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      Supporting and activating clinical governance development in Ireland: sharing our learning

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          – The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.


          – A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.


          – Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

          Research limitations/implications

          – The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

          Practical implications

          – The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.


          – Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

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          Most cited references 21

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          Huddling for high reliability and situation awareness

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            Fair and just culture, team behavior, and leadership engagement: The tools to achieve high reliability.

            Disparate health care provider attitudes about autonomy, teamwork, and administrative operations have added to the complexity of health care delivery and are a central factor in medicine's unacceptably high rate of errors. Other industries have improved their reliability by applying innovative concepts to interpersonal relationships and administrative hierarchical structures (Chandler 1962). In the last 10 years the science of patient safety has become more sophisticated, with practical concepts identified and tested to improve the safety and reliability of care. Three initiatives stand out as worthy regarding interpersonal relationships and the application of provider concerns to shape operational change: The development and implementation of Fair and Just Culture principles, the broad use of Teamwork Training and Communication, and tools like WalkRounds that promote the alignment of leadership and frontline provider perspectives through effective use of adverse event data and provider comments. Fair and Just Culture, Teamwork Training, and WalkRounds are described, and implementation examples provided. The argument is made that they must be systematically and consistently implemented in an integrated fashion. There are excellent examples of institutions applying Just Culture principles, Teamwork Training, and Leadership WalkRounds--but to date, they have not been comprehensively instituted in health care organizations in a cohesive and interdependent manner. To achieve reliability, organizations need to begin thinking about the relationship between these efforts and linking them conceptually.
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              ‘A Rounded Picture is What We Need’: Rhetorical Strategies, Arguments, and the Negotiation of Change in a UK Hospital Trust


                Author and article information

                Journal of Health Organization and Management
                Emerald Publishing
                15 June 2015
                15 June 2015
                : 29
                Issue : 4 Issue title : Clinical Governance and Leadership Issue title : Clinical Governance and Leadership
                : 455-481
                Quality and Patient Safety Division, Health Service Executive, Dublin, Ireland
                Quality and Patient Safety Division, Health Service Executive, Dublin, Ireland
                Quality and Patient Safety Division, Health Service Executive, Dublin, Ireland
                © Emerald Group Publishing Limited
                General review
                Health & social care
                Healthcare management
                Custom metadata


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