Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governanceRuyamuro K. Kwedza A E , Sarah Larkins B , Julie K. Johnson C and Nicholas Zwar A D
A School of Public Health and Community Medicine, UNSW Medicine, NSW 2052, Australia.
B College of Medicine and Dentistry and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Douglas, Qld 4811, Australia.
C Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 North St Clair, 20th Floor, Chicago, IL 60611, USA.
D Present address: School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
E Corresponding author. Email: firstname.lastname@example.org
Australian Journal of Primary Health 23(5) 451-457 https://doi.org/10.1071/PY16168
Submitted: 23 December 2016 Accepted: 14 June 2017 Published: 21 August 2017
Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning; alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members’ alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants.
Additional keywords: Australia, case study, quality of health care, rural health, safety.
ReferencesAustralian Bureau of Statistics (2013) Australian health survey: health service usage and health related actions, 2011–12. (ABS: Canberra, ACT, Australia) Available at http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/F758234080C6F33BCA257B39000F296E?opendocument [Verified 12 September 2014]
Australian Council on Healthcare Standards (2004) ACHS News, issue 12. (ACHS: Sydney, NSW, Australia)
Bowen GA (2009) Document analysis as a qualitative research method. Qualitative Research Journal 9, 27–40.
| Document analysis as a qualitative research method.CrossRef |
Braithwaite J, Travaglia J (2008) An overview of clinical governance policies, practices and initiatives. Australian Health Review 32, 10–22.
| An overview of clinical governance policies, practices and initiatives.CrossRef |
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
| Using thematic analysis in psychology.CrossRef |
Brennan N, Flynn M (2013) Differentiating clinical governance, clinical management and clinical practice. Clinical Governance: an International Journal 18, 114–131.
| Differentiating clinical governance, clinical management and clinical practice.CrossRef |
CRANAplus (2013) A clinical governance guide for remote and isolated health services in Australia. (CRANAplus: Alice Springs, NT, Australia) Available at https://crana.org.au/files/pdfs/CRANAplus_Clin_Gov_Guide_online_Sep13.pdf [Verified 15 February 2015]
Department of Health (New South Wales) (1999) A framework for managing the quality of health services in New South Wales. NSW Department of Health, Sydney, NSW, Australia.
Department of Health (Queensland) (2012) Model governance framework clinical safety and quality in hospital and health services. Patient Safety and Quality Improvement Service, Centre for Healthcare Improvement, Brisbane, Qld, Australia.
Dorgan S, Layton D, Bloom N, Homkes R, Sadun R, Van Reenen J (2010) ‘Management in Healthcare: Why Good Practice Really Matters.’ (McKinsey and Company and London School of Economics: London, UK)
Gauld R, Horsburgh S, Brown J (2011) The clinical governance development index: results from a New Zealand study. BMJ Quality & Safety 20, 947–952.
| The clinical governance development index: results from a New Zealand study.CrossRef |
Goodall AH (2011) Physician-leaders and hospital performance: is there an association? Social Science & Medicine 73, 535–539.
| Physician-leaders and hospital performance: is there an association?CrossRef |
Greenfield D, Nugus P, Fairbrother G, Milne J, Debono D (2011) Applying and developing health service theory: an empirical study into clinical governance. Clinical Governance: an International Journal 16, 8–19.
| Applying and developing health service theory: an empirical study into clinical governance.CrossRef |
Hogan H, Basnett I, McKee M (2007) Consultants’ attitudes to clinical governance: barriers and incentives to engagement. Public Health 121, 614–622.
| Consultants’ attitudes to clinical governance: barriers and incentives to engagement.CrossRef | 1:STN:280:DC%2BD2szoslKgtg%3D%3D&md5=874f70f6b09cee4ae75eebeea7401dc1CAS |
Lincoln YS, Guba EG (1985) ‘Naturalistic Inquiry.’ (Sage Publications: Beverly Hills, CA, USA)
Makeham M, Pont L, Prgomet M, Carson-Stevens A, Lake R, Purdy H, Purdy H, Westbrook J (2015) Patient safety in primary healthcare: an evidence check review brokered by the Sax Institute for the Australian Commission on Safety and Quality in Health Care. (Sax Institute: Sydney, NSW, Australia) Available at https://www.safetyandquality.gov.au/wp-content/uploads/2015/12/Patient-safety-in-primary-healthcare-a-review-of-the-literature-August-2015.pdf [Verified 9 August 2017]
Merriam S (2009) ‘Qualitative Research: a Guide to Design and Implementation.’ (Jossey-Bass: San Francisco, CA, USA)
National Health Hospitals Reform Commission (2008) A healthier future for all Australians: interim report December 2008. Australian Government, Canberra, ACT, Australia.
Patton MQ (2002) ‘Qualitative Research and Evaluation Methods.’ (Sage Publications: Thousand Oaks, CA, USA)
Phillips CB, Pearce CM, Hall S, Travaglia J, de Lusignan S, Kljakovic M (2010) Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence. The Medical Journal of Australia 193, 602–607.
Productivity Commission (2005) Australia’s health workforce: research report. Productivity Commission, Canberra, ACT, Australia.
Royal Australian College of General Practitioners (2010) RACGP Standards for general practices, 4th edn (updated 2013). (RACGP: Melbourne, Vic, Australia) Available at http://www.racgp.org.au/download/documents/Standards/standards4thedition.pdf [Verified 4 March 2016]
Saldaña J (2013) ‘The Coding Manual for Qualitative Researchers.’ (SAGE: Los Angeles, CA, USA)
Scally G, Donaldson L (1998) Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal 317, 61–65.
| Clinical governance and the drive for quality improvement in the new NHS in England.CrossRef | 1:STN:280:DyaK1czhs1ajtw%3D%3D&md5=34030bd16fb8039fedfa93e700b65c6eCAS |
Som C (2005) Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors’ response to clinical governance. International Journal of Public Sector Management 18, 463–477.
| Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors’ response to clinical governance.CrossRef |
Som C (2009) Sense making of clinical governance at different levels in NHS hospital trusts. Clinical Governance: an International Journal 14, 98–112.
| Sense making of clinical governance at different levels in NHS hospital trusts.CrossRef |
Spigelman AD, Rendalls S (2015) Clinical governance in Australia. Clinical Governance: an International Journal 20, 56–73.
| Clinical governance in Australia.CrossRef |
The Australian Centre for Healthcare Governance (2013) Research: clinical governance in community health. (ACHG Melbourne, Vic., Australia) Available at http://healthcaregovernance.org.au/reasearch [Verified 1 February 2015]
Yin RK (2009) ‘Case Study Research: Design and Methods.’ (SAGE: London, UK)