Event: Interpreting the Information Governance Toolkit – 29 September, London

SBK Healthcare are running a one day event on Information Governance Toolkit (IGT). According to SBK Healthcare, the event has been designed to provide participants with key guidance and practical advice on successfully meeting the IGT requirements for 2008/09.

The speakers are drawn from the NHS and topics cover how to approach the IGT requirements, including how to incorprate the requirements into the Workplace; developing systems of effective documentation to satisfy auditors; meeting organisational IG Statement of Compliance (IGSoC) obligations; record quality checking and audit; and putting IGT practices into place.

For further information, click here.

US poll puts hospitals’ reputation significantly below supermarkets!

Every year, a Harris Poll in the USA measures public attitudes about 20 different industries, including hospitals. Specifically, the poll asks whether each industry is generally doing a good or a bad job of serving consumers.

In this year’s poll, supermarkets are the clear winners with a score of 84, with online search engines (65), computer hardware companies (64), computer software companies (59), hospitals (53) and Internet service providers (52) next in the ‘top five’ list.

Healthcare Governance Review wonders what hospitals might be able to learn from online search engines and computer hardware and software companies in the USA that might help improve hospitals’ reputation with customers (i.e. patients)?

For further details of the 2008 Harris Poll, click here.

Notable Quote – Dr John Carver on governance and board effectiveness

“A carefully crafted, conceptually rigorous purpose of governance………..forms the heart of board effectiveness.”

Dr John Carver. Boards That Make a Difference, p. xxviii

Research fails to find link between mortality, quality of care and hospital performance

As reported in the Health Service Journal (HSJ – 24 August 2008), “Academic research has cast serious doubt on the link between hospital mortality rates and quality of care, raising questions over Department of Health moves towards routine publication of death rates.”

The NHS West Midlands Strategic Health Authority commissioned research by Birmingham University’s department of public health and epidemiology after five of its trusts were listed as “poor performing” on mortality in Dr Foster Intelligence’s Hospital Guide 2007, published in April last year.

In its report, the University is highly critical of the way hospital standardised mortality ratios produced by  Dr Foster Intelligence were reported and published, describing the Dr Foster mortality ratio as “a metric which is at best ambiguous and at worst potentially misleading”. The report states “We found little or no evidence that a high standardised mortality ratio systematically reflects poor quality of care or a failing hospital.”

Read the full HSJ article here.

NHS governance news on the ‘Fade Library’ blogsite – a service of Liverpool PCT

Readers might like to know that the library service of Liverpool Primary Care Trust (PCT) – known as the ‘Fade Library’ – regularly posts news items relating to governance in the NHS on its blogsite.

Read the Fade Library’s NHS governance news items here.

British Standards Institution publishes free ‘whistleblowing’ code of practice

According to British Standards Institution (BSI) there is increasing emphasis on the role that whistleblowing plays “both as an instrument of good governance and a manifestation of a more open culture.”

Consquently, BSI has published a code of practice for whistleblowing arrangements at work. The code marks the ten-year annivesary of the Public Interest Disclosure Act which introduced legal protection for “whistleblowing” employees who uncover criminal behaviour or dangerous practices at work.

The new code sets out good practice for the introduction, revision, operation and review of effective whistleblowing arrangements in all types of organisation across the private, public and voluntary sectors.

You can freely download the new code of practice here.

In the USA, the Joint Commission issues its 2009 national patient safety goals

The Joint Commission has issued its 2009 national patient safety goals for hospitals, ambulatory care, behavioural care, disease-specific care, critical care, home care, laboratories, long-term care and office-based surgery.

The goals relate to:

1. Identifying patients correctly
2. Improving staff communication
3. Using medicines safely
4. Preventing infection
5. Checking patient medicines
6. Preventing patient from falling
7. Helping patients to be involved in their care
8. Identifying patient safety risks
9. Watching patients closely for changes in their health and responding quickly if they need help
10. Preventing errors in surgery

For full details of the Joint Commission’s 2009 national patient safety goals, click here.

Governance concerns over scrutiny committee’s potential for conflict of interest with LINKs

As reported on PublicNet, the World Wide Web community created for everybody interested in the public sector and its management, “When the newly established Local Involvement Networks [LINKs] identify concerns about local health or social care services, they refer the issues to the scrutiny committee of the local council. Consultations on the management the new Networks has revealed worries about a potential conflict of interest that may result form this arrangement.”

This arises because “Where an issue involves the local social services………..there is a risk that some members of scrutiny committees may have a governance responsibility for the social service they are required to challenge.”

