Leadership and Clinical Governance Essay Example

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Leadership and Clinical Governance 12

Leadership and Clinical Governance

Leadership and Clinical Governance


In today’s modern society, the health sector has been experiencing numerous changes especially in the past quarter of the century. In addition, the patients are aware of their fundamental rights while both the practitioners and healthcare providing facilities have been able to enhance their methods of service provision. There have also been changes in the legal systems and associated punitive measures, which contributed significantly transformation within the health sector. Clinical governance outlines the systems and standards within the clinical practice to meet the ever-increasing demands of the patients. With these systems, the practitioners can go beyond their traditional roles, which entails the provision of the health care and supporting the patients through the provision of high-quality care system containing diversified themes and processes. Globally, most patients continue to experience deteriorating healthcare services due to the increasing negligence of the practitioners (Australian Commission on Safety and Quality in Health Care, 2012). It is from such background that the risk management, as a system, seeks to develop good and responsible practice among the healthcare practitioners to prevent the occurrence of adverse incidences. Therefore, risk management reduces the chances of the practitioners from incurring losses and possibilities of experiencing the unwanted outcome. As part of the clinical governance, risk management incorporates policies, procedures, and systems within the healthcare profession (Briner et al., 2010, 159). Other factors determining the clinical governance are information, performance management, programmes of improving quality, and accountability. In all healthcare profession, clinical governance is paramount to ensure that the services provided are of high quality, effective, patient centred, and safe to those seeking such services.

From the case study, a registered nursing practitioner failed to follow the outlined procedures and systems, which led to the provision of unsatisfactory services to the patient. Healthcare is a delicate profession that requires effective conduct and ensuring compliance with the required ethical standards. Besides, the nurses should work under the guidance of a qualified doctor of which, when the incident occurred, only the nurses were available (Salas & Frush, 2013, 177). The responsibility of the hospital management is to ensure that it allocates qualified doctors to the nurses to prevent the occurrence of incidences that might compromise the health of the patients. Medical practitioners work in shifts; hence, all of them should be aware on how their programmes run. It took the nurses time to decide the category in which the patient falls since there was no doctor to offer them direction. However, if the hospital had qualified nurses in their areas of operation, then such incident could have been under control in their care.

The patient had SOB background of advanced COPD. With the admission into the Emergency Ward, the nurses could have commenced the treatment to enhance the patient’s level of consciousness. Moving the patient from one care system to another greatly contributed to the decreasing level of consciousness, abnormal vital signs, confusions, and continuous unwitnessed. Moreover, it is important to commence treatment after a thorough analysis of the patient’s health to assert that the treatment offered is in line with the required standards and relevant (Robinson & Cook, 2006, 199). However, during the process of the healthcare provision, the nightshift nurses failed to seek guidance from RN Elliot to conduct an assessment on the patient. Such assessments include both the mental and physical conditions as required by the nursing code of conduct. Furthermore, it was crucial that the nurses submit the assessment report to the qualified doctor, McKenzie. In most cases, the nurses often follow the directives of the doctors. Nonetheless, in this case, the nurses failed to inform and request the doctor to come and review the worsening condition of the patient. As a result, all the care systems offered by the nurse were below the required standards of the National Standard 9. The nurse also failed to identify the early warning signs of clinical deterioration that led to the worsening state of the patient.

Literature Review

In the late 1990s, the concept of clinical governance was fairly a new concept. As a result, the government and other stakeholders within the healthcare profession have been trying to shade light into the concept. Most pieces of literature support that the fact that the concept of clinical governance can transform the healthcare sector to the better. However, some of the pieces of literature are also sceptical about the practicability of the clinical governance arguing that its success depends on the leadership skills and the level of understanding of the nurses (McKinnon, 2007, 216). The concept of clinical governance is more of managing the risks within the healthcare profession than any other thing. It is the responsibility of the healthcare practitioners to manage the risks both at personal and corporate levels. There are several definitions of clinical risks; however, it is crucial to note that it is variation from the planned treatment procedures, therapy, and diagnostic care processes, which the nurses contravened while performing the treatment. Additionally, clinical risks involve problematic clinical outcomes.

