Hospital Pharmacist
Vol 10 No 6 p234
June 2003

CHI clinical governance reviews — should we pay attention?

By Raliat Onatade, MSc, MRPharmS

Since its inception in 2000, the Commission for Health Improvement (CHI) has published over 260 clinical governance reports on NHS organisations, the majority of which are reviews of clinical governance arrangements in acute trusts. Over 90 per cent of acute trusts have been reviewed, but as CHI disappears into CHAI (Commision for Healthcare Audit and Inspection) in 2004, do hospital pharmacists need to bother about clinical governance reports? Or are the clinical governance reviews of other organisations of no consequence to us?

A quick search within the published reports of acute trusts reveals that the pharmacy-related areas of clinical governance most often mentioned are:

• Reporting and managing prescribing and administration errors

• Providing information to patients, carers, prescribers and other staff

• Discharging patients

In some cases CHI has commended trusts for notable practices in these areas, but often they are raised as areas that need addressing, for example, where discharge is delayed because medicines are not ready for the patient to take out.

These issues are obviously not new. Hospital pharmacists are aware of the challenges, so why read CHI reports to tell us what we already know? CHI reviewers are senior doctors, nurses, managers, allied health professionals, pharmacists, and lay people. When considering service needs, it is very easy to navel-gaze and forget to consider what our stakeholders want from us. Clinical governance principles, applied appropriately, ensure NHS staff take each others' needs into account. CHI reports help with this by highlighting the pharmacy issues that patients, senior managers and other clinicians believe are important.

Do clinical governance reports have any other uses? Many trusts use published clinical governance reports to identify other organisations which have successfully solved problems that they are struggling with. If a pharmacy department has a good error prevention scheme, for example, there is no reason why they cannot be asked about their secret for success. Hospital pharmacists are very good at networking and sharing lessons. CHI reports can facilitate this by pointing out pharmacy departments outside a local network who may be able to help with a particular problem. Organisations that have the same problems are also a useful source of information. Action plans produced as a result of a review are publicly available on CHI's website. If a trust has been asked to address a problem that you are also facing, reading their action plan (or talking to them) to find out the steps they are taking may help point you in the right direction.

There are other reasons why it is important for pharmacists to be aware of the contents of clinical governance reports. If CHI recommends that a trust takes action in an area of concern, pharmacy managers have a responsibility to ensure that this is not also an issue for them, and if it is, to take steps to address it. If a theme or issue is highlighted in reports, there will be little excuse for a manager failing to recognise that they should sort out a similar problem in their organisation. Whether or not other organisations' clinical governance reviews can be used as a lever for change will depend on local circumstances. With the linking of CHI reports to performance ratings, organisations that have not yet been reviewed may be especially keen to ensure they tackle known areas of concern.

Moreover, reports of clinical governance reviews that are not obviously concerned with pharmacy should still be required reading. Clinical governance can be divided into nine broad components, which are further sub-divided to allow for the detailed assessment of clinical governance structures and processes. All components are applicable to individual departments as well as trust-wide.

The common pharmacy-related issues mentioned at the beginning of this comment usually come under the "patient experience", "risk management", "patient involvement" and "clinical effectiveness" components. However, all pharmacists should consider applying locally the lessons from all categories of clinical governance. Some examples of areas where CHI has made comments that are not directed at pharmacists but which, nonetheless, should be acted on by pharmacists are:

• Patient experience — promoting privacy and dignity, and enhancing patient environment

• Education and training — ensuring equity of access to resources

• Risk management — encouraging an open and fair culture, feedback to staff

• Clinical audit — including forward planning, prioritisation, multi-disciplinary involvement and effective dissemination

• Clinical effectiveness — providing information on treatment and medicines

• Staff management — managing appraisals, temporary staff and staff induction

• Use of information — developing and using performance and quality indicators to ensure the provision of quality services

• Strategic capacity — promoting leadership, communication, and external partnerships

• Patient consultation and involvement — providing information and counselling to patients

Pharmacists with an interest in or responsibility for clinical governance may be surprised at how much useful information can be gathered by not limiting themselves to pharmacy-specific issues. CHI reports on clinical governance are currently under-used by pharmacists. With recruitment problems and the increasing demands on hospital services, some pharmacists may feel that they have to concentrate on the basics before they start doing these "extras". Clinical governance is not an extra, it is a way of working and delivering services. CHI reviews have shown that if clinical governance principles are embedded in the culture and if services are viewed in a systematic and structured fashion through a clinical governance framework, clinical governance becomes part of everyday practice.

Interested pharmacists should take the time to review the valuable resources on the CHI website (www.chi.nhs.uk)