For further information, click here.

View from the USA – Holding healthcare executives accountable for patient safety

An interesting article from ECRI Institute discusses the responsibility and accountability for quality improvement in healthcare organisations from the top down: from the governing board’s responsibility for overseeing patient safety and quality efforts, to CEOs’ and other executives’ accountability for meeting patient safety and quality goals, and to all other staff’s commitment to improving patient safety and quality as part of their job descriptions and performance reviews.

In addition, selection of patient safety and quality measures, challenges to implementing such efforts, and the future of governing board involvement and executive accountability are discussed.

Download the article here.

Regulations regarding suspension and dismissal of non-executive directors are in force: DH is now consulting on “Phase two” proposals

The Primary Care Trusts and National Health Service Trusts (membership and procedure) Amendment Regulations 2008 came into force on 16 June.

The purpose of these amendment regulations is to enable the Secretary of State in England to suspend the chairman or non officer members of a Primary Care Trust (“PCT”) and the chairman or non-executive directors of a National Health Service trust (“NHS trust”). The regulations also provide for:
- how a suspension should be notified,
- the period of suspension,
- reviewing, revoking and extending a suspension, and
- amending the number, or maximum number, of members of PCTs and NHS trusts where a member has been suspended

An explanatory memorandum to the new regulations can be downloaded here.

In addition, a useful article providing further explanation on the new regulations was published in the Health Service Journal on 8 August 2008. The article, written by Mark Leach, a partner in the employment team of Weightmans Solicitors, can be viewed here.

The Department of Health is now consulting on proposals for ”Phase two” of its introduction of new powers of suspension. The new proposals aim to extend powers of suspension to chairs and non-executive members of SHAs, SpHAs and other Health Bodies. The deadline for consultation feedback is 9 October 2008. For durther information, click here.

Related link here.

Outcomes measurement – the key to improving quality in the NHS

The Darzi report High Quality Care for All signalled a shift to better quality care being the main theme of NHS reforms in England. Consequently, quality will become an issue that will be at the centre of most systems of governance in the NHS.

According to Jon Sussex and Adrian Towse, writing in the Health Service Journal, 14 August 2008, “….the purpose of the NHS is to improve the health of the population. So the most important measures of quality are measures of the outcomes of care. The best assessment of that will usually be provided by the patient. The simple notion that people can express the extent to which care leaves them feeling better or worse is the essence of measuring patient outcomes.”

Sussex and Towse say that “Data on patient outcomes is needed to provide vitally needed answers to four types of questions:

1. NHS staff who deliver healthcare and commissioners need information on outcomes to help them benchmark and improve the effectiveness of what they do;
2. patients need information on outcomes to be available to enable them – should they so wish – to compare different providers;
3. commissioners need information on performance and productivity, to decide how to get the greatest benefit from the resources at their disposal and how to allocate resources between different patient groups and types of care;
4. the government needs to know how productive the NHS is: how much health benefit the NHS is producing for the funds it receives. Currently, productivity is measured in terms of the amount of activity in the NHS – the numbers of patients seen and treated – but there is no reference to how successful the activity is in improving patient health.”

Sussex and Towse are principal authors of the Report of the Health Economics Commission on NHS outcomes, Performance and Productivity, which can be downloaded here.

USA: With surgical errors costing £750m per year, many states refuse to pay for ‘medical mistakes’

Separate reports on msnbc.com tell of surgical errors in the USA costing $1.5billion (approx. £750million) per year and of hospitals in 23 states saying they will shred bills for certain medical mistakes, including operating on the wrong body part or the wrong person, or giving someone the wrong blood.

These reports make very interesting reading. John R. Clarke, medical director of ECRI Institute, sponsor of Healthcare Governance Review, is featured in the ‘bill shredding’ report.

Read the ’surgical errors’ report here and the ‘bill shredding’ report here.

UPDATE 21/8/08: Re. surgical errors study, read AHRQ press release here and PubMed abstract here. Also, the World Health Organization (WHO) has issued a checklist for making surgery safer. Download the checklist here and read the associated WHO press release here.

DH lunches consultation on regulating NHS bodies in relation to healthcare associated infections

The Department of Health (DH) in England has launched a 10 week consultation on ‘Changes to arrangements for regulating NHS bodies in relation to healthcare associated infections for 2009/10.’

The consultation document describes the draft regulations which will make it a legal requirement to protect patients, healthcare workers and others from identifiable risks of acquiring a healthcare associated infection. Under the draft regulations, individuals found gulty of an offence can be fined up to £50,000.

