions for improving care when standards

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are not met (Prenestini et al. 2015). Studies have explained this procedure as the selection of
different aspects of the structure, procedures as well as outcomes of care that are systematically
evaluated against that of the explicit criteria (Cho et al. 2016). When required, improvements are
also seen to be implemented at an individual, team as well as organizational level and then the
care is re-evaluated for confirming the improvements.
Reasons for undertaking clinical audits:
Clinical audit is actually a tool which is used for discovering how well the clinical care is
being provided by the healthcare professionals and also helps in learning if there are any
opportunities for improvement. Therefore, when clinical audit is conducted, it can help in
understanding the knowledge or skill gap of the professionals and accordingly further actions are
taken for helping the professionals overcome their barriers and bridge the knowledge gap. It not
supports professionals in their career growth and helping them to develop expertise skills but
also enable them to provide high quality and safe care to patients (Fardazar et al. 2015). It can
also be utilized in association with different changes in the care provision and also for
confirming that whether the current practices are able to meet the expected levels of the
performance (Welp et al. 2015). Firstly, clinical audit helps in offering a way for assessing and
improving patient care and also for upholding professional standards and “doing the right
things”. Secondly, through clinical audits healthcare professionals are also able to identify the
risks that are present within the service and accordingly steps are taken to mitigate the risks and
ensuring safe care services to the patients (Paton et al. 2015). Third, regular audit activity helps
in creating a culture of quality improvement in that of the clinical setting. Fourth, many of the
studies are of the opinion that clinical audit is educational for the participants and it involves
being up-to-date with the different evidence based good practice. Fifth, it also provides an

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opportunity for increased job satisfaction for the healthcare professionals and is also seen as an
important component of professional practices helping in improving the quality and the
effectiveness the care.
Clinical audit and its association with that of safety and quality care to patients:
Clinical audits form the backbone of the clinical governance in most of the healthcare
services in the present generation. The main function of the clinical audit procedures are to
establish whether services are being delivered following the required quality standards and if not
met, steps are implemented for improving them (Govaert et al. 2015). With the help of successful
clinical audits, professionals would be able to bale to collect the relevant data as well as analyze
the data and then understand it and then use the data for formulation of plans and strategies that
would be implemented for improvement. Studies are of the opinion that clinical audits should
ensure giving confidence to all the stakeholders of the organization that it has the capacity of
monitoring the care of the people who are using the services (Faggerstorm et al. 2018). They
should thereby make positive differences by flagging different types of shortfalls in the care
service that have the ability in compromising the safety of the people who are using the services
(Prades et al. 216). Clinical audits also help in setting comparison of the care standards of a
healthcare sector with that of the national health standards set on the basis which are good for the
care of the service users who use them. Audits mainly help in allowing such comparisons to be
made openly as well as transparently and this help to provide information to that of the public.
An example about how I can manage clinical audit:
Enquiries into different types of serious incidents would mainly include an audit of
relevant care as well as service parameters as well as other factors so that lessons can be learnt

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from the incidents and thereby disseminated into the wider improvement. Such audits are seen to
be helpful as they reveal any areas of vulnerability that might compromise required standards for
safety (Treble et al. 2015). I would try to focus on the strengthening of these areas as these would
help in the reduction of the risks to the safety and also reduce the chances of similar serious
incidents recurring again in the practices. Studies are of the opinion that such one-off audits
mainly follow serious incidents which require a deeper level of interrogation as well as scrutiny
than it is required for regular routine audits (Kear et al. 2015).
Steps of clinical audit that I would be following:
 The first stage of the clinical audit is planning for the audit. Of a clinical audit is
needed to be successful in identifying the areas if improvement or he areas if
excellence, it should include effective planning as well as preparation (Liu et al.
2019).
 The next step is called the standard and criteria selection. When the topic for the
clinical audit is already selected, the next essential step is to review the available
evidences to identify the standards and then auditing the criteria against which the
audit would be conducted (Chambers et al. 2016)
 The third step would be mainly including measuring the performance. This would
include four parts with the first being collection of the data about the current
practices in order for facilitating the comparison and the second one is data
analysis like converting a collection of facts into useful information for
identifying the level of compliance with that of the agreed standard (Cope et al.
2016). The third step is called the drawing conclusions like identifying the
reasons why standards was not met. The fourth step is called the presentation of

