Clinical Governance

Question 1

What is clinical governance?

Answer 1

a systematic approach to maintaining and improving the quality of patient care within a health system

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

Question 2

What are the 6 dimensions of healthcare quality?

Answer 2

1. person-centred
2. safe
3. effective
4. efficient
5. equitable
6. timely

Question 3

What does it mean for healthcare to be person-centred?

Answer 3

partnership between patient, families and those delivering healthcare which respects individual needs and values and demonstrates compassion, continuity, clear communication and shared decision making

Question 4

What does it mean for healthcare to be safe?

Answer 4

• no avoidable injury or harm from healthcare received
• appropriate, clean and safe environment provided for delivery of healthcare services

Question 5

What does it mean for healthcare to be effective?

Answer 5

• ascertaining that intervention works
• determining the most appropriate interventions, support and services provided to everyone
• determining whether the benefit is maximised for the given costs
• wasteful or harmful variation eradicated

Question 6

What does it mean for healthcare to be equitable?

Answer 6

• ensuring all patients are treated fairly
• ensuring distribution of care is based on needs
• high quality services provided to everyone

Question 7

What does it mean for healthcare to be timely?

Answer 7

Appropriate treatment, support and services provided at the right rime for everyone

Question 8

What factors contribute to adverse events?

Answer 8

• human factors
  
  • teamwork
  • communication
  • stress
  • burnout
• structural factors
  
  • reporting systems
  • infrastructure
  • workforce loads
  • environment
• clinical factors
  
  • complexity of care
  • length of stay

Question 9

What are the 6 components of Clinical Governance?

Answer 9

1. education & training
2. clinical audit
3. clinical effectiveness
4. research & development
5. openness
6. risk management

Question 10

How can the dimensions of healthcare quality and clinical governance process be delivered?

Answer 10

• setting quality standards
• delivering quality standards
• monitoring quality standards

Question 11

How can quality standards be set?

Answer 11

• good clinical practice changes in light of evidence from research
• reduction to minimum time lag of implementation of research findings into clinical practice
• promoting implementation of research in clinical practice
  
  • critical appraisal of literature
  • development of clinical guidelines/protocols
  • implementation strategies
• clinical guideline definition

Question 12

What are the 7 As of leaks between research and practice?

Answer 12

• aware
• accept
• applicable
• able
• act
• agree
• adhere

Question 13

What is the aim of clinical guidelines?

Answer 13

• improve the quality of healthcare
• recommendations
• standards for clinical audit
• education and training
• informed patient decisions
• improve communication

Question 14

What clinical guidance currently exists for dentistry?

Answer 14

• SIGN Guidelines
• NICE
• SDCEP
• HIS

Question 15

What are the different evidence levels and which study types fit into each?

Answer 15

• 1
  
  • systematic review
    
    • Cochrane
  • RCT
• 2
  
  • cohort
• 3
  
  • case-control
• 4
  
  • case series
• 5
  
  • narrative review
  • editorial
• N/A
  
  • case report
  • epidemiology
  • animal studies

Question 16

What are the strongest sources of scientific evidence?

Answer 16

• meta-analyses
• systematic reviews

Question 17

What is the aim of SDCEP?

Answer 17

to support dental teams throughout Scotland by providing guidance developed by the profession for the profession on topics identified as priorities for dentistry in Scotland

Question 18

How can quality standards be delivered?

Answer 18

• life long learning
  
  • CPD
    
    • 100 hours every 5 years

Question 19

What are the different formats of CPD?

Answer 19

• courses and lectures
• training days
• peer review
• clinical audit
• reading journals
• attending conferences
• e-learning activity

Question 20

What are the highly recommended topics for CPD?

Answer 20

• medical emergencies
• disinfection and decontamination
• radiography and radiation protection
• legal and ethical issues
• complaints handling
• oral cancer: early detection
• safeguarding children/young people/adults

Question 21

What is SDRS and what does it do?

Answer 21

• Scottish Dental Reference Service
  
  • monitor quality and probity of treatment
  • review sample of patients yearly

Question 22

What is a clinical audit?

Answer 22

a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change

Question 23

What are the 7 steps of a clinical audit?

Answer 23

1. select topic
2. set agreed standards & decide on data
3. observe practice and collect data
4. analyse data and determine deviations
5. identify any areas of change required
6. make necessary changes
7. repeat audit process and determine improvements

Question 24

What are the educational strengths of audit?

Answer 24

• critical review of current practice
  
  • encourages learning new things
• small group work
  
  • modifying attitudes
  • management of clinical conditions
  • re-enforcemeny of agreed procedures
• observation of practice
  
  • indicate gaps in knowledge/skills

Question 25

What is the aim of a peer review?

Answer 25

to share experiences and identify area in which changes can be made with the objective of improving the quality of care/service offered to patients, share learning and implement change