“What on earth is clinical governance?”
In the first of a series of articles
on clinical governance, Catherine Dewsbury, the Royal Pharmaceutical Society’s
clinical governance pharmacist, debunks some myths
In the five months since I came into post as the
Society’s clinical governance pharmacist I have learnt many things. One
of them is that there are a number of misunderstandings about clinical
governance and what it means for pharmacists and for pharmacy practice.
I hope to counter these misconceptions and fuel a debate on how we might
address clinical governance in the profession. This article is based on
questions and comments I have received.
"Clinical governance is just a fad and if we
ignore it, it will pass." This is a myth. Clinical governance has
been with us for a long time and should be at the heart of all professional
practice. So pause for a moment to think about the Society’s Royal Charter,
which requires it "to promote pharmaceutical education and the application
of pharmaceutical knowledge".
How does the Society do this? It has worked with
pharmacy educators and students, monitored schools of pharmacy and increased
the levels of educational attainment required to meet the requirements
to be registered as a pharmacist. The Society has promoted audit, continuing
education and continuing professional development. Its inspectors monitor
standards and practice. In addition, pharmacists have a Code of Ethics
which requires them to keep up to date and act in the interests of patients.
In its section on key responsibilities of the pharmacist, the code says:
"Pharmacists in professional practice use their knowledge for the well-being
and safety of patients and the public."
So clinical governance is not the latest fad. It
concerns the regulation of professionals, their professional education
and knowledge and the application of that knowledge in practice in the
interests of patients and the public.
"Clinical governance is just another excuse to
blame us when something goes wrong." This is one of the big misunderstandings.
Clinical governance is about creating an open culture in which people
can learn from each other. It requires an understanding that incidents
and errors happen for all sorts of reasons, not just because of people.
Of course, pharmacists need to have the knowledge and skills to undertake
the roles required of them and keep up to date with development, but environmental
factors such as working practices, systems and workload all contribute
to incidents.
The fact that clinical governance at the Society
is a responsibility of the Professional Development Directorate rather
than the Professional Standards Directorate gives an indication that the
Society wants to promote an open, "no blame" culture, where errors and
incidents are taken seriously. It wants people to understand how incidents
occur and share those lessons with the profession so that all pharmacists
can learn from the analysis and minimise future risks to patients.
"When are you going to start your clinical governance
inspections?" I am not an inspector. Clinical governance is not about
inspection. It is a professional commitment to quality. It necessitates
setting standards and reviewing them, wanting to improve, being willing
to learn from others and using tools to demonstrate that one is improving.
As for monitoring standards, the Society already has inspectors who do
that.
"Clinical governance is the new name for audit,
isn’t it?" This is another common misunderstanding. Audit is one of
the tools for measuring performance against standards. It helps in identifying
the priorities for improvement. Audit also highlights those areas where
people can pat themselves on the back and say well done, before setting
higher standards and starting the cycle again.
"The community pharmacy baseline assessment tool
report is completed, so that’s it. We’ve done clinical governance, haven’t
we?" There is more to clinical governance than the baseline assessment
for community pharmacy. The word "baseline" is the clue. The assessment
is a tool for getting started. It provides a structured way of looking
at practice and services to get pharmacists thinking about their strengths
and weaknesses.
The assessment tool is not perfect, but many pharmacists
have used parts of it and developed other areas themselves. Many have
already completed it and are working on action plans they have developed
from the results. Some people have done this for their own pharmacies,
but in some areas the local pharmaceutical committee or other local body
has produced reports for a locality.
The Society is looking at how the tool might be
improved. But that should not stop pharmacists from using the baseline
assessment. Changes to the tool are inevitable because Society staff are
already adopting the principles of clinical governance and reviewing their
own practice.
"Who is going to do clinical governance to me?"
No one. Much of clinical governance must come from within. It is about
looking at one’s own practice, considering how it might be improved, and
then changing practice, implementing the changes and finding out if the
changes work. This can be summed up in the well-known mantra of the pioneer
of autosuggestion, Émile Coué (who happened to be a pharmacist too): "Every
day in every way I am getting better and better."
Other people may be able to suggest alternatives
to try, but there is no one model for pharmacists to buy or rent because
they practise in different ways and every pharmacy is different. No other
person can "do" clinical governance to you. As Coué told his patients:
"The power is within yourself."
"So what you are saying is that clinical governance
is yet another new role for pharmacists?" No. That is another myth.
Clinical governance is a new name for a group of existing functions. Pharmacists
will carry out these functions more formally than in the past because
they will be recording more of what they do so that they can demonstrate
it to others. That is no bad thing. Pharmacists all know that they do
much more than stick labels on boxes and offer advice on over-the-counter
medicines, but that is the public face of pharmacy in most settings. Pharmacists
cannot expect other people to understand and value what they do it if
they cannot explain it or measure it. Clinical governance gives them that
opportunity.
And finally . . .
Be positive. Clinical governance is good for us.
Clinical governance will help pharmacists as they continue to improve
and to enhance their reputation as experts in medicines, managing risks
and improving quality in the interests of patients and the public.
Let me know what you think about clinical governance
and send me copies of your examples of good practice (Royal Pharmaceutical
Society, 1 Lambeth High Street, London SE1 7JN; fax 020 7572 2501; e-mail
cdewsbury@rpsgb.org.uk).
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