How to engage clinicians in clinical governance
It's crucial to frame clinical governance as a way of supporting clinicians to do their work.
Giving doctors another form to fill out is not the way to engage them in better clinical governance, according to Dr Peter Choi, Director of Medical Services at John Hunter Hospital, Hunter New England Local Health District.
Dr Choi, a nephrologist who has long worked to drive better care in the United Kingdom and Australia, is mindful of how clinical governance policies and procedures affect clinicians on the ground.
He says clinicians may not see the value in clinical governance, especially when it is perceived as adding to a bureaucratic burden.
‘A lot of clinical governance still involves retrospective action. We might believe that it helps patient care because we identify a problem and fix it, but in my experience that never actually happens,’ Dr Choi says.
‘I think we need to turn clinical governance around to be much more focused on being proactive. If something we’re discussing in a clinical governance context doesn’t directly help a clinician to provide better care, then we shouldn't be doing it.’
The key to is to engage clinicians in developing clinical governance, and to do that health services need to make the case for why clinical governance is needed, Dr Choi says.
For example, when talking to doctors it is important to reframe the language of clinical governance around meeting clinical goals. ‘As a clinician, I don’t call it clinical governance – I say it’s how we can make things better.’
He also believes it is important for the board and executives to be transparent and honest with clinicians about financial priorities.
Dr Peter Choi, Director of Medical Services, John Hunter Hospital, Hunter New England Local Health District
‘It is difficult being in an executive or on a board because you have that fundamental balance of clinical care and the bottom-line dollar in the way that clinicians don’t have. And often where I think clinical governance top down from executives fails is because they don’t want to be in a difficult conversation or acknowledge that balance, and it creates suspicion.’
It comes down to establishing trust between executives and clinicians. Dr Choi says he has a respectful and healthy relationship with his chief executive, as well as with clinical colleagues who regularly see him in the wards.
The health service has helped to build this relationship through a monthly meeting of the executive and around 70 staff specialists and visiting medical officers, brokered by the Medical Staff Council.
‘The conversation is very respectful,’ Dr Choi says. ‘It’s made clinicians feel heard because they can talk directly to the chief executive and get a sense that the executive understands what's happening.’