From the case study, the hospital has no guidelines for the clinical governance, which resulted in the deterioration of the patient’s health due to unavailability of the qualified medical doctor. Most healthcare facilities have no implemented clinical governance since most practitioners view risk management with reference to their professional positions that to some extent contributes to the holistic risk management (McKinnon, 2007, 73). Therefore, risk management in a sizeable number of healthcare systems is partial. While establishing an effective healthcare leadership, it is important to focus on the major features of clinical governance including combined political, societal, and professional expertise. The concept also needs to integrate the features from all the concerned stakeholders, leadership styles, and frameworks developed by the state to guide the practices within the healthcare systems (Marshall & Marshall, 2011, 141). These activities aim to harmonize the clinical governance across the health facilities. The management trends also play a crucial role in contributing to the desired systems with the healthcare system. For example, the declaration of the National Health Service (NHS) that entitles all the patients to high standard of the care systems. In some cases, the pieces of literature contend that it is not easy to define quality within the healthcare.

There are several approaches to the concept of clinical governance. The best method of enacting the clinical governance is through encouraging the practitioners to incorporate the governance activities while undertaking their normal duties within the healthcare facilities (Lloyd, 2008, 192). In the case study, the condition of the patient deteriorated since there were guidelines within the hospital outlining how the nurses could integrate clinical governance while executing their roles. All organizations, irrespective of the sector of operations, require the alignment of the structures to ensure efficient and reliable performance. Healthcare facilities must have proper organizational structures with clear roles that encourage accountability among the practitioners. With compliance to such structures, the nurse might have helped improve the condition of the patient (Carayon, 2012, 232). Besides, the organizational structures need to have manageable means, distinct managerial responsibilities, clinical leadership, decision-making, and effective strategic planning activities while formulating quality structures. More importantly, for the success of the healthcare sector, while implementing the concept of clinical governance especially in risk management, those designing the structures within specific healthcare facilities need to be able to design the structures and roles around the people with the ability to conduct their duties properly. In addition, the structures should be based on the performance through assigning the roles to the practitioners to prove that they have the capacity to address them.

In a conventional quality management systems, the physicians are the people responsible for the diagnostic programmes of which the head nurses (HN) ensure that the problem experienced by the patient care units are addressed effectively. The nurses also ensure the provision of quality medication as part of their responsibility for ensuring a better recovery (Youngberg, 2011, 105). However, the main contention associated with such structures within the healthcare facilities is that it does not provide the room for consultation among the practitioners operating in different hierarchies. This major factor contributed to the deterioration of the health condition of the patient. If the doctor had been in the hospital when the patient arrived, then she should have given direction to the nurses on how to deal with the patient’s condition (Rowley & Waring, 2011, 115). However, some of the successful implementations associated with clinical governance and risk management within the healthcare facilities have been able to include different people working within the health facility to work jointly and come up with an ideal structure of improving the care systems used. Besides, there should be an open communication between the leaders and intercommunication among the nurses.

The American College of Medical Quality published their case study in 2009 that involved both the clinicians and the administrators in designing the governance structure. The integration of the practitioners and management increases the probability of the clinical governance success since everyone involved in the decision-making process want the structure to succeed (Gunderman, 2009, 207). In most cases, the clinicians often feel the need of upholding the processes involved in the care as required by the organizational structure while the administrators focus on the active role of ensuring that the quality and cost of achieving such desired outcomes are upheld. The conventional structure used with the organization also failed to involve the stallholders. According to Dimond (2004, 160), there are several domains making up the effective clinical governance including clinical audit, patients and public involvement, risk management, clinical standards, staffs and practitioner management, and professional development of the staff by training them and utilizing technology. Public participation with the healthcare sector involves the acceptance by the practitioners that the recipients of the care services might have the feedback or suggestions of improving the quality of the care provided within the institution (Kelly, 2008, 297). Some of the ideal ways of involving the patient include surveys or engaging them in the long-term care programmes that allow them to voice their opinions on matters relating to care programmes.

