Monday, August 1, 2011

Consumers and Clinical Governance

Peggy Brown addressing the
ACT Clinical Senate, June 2011
Russell McGowan, Kate Moore, Janne Graham and Darlene Cox attended the inaugural ACT Clinical Senate on 28 June 2011.  
The Clinical Senate is a new group in the governance structure of the ACT Government Health Directorate whose role is to  provide a forum for advice to the Director General on matters relating to:
  • The coordination and development of clinical planning  
  • Clinical and resource decision making
  • Other relevant clinical issues in health service delivery in the ACT
  • Issues of concern to the Chief Executive
It will provide a mechanism for increased participation and advice from nurses, medical practitioners, allied health professionals and consumers on clinical issues.  It is in its infancy but promises to be a valuable forum if it evolves along the lines of the clinical senates in Western Australia, South Australia and Queensland.

The focus for the evening was on clinical governance. The evening was facilitated by Chris Baggoley. Speakers included Peggy Brown (Director General), Lee Martin (Deputy Director General), Dr Frank Bowden and Janne Graham.
Janne's notes are included here.

Janne Graham speaking at the
ACT Clinical Senate, June 2011

I’ve probably seen at close hand more reorganisations of ACT Health than any of you. Nevertheless, I am feeling very positive about this one where the emphasis across all services is safety and quality.

Safety for us means managing avoidable risk and sharing information about inherent risk so that community members, patients and families can make appropriate decisions for themselves and actively participate in their care. There is ample evidence now that where consumers and carers have the opportunity to be involved we can contribute to our safety.

Quality for us means that both the consumer experience and the health outcome will be as good as it can be.

Great news that the elective surgery waiting times are reducing (even if Canberra Times can only make it a page two story) but whatever the wait there are people with lives they are trying to live while on that waiting list. How are they being supported with care and information during that wait? As an example a health service moving towards excellence will be accepting its share of responsibility for these less tangible aspects of the patient journey.

It seems to me that the new structure enables this broader attention. It enables effectiveness and efficiency to move in tandem.

We are looking for clinicians to focus, not only on your own practice at the bedside or on the operating table, but in sharing in ensuring better systems.
  • For example, for you to give the right injectable at the bedside you need to know there is a system in place which ensures the right product and the right time etc.
  • Discharge of a patient not only results in a free bed but may, when not planned well, have significant ramifications for other parts of the health service, the community sector, the family and patient themselves.
Hence, you share responsibility for the system (and the shared benefit).

We look to you to play a leadership role, to support those who work in the team and to you. In turn, we expect you to be supported as you accept responsibility.

We know what it is like to have ideas and possible solutions to problems and not to be heard. Good governance, we believe will give all of us a better opportunity to take responsibility for a better service.

We know as individual consumers and as an organized movement which hears the stories that there are inherent risks in health care. With you we are contributing to some of the initiatives which avoid risk and near misses. We know that “to err is human” so we want a culture which moves from blame to becoming an active learning organisation where error is identified and acknowledged and where the lessons learned are documented, acted on and applied. We think that the Clinical Senate can play an important role in developing and promoting this culture.

We believe that there is a strong case for proactively reporting error, for an open process of peer review and of community reporting. The community hears the bad stories and unfortunately these often influence confidence more than the good ones. Leaders who  support a more open culture of questioning and reflection will develop a more confident workforce, and a more supportive community.

I recently toured Weipa Bauxite mine. Boy! Are there some potentially risky activities there! Expensive too! One tyre on one of their machines costs somewhere between the value of my house and yours and there may be up to a dozen tyres on one vehicle. The drivers know quite clearly that they are accountable for those tyres. Damage may not be caused by them, it may be inherent in the structure or some demand outside their control but they must know the condition of each tyre each time they take over a vehicle and each time they hand it over.

We think of accountability not as a set of reports but of a genuine closing of the loop whether it is in the handover of an individual patient, following through on recommendations for change, Evaluating when introducing new procedures .. and so

We have great expectations that the new governance arrangements, as they are worked through will enable clinicians to
  • take responsibility and be supported,
  •  to further a reflective learning culture and
  • to be accountable to each other and the community for their contribution to excellent health care.
I believe that an active engaged clinical senate, adequately resourced can provide powerful and effective leadership to this journey towards clinical excellence.

Janne Graham
Member, HCCA

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