Charlotte Leigh graduated from the University of Leeds 2012 and currently completing DF1 in Essex.
In this article Charlotte highlights why clinical governance is the new hot topic and thus often the most dreaded question by young dentists on the interview circuit. It isn't something often taught in detail and often met with a baffled response until you get into practice.
Charlotte describes clinical governance as it applies to the NHS in the UK. The principles of quality assurance also apply internationally and there may be some variances.
What is Clinical Governance?
Clinical governance is an NHS and CQC requirement. It is a framework for quality assurance on the NHS and essential for all GDS dentists. The NHS definition is a:
Framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (NHSE, A First Class Service, 1998).
It is a framework to ensure that healthcare professionals are consistently delivering high quality treatment and seeking to continuously improve it. Clinical governance can be broken down into three components:
- Clinical Effectiveness
- Risk Management
- Patient focus and public involvement
The NHS has a clinical governance framework which forms the basis of many practices clinical governance policies. The current NHS clinical governance framework is within the Department of Health publication 'Standards for Better Health (2004)' and outlines the level of quality of services that all NHS organisations are expected to meet or as a minimum be working towards. The framework is made up of 24 core and 12 developmental standards across seven areas. Those in the earlier publication were not wholly relevant to dentistry so in 2006 a further publication was developed: 'Primary Care Dental Services Clinical Governance Framework (May 2006)'. These dental standards focus on 12 themes such as evidence based practice and prevention and public health.
What does Clinical Governance cover?
There are seven pillars which form the basis of clinical governance and it can be cleverly divided into the CAREPUS acronym to make it easier to remember.
C - Clinical effectiveness
A - Audit
R - Risk assessment
E - Education
P - Policy
U - Using information and IT
S - Staffing and services
Reviewing all these components of your practice can help form the basis of your clinical governance framework.
How is Clinical Governance relevant to Dentistry?
Clinical governance provides all practices with an opportunity to review their current practice. The basis of a clinical governance framework must include the whole dental team. The whole team must;
- understand what the practice is supposed to do - what is the main objective?
- understand their role in delivering the service
Monitoring systems should be put into place to tell you whether you are achieving the goals set. These processes must allow for continuous improvement and be continually reviewed. An example could be doing an audit on cross infection control. The infection control policy is discussed followed by an audit carried out and then any changes implemented to improve the standards in the practice.
What do we need to do?
Clinical governance includes:
- Policies - these are the basis of all the actions in the practice
- Procedures - these detail how everything is carried out
- Risk assessments - how they are identified and managed
- Audits - how your current practice compares to the gold standard
- Reviews - that all the above have been carried out and identifies the difficulties, results and any changes necessary
It is important to put new policies and procedures in place to prevent any problems from recurring. The whole practice team can review policies; check that procedures are being followed and that standards are being met.
In conclusion, ask your practice principal, practice manager or have a look through all the folders in the office for your practice clinical governance policies. Make sure these are up to date as this a requirement and see if there is a particular area of the practice that needs improvement or that you can assist with. There may be a particular area of dentistry that interests you and this may allow you an opportunity to investigate it further. Always keep a record of any further work you do as a log for the future. You may be covering a lot of the necessary clinical governance in your practice meetings without even knowing it!
Charlotte Leigh
[email protected]