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the results that mainly include maximization of the impact of the clinical audit on
the audience for generating discussion for the stimulation and also supporting
action planning.
 The fourth step that I would follow is the making improvement stage. The
purpose of this stage is assessing the degree to which the clinical services would
comply with the accepted evidence-based practice standards (Stimpfel et al.
2019).
 The fifth step would be sustaining improvements. This step mainly includes the
monitoring of the quality improvement plan along with performance indicators
and even dissemination and celebrating success and then remembering to close
the loop which is also called re-auditing (Griffith et al. 2016).
In the above mentioned way, I would be participating and developing clinical audit programs and
undertakes such programs in the systematic approach so as to ensure that the best care services
can be provided to patients that ensure high quality and safe.
Risk management:
An important aspect of clinical governance is risk management. By effective risk
management, healthcare professionals can successfully identify what can go wrong while caring
for patient and also understanding the factors that can influence the safety of the patients and
prevent the risks of injury or harm of their well-being (Howell et al. 2015). Professionals also
would need to learn new lessons from any form of adverse events and thereby ensure prevention
of the recurrence. They would need to arrange systems in ways by which they can reduce risks.
The number of nursing professionals as well as their skills also contribute to ensure that patients

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can be provided safe and quality care and that any forms of risks are identified and prevented by
them before they affect patient health. The following paragraphs would show how numbers of
nurses and skill-mixing can ensure effective risk management providing patient with safe care.
Staffing and staff management:
Staffing as well as staff management is extremely vital for the ability of every healthcare
centers to provide high quality patient care. Every organization needs to have appropriate
number of staffs that align with the patient needs of the organization. Such cohorts of staffs
should have the appropriate skill mix so that they can handle various forms of treatments as well
as the different needs of the patient thereby enhancing patient satisfaction. Studies are of the
opinion that hospitalized patients are seen to face avoidable deaths when the staffing levels of the
registered nurses are low (Falk and Wallin. 2016). The study had also stated that the presence of
additional amount of unregistered nursing assistants never becomes able to mitigate the risks
according to the retrospective analysis of the data from large acute hospitals. Twigg et al. (2016)
had shown that each day spent in an RN-understaffed ward witnessed over a period of 3 years
have been seen to conferred a 3% rise in the mortality risk whereas an additional hour of care
provided by that of the RN was found to be associated with a 35 reduction in the chances of
preventing avoidable deaths and also increased patient satisfaction. An interesting data that had
been also obtained from evidence based searches showed that in contrast, a high level of nursing
assistant staffing can never compensate for the low staffing levels of the registered nurses. A
high level of nursing assistant staffing could not reduce the mortality risks and were in turn
found to be associated with an increased risk for death among the vulnerable patients (Martsolf
et al. 2016).

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Impacts of low staffing on the quality and safety of patient care:
Firstly, reduction in the number of nursing employees is seen to affect the patient safety
increasing the higher risk for adverse events.. The fewer the nurses in monitoring the patients of
the hospital, the higher will be the chances of adverse events taking place. It has been found that
each extra patient that is assigned to that of the nurse results in a 7% increase in the in the risk
for the hospital acquired infections along with more than 50% increase in the respiratory failures
and almost an increase in the 20% increase in the overall medical complications (Park et al.
2017). Secondly, another important impact of low staffing in the healthcare unit is employee
burnouts. Reduction in the amount of nursing staffs in any of the healthcare facility would result
in the existing nurses having to work for longer periods of time than before. This would not only
result the existing nurses to experience burning out after working excessively for longer hours
but the healthcare organization would also result in experiencing higher than necessary
turnovers of the nursing employees. When nurses get forced to work for long hours to meet the
patient demands, they are found to be far more prone in making mistakes when it comes to the
patient care in different cases (Feo et al. 2016). For example, a single mistake with regards to
medication dosage or even basic care instructions can be found to be fatal to the patients. Third,
inadequate staffing is also found to be intricately associated with longer stays for patients. When
nurses have to care for large number of patients than they are able to cope with, the situation can
result in having the patients to stay for longer days in the hospitals than necessary. This is mainly
because that they are not monitored as often they should be which would result in the
development of the conditions like that of the bed sores and many other serious medical
complications (Chau et al. 2015). Moreover, hospitals are fined every time when patients
develop any form of hospital acquired infections as well and therefore, hiring additional nurses