The document also explains the link with the restructured Code of Practice for the prevention and control of healthcare associated infections which enables the Care Quality Commission to use it as criteria for monitoring compliance with regulations. NHS providers will need to comply with these regulations as a requirement of their registration with the new Care Quality Commission.

In addition, the document describes the system of enforcement powers in the Health and Social Care Act 2008 that is intended to apply to providers should they fail to comply with the requirements of registration and makes proposals for secondary legislation to support these powers. The DH says that the  Care Quality Commission will publish further details of its enforcement policy in due course.

Download the DH consultation document here.

Building a culture of patient safety through effective governance in Ireland

The report by the Commission on Patient Safety and Quality Assurance in Ireland is now published. Titled ‘Building a culture of patient safety’ the report sets out a governance framework for patient safety and quality in Irish public healthcare.

At 242 pages long, this is a comprehensive and extensive report (and it contains 219 mentions of the word ‘governance’ – Ed.).

The vision around which a health system-wide governance framework for patient safety should be based is stated in the report as “Knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes.”

Healthcare Governance Review spoke to Dr Deirdre Madden, Chairperson of the Commission on Patient Safety and Quality Assurance, about the report. In particular we asked her about the report’s focus on effective governance as a means by which a culture of patient safety and quality can be effected.

Dr Madden said that “Medicine is not a risk-free enterprise; errors occur in every healthcare system in the world. However, we must never be complacent about errors, and must recognise and face the serious consequences that errors have for patients, their families and the clinicians involved. We must develop a positive patient safety culture by putting in place structures and systems that ensure effective governance in our healthcare facilities based on strong and clear reporting relationships and delegated levels of authority, robust accountability mechanisms and patient involvement at all levels of healthcare decision making. We must ensure that the potential for error is minimised to the greatest extent possible by strong professional leadership on safety and quality, active participation in audit, and commitment to sharing lessons learned from adverse events. A system-wide approach to safety and quality will help to ensure that wherever a patient receives care, it will be safe and effective, delivered by appropriately skilled professionals in facilities that are well governed, fit-for-purpose and have patient safety as their paramount priority in all that they do.”

Readers are strongly encouraged to read the report, which, in the opinion of Healthcare Governance Review, paints the most complete and comprehensible understanding of healthcare governance that presently exists anywhere in the world.

Download a copy of the report here.

Related link.

Scottish C.difficile review points to need for governance improvements

An independent review into failures at the Vale of Leven Hospital in Dunbartonshire recommends the development of policies on ”the governance of infection control, the development of clinical leadership to board level, improvements to patient communication, maintenance of a safe environment and death certification practices”.

The review, carried out by the Department of Public Health at Aberdeen University, examined how an outbreak of Clostridium difficile led to the deaths of nine people, and contributed to the deaths of nine more. The review report has been passed to the procurator fiscal to see if charges should be brought.

The report said: “The facilities at the Vale of Leven Hospital were inadequate for effective patient isolation and infection control, and there were frequent patient transfers between wards and other hospitals during this period.

The Scottish Cabinet Secretary for Health and Wellbeing Nicola Sturgeon said that “NHS Boards should be in no doubt – leadership, governance and accountability are the means by which patients and the families can have confidence in our hospitals.”

For further information, including access to the Aberdeen University report click here.

Monitor intervenes following financial governance failings

Monitor, regulator of NHS foundation trusts, has used its statutory powers to intervene on a “financial governance” matter following a “significant failure” by the Royal National Hospital for Rheumatic Diseases  foundation trust to comply with its terms of authorisation.

The “significant failure” relates to a “requirement for a restatement of the Trust’s accounts for 2006/07, reflecting an increase in losses from £40k to £650k, and further significant operating losses in 2007/08.”

The Trust “delivered financial losses over the period from April 2006 to March 2008, the full extent of which were not brought to the attention of the Trust Board or disclosed to Monitor until June 2008, following re-statement of the Trust’s accounts by the external auditors.” The trusts financial risk rating has, as a consequence, droped to ‘1′ – denoting the highest level of financial risk.

In taking action, Monitor recognised that “…[the Chair and his] non-executive colleagues are largely new to the role over the last six months, and that one non-executive is shortly to take up their position.”

Monitor also stressed that they had “….no concerns as to the quality of the clinical care provided by the Trust to its patients” and that the failings “….should not be construed as providing any comment as to the capabilities and competencies, or otherwise, of the Trust’s Board or the executive team, or of Monitor’s confidence in them.”

