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Clinical Governance
Michael W Gorton AM, Principal
21 July 2016
> Liability:
> Entity
> Individuals
> Vicarious Liability
> Accountability:
> Delegation
> Reporting
> Risk Management:
> Legal Risk
> Financial Risk
> Business Risk
> Compliance:
Corporate Governance
2
> Investigation into Wesley Hospital's response to legionnaires' disease by: Sean Parnell and Sarah Elks
> AN investigation into the Legionella outbreak at a Brisbane private hospital will examine whether enough precautions were taken and whether the alarm was raised soon enough The Australian, 10.13 am, 7 June 2014
"the board has the complete responsibility for
clinical outcomes of the organisation"
The Board’s Role in Clinical Governance
3
> “Corporate governance is the system by which companies are directed and controlled. Boards of directors are responsible for the governance of their companies.”
The Cadbury Report 1992
> "the framework of rules, relationships, systems, and processes within and by which authority is exercised and controlled in corporations“
ASX Corporate Governance Principles
Clinical Governance in context
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> Risk Management> getting it wrong less often
> Quality Assurance> getting it right more often
> Clinical Governances> roles and responsibilities> systems and processes
Risks
5
Source: Robert I. Tricker, International Corporate Governance: Text Readings and Cases, New York: Prentice Hall, 1994, p.149
Clinical Governance in context
6
Compliance roles Performance roles
Provideaccountability
Strategyformulation
Monitoring andsupervising Policy
makingPast and present
orientatedFuture
orientated
External role
Internal role
Approve and work withand through the CEO
7
Healthcare is a Risky Business
Harvard Medical Practice Study, 1991:> 3.70% of hospital admissions lead to “adverse
events”
> 1.85% of hospital admissions lead to avoidable “adverse events”
> 0.50% of hospital admissions lead to “adverse events” resulting in death
> Corresponds to 120,000 avoidable deaths per annum in USA
Why is Risk Management an issue in Healthcare?
8
9
> Purpose and scope of clinical governance
The Clinical Governance System
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• Improved patient care• Patient satisfaction• Quality control and improvement• Cultural change• Risk mitigation• Compliance• Cost management• Competitive advantage• Stakeholder satisfaction
Summarised
• Risk management• Leadership and culture• Patient experience
> Quality:> Incident reporting and review
> Morbidity and mortality review
> Credentialing and privilege
> Clinical Practice Guidelines
> RCA/Sentinel Events
> Audit (personal and system)
> Policies
> Education and training
Risks
12
> Legal Issues> QP Registration
> Legal professional privilege
> FOI
> Patient confidentiality
> Defamation
> Subpoena
> Coroner
> Whistleblower legislation
cf. Open Disclosure – apology protection
Risks
13
Quality-related activities at Board level
% (n=82)
Quality performance is on the agenda at every Board meeting 79
Board regularly reviews data on medication errors/hospital acquired infections 77
…
Board members receive formal training that covers quality of care 52
Board has a strategy relating to communication with patients & families 51
Board monitors quality and safety of care against external benchmarks 50
…
Board receives quality of care data analysed according to the cultural and
linguistic background of patients (including ATSI background)32
Board members receive training on healthcare disparities 22
The “Lake Wobegon” effect
Worse About the same
Better or much better
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall quality of health care
Safe and skilled workforce
Experience or satisfaction of patients and families with health care
Identifying, managing and reporting health care incidents
Perc
enta
ge o
f Boa
rd m
embe
rs
Board members’ self-assessment of performance compared with a typical health service in Victoria
Perceptions of influence
Chief Execu-tive
Director of Nursing
Board Quality Committee
Medical direc-tor
Other clinical leaders
Quality manager
Board Chair or Board
Patients; community
0%
10%
20%
30%
40%
50%
60%
70%Chart Title
Rank
ed fi
rst o
r sec
ond
mos
t inf
luen
tial
> Systems and processes for assurance> People who understand and can
assess (Management/Board) skills/experience
> Leadership and culture
Lessons from Bacchus Marsh
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18
QUESTIONS
The information contained in this presentation is intended as general commentary and should not be regarded as legal advice. Should you require specific advice on the topics or areas discussed please contact the presenter directly.
Disclaimer
19
Level 12, 469 La Trobe Street, Melbourne, VIC 3000 P: +61 3 9609 1555Level 8, 28 University Avenue, Canberra, ACT 2601 P: +61 2 6171 9900
Liability limited by a scheme approved under Professional Standards Legislation
