Action 6.02

The Clinical Governance Standard has specific actions relating to health service organisations’ quality improvement systems:

• Action 1.08 – quality improvement systems
• Action 1.09 – reporting
• Action 1.11 – incident management and investigation systems

Health service organisations should use these and other established safety and quality systems to support monitoring, reporting and implementation of quality improvement strategies for clinical communications

Strategies to improve effective communication will take time, leadership, commitment (across the whole organisation) and resources.¹

Identify a suitable individual, group or committee to take responsibility for monitoring and evaluating organisation-wide clinical communication systems. Consider how monitoring and evaluation in relation to improving clinical communications inform and feed into existing evaluation processes in the organisation.

In large organisations, the local workforce (for example, in units, wards) may find it useful to set up a local project team or appoint a member of the workforce to oversee, plan and coordinate the implementation and evaluation of the clinical communication systems in their own local setting. Tailor this to the individual workforce and setting, but ensure consistency with best-practice guidelines.

Monitor effectiveness and performance

Use the organisation’s quality improvement systems to identify and prioritise the organisational and clinical strategies for clinical communications.

Strategies for monitoring effectiveness of clinical communications may include:

• Audits of workforce compliance with policies, procedures and protocols for clinical communication and associated processes
• Audit and evaluation of patient healthcare records to check whether critical information has been recorded and acted on; this could include information contained in discharge summaries, clinical handover checklists or consent forms, actions taken as a result of an alert, and timely communication of critical information.

Stakeholder engagement at all levels of the organisation is an essential part of quality improvement systems and to lead change. This includes feedback from patients, carers and families about their experience with the organisation’s communication processes.

Ensure that quality improvement and incident management and investigation systems include monitoring and evaluation of incidents, adverse events and near misses relating to patient identification, procedure matching, clinical handover at transitions of care, failure to communicate critical information, and inadequate or poor documentation. These incidents could include:

• Mismatching events
• Clinical handover incidents
• Communication errors that contribute to misdiagnosis or failure to escalate
• Readmission because of poor discharge planning.

Ongoing monitoring of adverse events allows organisations to keep track of whether there are safety gaps in their clinical communication processes, and to modify these processes to suit the service context. Evaluation allows organisations to measure the progress and impact of clinical communication processes and possible improvement strategies.

Safe Communication, developed by the Quality Improvement Clinic (United Kingdom), is a useful step-by-step guide to measuring the effectiveness of clinical communication processes.²

Implement quality improvement strategies

Implementation of quality improvement strategies is essential to ensure that clinical communication systems and processes continue to operate effectively, and any areas for improvement are identified and acted on. It can also help to determine where communication is being done well in the organisation. Ongoing monitoring and regular evaluations are necessary to track changes over time, and to report on adverse events or risks that may relate to clinical handover or other communication failures.

Use the results of monitoring activities to show improvements, or areas in which improvement is required. If appropriate, use quality improvement activities that are consistent and measurable across the corporate group, network or health service.

Use the results of organisational risk assessments to identify gaps, plan, and set priorities for areas for investigation or action.

When adverse events or near misses occur, specifically investigate to identify any issues in the performance or use of the system. Use this information to make improvements.

One model to implement strategies to improve clinical communications is the plan–do–study–act (PDSA) cycle.^{2, 3} The PDSA cycle is an iterative feedback process that allows improvements to respond to changing circumstances or consequences, as well as ensuring continual and increasing engagement of clinicians. Engagement of clinicians and other relevant workforce members is essential to any quality improvement process.¹

Report outcomes

Ensure that processes are in place to facilitate feedback, and provide review findings from monitoring quality improvement processes to relevant committees or meetings about governance and leadership. Members of the relevant committee or the individual(s) responsible for governance arrangements should ensure that actions are taken to improve clinical communication systems.

Data obtained through these processes should be fed back to the highest level of governance and the local workforce. This may help inform clinicians and the local workforce of areas that may need improvement, and provide a strong case for them to change practice and take part in improvement activities. This feedback process also contributes to a culture of transparency and accountability.