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would prove to be important in reducing the running costs of the hospitals in the long run.
Fourth, another important impact of inadequate staffing is associated with increased likelihood of
the death of patients. Nurses who have increased workloads would obviously not be able to take
good care of the patients assigned to them like the way they should do. Patients would not be
able to achieve the best possible care missing out on important interventions and improper
medication administrations (Ball et al. 2018). This would be resulting in the deaths of more than
one or more patens like those in the high care or intensive care wards required for round the
clock monitoring so that the patients can get well soon.
Nursing skill mix and impact on the patient safety:
Studies have shown that higher nurse-patient ratio is not the only factor that governs the
better quality care and lower mortality rates of the patients. Nursing skill mix is also found to be
an important contributing factor that also has great impacts on patient safety and quality care.
Skill mix can be seen to refer to the skills as well as the experience of the staffs along with their
continuing education and professional development, combinations of skills that are available at a
particular time, years of experiences and how they would be bringing these together for
influencing their professional judgment and provide high quality care for the patients. it has been
found that good skill mix of the nurses can contribute to high quality of the patient care and also
help in ensuring patient satisfaction and even clinical outcomes. Better the nursing skill mix of
the professionals in the hospital, it would help in managing the rising costs of staffing of nurses
and would also help in managing the labor market which is shrinking. Studies are of the opinion
that staffing costs mainly include for about 60 to 80% of the operating costs (Cho et al. 2016).
Therefore, it is important for determining the “right” combination of the staffs with the right
form of skills that would help in maintaining the critical component of the successful and

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efficient health care delivery. In the present day system, every healthcare centre is already facing
huge constrains in funding and resource allocation due to increased demand of patient services.
In such situation, recruiting more nurses but with lesser skills and knowledge can only provide
more pressure in the funding of the hospitals. Hence, it is important for hospitals to ensure that
the nurses who are hired have appropriate skill mix so that they can handle every crucial
situation successfully (MacPhee et al. 2017). They should be provided training and would be
given the scope of continuous professional development where they should be encouraged to
develop skills that can help them to provide comprehensive care to patient (Goldstein et al.
2017). For example, when one nurse is able to provide bedside care but is also successfully able
to conduct diagnostic tests in the path lab or is able to undertake processes of cardiopulmonary
resuscitation can save the patient successfully at that critical time which can get wasted for
summoning experts and similar others before they actually arrive.
Ways I can ensure effective staffing:
It has been found that lower staffing of the nurses causes adverse events on patients.
Lesser number of nurses may tend to fail miserably to handle the increased number of patient
and at the same time they would be more prone to make mistakes that can threaten the lives of
the patients. It is also found that such issues result in emotional burnouts as well. Hence, I would
be working with the human resource departments to develop policies by which new recruitment
would be done that would help in meeting the nursing shortage (Chau et al. 2015). Foremost
significance would also be provided to the skills and knowledge that are acquired by the nurses
in their careers as more nurses with better skill mix would be given the first opportunity. The
organization would be also focusing on the development of skills of various kinds among the
present nurses through training and workshops. Policies would be developed that would ensure

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proper work-life balance and external motivation techniques like that of incentives and other
benefits.
Conclusion:
From the above discussion, it can be known that staffing and management and clinical
audits are two important pillars that contribute to efficient clinical governance in the hospitals in
the nation. Clinical audits help in identifying the risks and scopes for improvement in the
healthcare services thereby ensuring patient safety and quality care. Efficient staffing and
effective skill mix can also avoid adverse patient outcomes and help in managing the operational
funds of the healthcare centers. Hence, these aspects need to be managed effectively so that
clinical governance can be ensured in every healthcare organization.

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