For further information, click here.

UK Government publishes “National Risk Register”

The Government has published a “National Risk Register” that sets out its assessment of the likelihood and potential impact of a range of different risks that may directly affect the UK. This was promised in the National Security Strategy published earlier this year.

The publication of information on these risks, previously held confidentially within government, is intended to encourage public debate on security and help organisations, individuals, families and communities, who want to do so, to prepare for emergencies. The Register provides an assessment of the
most significant emergencies which the United Kingdom and its citizens could face over the next five years summarised into three categories: accidents, natural events (collectively known as hazards) and malicious attacks (known as threats).

A Cabinet Office spokeswoman said: “It looks at the whole range of risks and looks at them from a national perspective. It is the first time all of this has been brought together in this way.”

The risk register is due to be updated annually.

The risk register contains information for organisations that will be of particular interest to healthcare organisations in the UK. [Interestingly, risk registers are believed to have first been introduced to the UK in 1999 through the Department of Health's Controls Assurance project for the NHS in England - Ed.]

The National Risk Register can be accessed here.

Paul Stanton on ‘confusion and muddle in the DH and the NHS about the nature of governance’

In his latest Health Service Journal article Paul Stanton argues that “The good of the public must be served ahead of NHS boards’ narrowly defined organisational interests, placing them as servants of the community need and not its masters.”

He also states that “There is significant confusion and muddle in the DH and the NHS about the nature of governance.” He goes on to say that “It is not uncommon to hear senior figures talking about boards managing or leading their organisations. This implies a fundamental lack of clarity about the explicit separation that should exist between the task of a board, which is primarily legislative (making policy, setting strategic goals and holding the executive, and through them the organisation, to account) and the task of the executive (albeit some executives are also corporate directors within the legislative board), which is to lead and manage the organisation so that policies are implemented, strategic goals are achieved and the local community is served.”

In making this distinction, Paul says he is “influenced by the work of John Carver, whose model of ‘policy governance’ is admirably clear……….”

Read Paul’s full article here.

Patient safety and quality at risk through healthcare professionals behaving badly

The Joint Commission – the USA’s largest healthcare accreditation body – is warning that “rude language and hostile behavior among health care professionals goes beyond being unpleasant and poses a serious threat to patient safety and the overall quality of care.”

It has issued a Sentinel Event Alert titled ‘Behaviors that undermine a culture of safety’, which is based on years of research. The Alert states that “Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.”

To help put an end to intimidating and disruptive behaviors among physicians, nurses, pharmacists, therapists, support staff and administrators, the Sentinel Event Alert recommends that health care organisations take 11 specific steps, including the following:

- Educate all health care team members about professional behaviour, including training in basics such as being courteous during telephone interactions, business etiquette and general people skills;

- Hold all team members accountable for modelling desirable behaviors, and enforce the code of conduct consistently and equitably;

- Establish a comprehensive approach to addressing intimidating and disruptive behaviors that includes a zero tolerance policy; strong involvement and support from physician leadership; reducing fears of retribution against those who report intimidating and disruptive behaviours; empathising with and apologising to patients and families who are involved in or witness intimidating or disruptive behaviors;

- Determine how and when disciplinary actions should begin; and

- Develop a system to detect and receive reports of unprofessional behaviour, and use non-confrontational interaction strategies to address intimidating and disruptive behaviours within the context of an organisational commitment to the health and well-being of all staff and patients. 

Read the Joint Commission’s full Sentinel Event Alert ’Behaviors that undermine a culture of safety’ here.

NHS governance creep – ‘educational governance’

Healthcare Governance Reviewis concerned as much with ‘governance creep’ in the NHS, as it is with trying to get a handle on what good governance actually looks like.

There are now so many governance terms and terminology that keeping track of governance matters in healthcare is an almost impossible task. It all started with corporate governance, controls assurance and clinical governance. Then we had research governance, information governance, medicines governance, commissioning governance, local governance, converged governance, health and safety governance, risk governance, shared governance, integrated governance, and governance between organisations – to name but a few.

This article in the Health Service Journal was published in February 2007 and talks about ‘educational governance’. It’s author, John Ennis, says that “Good governance is as much about the quality of learning as it is about patient safety, or running an effective organisation.” He talks about standards developed by Skills for Healththat could help healthcare organisations develop an ‘educational governance framework’ for both clinical and non-clinical education.

Read John’s article here (registration may be required).