The Clinical Governance Standard has specific actions relating to health service organisations’ quality improvement systems:

• Action 1.08 – quality improvement systems
• Action 1.09 – reporting
• Action 1.11 – incident management and investigation systems

Health service organisations should use these and other established safety and quality systems to support monitoring, reporting and implementation of quality improvement strategies for clinical communications.

Strategies to improve effective communication will take time, leadership, commitment (across the whole organisation) and resources.¹

Identify a suitable individual, group or committee to take responsibility for monitoring and evaluating organisation-wide clinical communication systems. Consider how monitoring and evaluation in relation to improving clinical communications inform and feed into existing evaluation processes in the organisation.

Monitor effectiveness and performance

Ensure that quality improvement and incident management and investigation systems include monitoring and evaluation of incidents, adverse events and near misses relating to patient identification, procedure matching, clinical handover at transitions of care, failure to communicate critical information, and inadequate or poor documentation. These incidents could include:

• Failure to escalate
• Mismatching events
• Clinical handover incidents
• Unplanned transfers to overnight stays
• Delays in discharge
• Return to theatre
• Other key performance indicators developed in consultation with the workforce.

Ongoing monitoring of adverse events allows organisations to keep track of whether there are safety gaps in their clinical communication processes, and to modify these processes to suit the service context. Evaluation allows organisations to measure the progress and impact of clinical communication processes and improvement strategies. Ensure that members of the clinical workforce know about the processes to monitor and review incidents and adverse events.

Safe Communication, developed by the Quality Improvement Clinic (United Kingdom), and the OSSIE Guide to Clinical Handover Improvement provide useful guides to measuring the effectiveness of clinical communication processes.^1,2

Implement quality improvement strategies

Implementation of quality improvement strategies is essential to ensure that clinical communication systems and processes continue to operate effectively, and any areas for improvement are identified and acted on. Quality improvement systems can also help to identify where communication is being done well in the organisation. Ongoing monitoring and regular evaluations are necessary to track changes over time, and to report on adverse incidents or risks that may relate to clinical handover or other communication failures.

Use the results of monitoring activities to show improvements, or areas in which improvement is required. If appropriate, use quality improvement activities that are consistent and measurable across the corporate group.

Use the results of organisational risk assessments to identify gaps, plan, and set priorities for areas for investigation or action.

When adverse events or near misses occur, specifically investigate to identify any issues in the performance or use of the system. Use this information to make improvements.

One model to implement strategies to improve clinical communications is the plan–do–study–act (PDSA) cycle.^1,2 The PDSA cycle is an iterative feedback process that allows improvements to respond to changing circumstances or consequences, as well as ensuring continual and increasing engagement of clinicians. Engagement of clinicians and other relevant workforce members is essential to any quality improvement process.¹

Report outcomes

Ensure that processes are in place to facilitate feedback, and provide review findings to relevant committees or meetings about governance and leadership. Members of the relevant committee or the individual responsible for governance arrangements should ensure that actions are taken to improve clinical communication systems.

Examples of evidence

Select only examples currently in use:

• Policy documents that describe the processes for monitoring the organisation-wide clinical communication strategy and adverse events relating to clinical communication, such as
  • schedule of regular audits
  • risk-based schedule of reports provided to managers, relevant committees or the governing body
• Risk register that identifies clinical communication risks, and describes mitigation strategies and risk monitoring
• Key performance indicators relating to clinical communication that have been developed in consultation with the workforce
• Audit results of workforce compliance with policies for clinical communication and associated processes
• Formalised, structured processes that are used when developing quality initiatives to improve clinical communication (for example, PDSA cycle)
• Audit results of healthcare records for documentation that critical information has been recorded and acted on
• Quality improvement plan that includes activities to manage risks identified in clinical communication and associated processes
• Terms of reference and membership of committees responsible for developing and implementing the communication strategy and associated processes, and monitoring their effectiveness
• Committee and meeting records in which clinical communication issues were discussed
• Structured communication tools, forms and guidelines that are implemented and updated in line with identified risks, consumer feedback and committee recommendations
• Communication with the workforce, patients, carers and families about strategies to improve clinical communication
• Schedule of routine reviews of clinical communication policy documents, and updates in line with changes in best practice, emerging evidence, and results of audits and investigations.