In most healthcare facilities, the patients often forward their complaints, which require serious investigations. However, the major stress always occurs among the staff handling them since the patients could be angry, rude, and aggressive towards the practitioners due to the emotional experience that might have been ignored (Huber, 2006, 252). If the hospital fails to put across the supportive systematic approach of monitoring the complaints, then the practitioners could regard them as criticism, which might lead to the detrimental effect on the patients’ health. Therefore, in any open and honest environment where there is adequate monitoring of the complaints, there is often improved healthcare practices and maintenance of quality care systems. Nevertheless, in the absence of the supportive system, the patients might feel unsatisfied with the treatment procedures and refuse ay treatment offered to them (Chua, Ng, & Liaw, 2013, 507). Besides, the obsessive behaviour could have a negative effect on the health of the patient leading to increased health problems. Yet, in some cases, the complaining patients might feel that their treatment has been compromised if they forward their complaints. The nurses, therefore, need to carry out their treatment with much focus on the professional guidelines.

Another aspect of risk management that requires close monitoring is the clinical supervision to ensure that patient does not suffer. Furthermore, the clinical support provides the support system to the nursing practitioners as a means of ensuring that they provide high-quality treatment and services to the patients by evaluating their practices and encouraging the practitioners to learn from their previous experiences. The major challenge faced in the nursing profession is the development of the future nursing leaders. All nurses require powerful leadership skills especially those that provide direct care to those in the top management positions. Leadership goes beyond a series of skills or tasks. It is rather an attitude that tends to inform behaviour (Benner, Malloch, & Sheets, 2010, 78). Leadership skills ensure that the nurses are able to make quick and quality decisions that would guarantee good health of the patient. In addition, a clinical nursing leader needs to be involved in the direct patient care and continuously improve the care system affordable to the patients through influencing the treatment provisions delivered. Therefore, good leadership should be visible through demonstrations and consistency in the superior performance and delivering long-term benefits to those in the care system (Jasper & Jumaa, 2005, 242). Nursing leaders are not those who merely control the others but a visionary as well and help assist hospital management to plan, lead, organize, and control their activities.

There are competencies and skills that are crucial in the nursing leadership including social awareness, self-awareness, and the ability to manage relationships and one’s self. Social awareness determines the capacity of the nurse to gauge the emotions of the people and assist in identifying some of the consequences of hasty decisions that they have to make (Huber, 2014, 192). Thus, it ensures that nurses use their instincts in making the decisions while at the same time comprehending the surroundings that patients interact. On the other hand, self-awareness ensures that the nurses handle their emotions in an appropriate manner in all situations and always make wise decisions. More importantly is the self-management, which is the ability of the practitioners to adapt to the ever-changing circumstances involved in handling the patients and always perform their duties in a rational manner irrespective of the prevailing conditions (Knoll & Pearle, 2013, 217). The nurse should also be able to manage relationships, which relates more with the development, inspiration, and influence on others based on the line of duty. To achieve self-management skills, the nurses need to be effective and inspirationally positive to the people they interact with and ensure that they handle conflicts justly. These skills determine how the nurses in the leadership position carry out themselves while handling the patients (Steen, 2010, 50).

Nursing profession requires leadership skills to perform various functions including collaboration with the patients to provide optimum care, provision of relevant information and support, being role models, and advocating for the health care systems. Besides, the nurses need to possess personal qualities like courage, creativity, collaboration, and confidence (O’Brien, 2011, 122). The leaders need show much concern for the needs and objectives of the nursing practitioners and the working conditions affecting the performance within the healthcare sector. For example, the nurse leader might challenge other nurses to act through allowing them to contribute in the decision-making process and improving collaboration. As a result, such activities would help encourage other nurses in their work and help move the organizational focus from the leaders to the team.


The major priority within the healthcare sector is to ensure that the patient receives quality care system. Therefore, it is important that the health industry review its position on the risk management considering the significance and effectiveness of such practice. Management of the health safety risks might assist in preventing the accidents and deterioration of the health condition of the patients, which could cause problems towards the nursing practice and the general health sector. Furthermore, risk management helps to provide the benefits to both the patients and health practitioners. There is a need to ensure that the workers are properly educated in matters relating to safety and guidelines in patient treatment in an attempt to lessen the carelessness often evidenced within the healthcare sector. In a bid to please the patients by the healthcare practitioners, they lower the chances lawsuits from occurring and enhances the patient care. If an institution is to improve the quality of the quality healthcare system that it provides, then it has to collectively incorporate both clinical governance and risk management. Health facilities ignoring the need to harmonize the clinicians and other medical practitioners and stakeholders to the ideals exposes them to risks that might cost the institution huge amount of money while settling the cost associated with the negligence of the practitioners to the disgruntled patients to some extent it might cause the hospital its reputation.


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