Clinical Governance in Healthcare

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Member of the World Economic Forum Global Agenda Council 60 countries, 170+ occasions.

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65 senior healthcare leaders from 30 countries

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65 senior healthcare leaders from 30 countries

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10 characteristics of clinical and operational excellence 1 2 3 4 5 6 7 8 9 10

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In-depth interviews with leading providers and regulators The Mayo Clinic, USA Fortis Hospitals, India Jordan Specialty Hospital Helios Kliniken, Germany Sick Kids, Canada Salford Royal Foundation Trust, UK ...followed by four round-table discussions with more of the world’s leading organisations University Hospital Birmingham, UK King's College Hospital, UK Changi General Hospital, Singapore Intermountain Healthcare, USA The General Medical Council UK A global perspective on clinical governance – we brought together 43 global healthcare leaders from 12 countries Lausanne Boston Sydney Amsterdam

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We identified the four building blocks of a ‘high-reliability’ organisation: 1 2 3 4

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Methodically measuring care outcomes Understanding the key drivers of these outcomes Understanding how to make these outcomes best in class Systematically preventing avoidable harm to patients “More hand-offs, more errors” Even at seemingly low error rates per step, processes with multiple steps have unacceptably high error rates. Source: System changes to improve patient safety, Nolan, T W., British Medical Journal, 320, 771-3, 2000 “Being in control ” “Being in control ”

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The journey towards a high-reliability organisation No real Board oversight of quality; outcomes are not uniformly measured; responsibility is poorly-defined Attention to quality is becoming more systemic; progress depends on systems, not individuals; measurement of outcomes is common but not standard Key outcomes routinely reported; blame-free learning approach; a culture intolerant of breaking basic rules; clear individual responsibility & accountability Probably only required in the most high-risk environments: ICU, theatres, A&E PHASE:

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Mary Jo Haddad, Former President and CEO, SickKids Hospital, Toronto

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Building block 1: a culture devoted to quality

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The ‘concrete floor’ is the separation between clinical and managerial perspectives in most health care providers – financial and operational on one hand, clinical value for the patient on the other

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Building block 2: responsibility and accountability Without a clear vision of how to use them, even the best metrics are of little value

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1a 2a 1b 2b 3a 3b 4a 4b 3c 4c In the UK, the Quality Governance Framework tests the ‘robustness’ of quality governance in providers

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A mixture of announced and unannounced inspections, focusing on 5 domains: The Care Quality Commission – the UK quality regulator Setting standards of quality and safety Monitoring, inspecting and reporting publicly on performance In-depth investigations looking at care across the whole system. The Care Quality Commission – the UK quality regulator

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Building block 3: optimising and standardising processes

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Intermountain Healthcare – saving lives, reducing costs Intermountain Healthcare introduced standard workflow guidelines, and measured outcomes. They made dramatic and continuous improvements:

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Building block 4: measurement The world’s leading healthcare organizations share an obsession with measurement: state-of-the-art dashboards, process and outcome measures, many of which in real time. Quality and safety Productivity and efficiency Financial performance They also seek to benchmark themselves internationally, to learn from best practice around the world.

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System governance Many healthcare leaders see tension between a wealth of external requests for measurement – which they often feel measure the wrong things – and their own internal drive for excellence

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The first in our ‘What Works’ series.. Creating new value with patients, carers and communities For more information, visit kpmg.com/healthcare

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