The Clinical Governance Standard has specific actions relating to health service organisations’ quality improvement systems:

• Action 1.08 – quality improvement systems
• Action 1.09 – reporting
• Action 1.11 – incident management and investigation systems

Health service organisations should use these and other established safety and quality systems to support monitoring, reporting and implementation of quality improvement strategies for clinical communications.

Strategies to improve effective communication will take time, leadership, commitment (across the whole organisation) and resources.¹

Identify a suitable individual, group or committee to take responsibility for monitoring and evaluating organisation-wide clinical communication systems. Consider how monitoring and evaluation in relation to improving clinical communication inform and feed into existing evaluation processes in the organisation.

Monitor effectiveness and performance

Strategies for monitoring effectiveness of clinical communications may include:

• Audits of workforce compliance with policies, procedures and protocols for clinical communication and associated processes
• Audit and evaluation of patient healthcare records to check whether critical information has been recorded and acted on; this could include information contained in discharge summaries, clinical handover checklists or consent forms, actions taken as a result of an alert, and timely communication of critical information.

Stakeholder engagement at all levels of the organisation is an essential part of quality improvement systems and to lead change. This includes feedback from patients, carers and families about their experience with the organisation’s communication processes.

Ensure that quality improvement and incident management and investigation systems include monitoring and evaluation of incidents, adverse events and near misses relating to patient identification, procedure matching, clinical handover at transitions of care, failure to communicate critical information, and inadequate or poor documentation. These incidents could include:

• Mismatching events
• Clinical handover incidents
• Communication errors that contribute to misdiagnosis or failure to escalate
• Readmission because of poor discharge planning.

Ongoing monitoring of adverse events allows organisations to keep track of whether there are safety gaps in their clinical communication processes, and to modify these processes to suit the service context. Evaluation allows organisations to measure the progress and impact of clinical communication processes and improvement strategies.

Safe Communication, developed by the Quality Improvement Clinic (United Kingdom), is a useful step-by-step guide to measuring the effectiveness of clinical communication processes.²

Implement strategies for quality improvement

Implementation of quality improvement systems is essential to ensure that clinical communication systems and processes continue to operate effectively, and any areas for improvement are identified and acted on. It can also help to determine where communication is being done well in the organisation. Ongoing monitoring and regular evaluations are necessary to track changes over time, and to report on adverse events or risks that may relate to clinical handover or other communication failures.

Use the results of monitoring activities to show improvements, or areas in which improvement is required. If appropriate, use quality improvement activities that are consistent and measurable across the corporate group, network or health service.

Use the results of organisational risk assessments to identify gaps, plan, and set priorities for areas for investigation or action.

When adverse events or near misses occur, specifically investigate to identify any issues in the performance or use of the system. Use this information to make improvements.

One model to implement strategies to improve clinical communications is the plan–do–study–act (PDSA) cycle.^{2, 3} The PDSA cycle is an iterative feedback process that allows improvements to respond to changing circumstances or consequences, as well as ensuring continual and increasing engagement of clinicians. Engagement of clinicians and other relevant workforce members is essential to any quality improvement process.¹

Report outcomes

Ensure that processes are in place to facilitate feedback, and provide review findings from monitoring quality improvement processes to relevant committees or meetings about governance and leadership. Members of the relevant committee or the individual(s) responsible for governance arrangements should ensure that actions are taken to improve clinical communication systems.

Data obtained through these processes should be fed back to the highest level of governance and the local workforce. This may help inform clinicians and the local workforce of areas that may need improvement, and provide a strong case for them to change practice and take part in improvement activities. This feedback process also contributes to a culture of transparency and accountability.