Clinical Governance…or Quality and Safety at the

GNCH

Mike Mckean

Q&S GNCH

Q: are we the Great North Children’s Hospital?

• 2013: review of governance

• Engagement

• Structures

Clinical Governance Review: Improving service quality through frontline staff

Why review CG?

• GNCH open for 2 years.

• Increase in children/families choosing the GNCH for their care (workload increase estimated at 15%)

• Complexity of GNCH– has many departments and services – large wards with multiple teams per ward– several directorates manage children on its wards

• National drivers: – Quality improvement through empowering frontline staff.– Mid Staffordshire Review 6th Feb 2013 (“The Francis report”).

A note from the Francis Report• 290 recommendations, 164 witnesses• Structured around

– Warning signs– Governance and culture

• Failure – systems, organisations and individuals• Fundamental change in culture required• Change will not result from “top down” approach• Need to secure the engagement of every single person

serving the patient

A note from the Francis Report

• Fundamental change in culture required• Need to secure the engagement of

every single person serving the patient

Engagement ProcessSemi-structured interviews

Collect understanding, stories

Steering group meeting 1: Identify domains and themes

Workshop 1: Test themes generate ideas

Steering group meeting 2: Prepare themes and ideas

Workshop 2: Present to Stakeholders

Implementation

Distillation of stories

Distillation of ideas

Steering Group Meeting 1: identify domains and themes

5 domains identified:– Domain A: Current understanding and

experience – Domain B: Culture – Domain C: Sharing and boundaries– Domain D: Datix– Domain E: Follow through and support

Sharing and Boundaries: Themes

a. If in well defined area CG and QI can work well

b. Things fall between boundaries: ward, depts., directorates, local trusts and nationally (other children’s hospitals). – a 'cloud' where things don't always get followed through – we need to create a 'bridge' between pockets of good practice

c. Need education into what CG is

Directorate Q&S Structure

GNCH Symposium

• 2014: Risk and QI

• 2015: Transition

– CQC– Area of risk– Poor patient experience

GNCH Q&S Symposium

• Region wide• Examples of good transition

– Rheumatology– GP engagement– Oncology– Diabetes

• Share processes, lessons• Encourage transition

Date for diaries

• 18th September at St James Park

• DO COME AND JOIN US