Clinical governance in dentistry

clinical governanceWith DCT interviews around the corner, Elizabeth Offen thought it would be useful to provide an overview of clinical governance in dentistry.

So, what is clinical governance? According to Scally and Donaldson (1998), clinical governance is a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

Clinical governance also allows us to continuously monitor and improve our dental service. It is a framework for quality improvement and is therefore divided into a: setting standards and b: monitoring standards.

Setting standards is based on:

  • Clinical effectiveness and evidence-based dentistry
  • Risk management
  • Significant event analysis.

Monitoring standards involves:

  • Audit
  • Education/continuing professional development
  • Self-assessment and peer review
  • Public involvement – patient satisfaction surveys.

Setting standards

Clinical effectiveness is how successful a service is. This includes assessing its outcomes, safety, cost effectivity.

  • Following evidence-based practice helps maximise our clinical effectiveness
  • Sources such as the Cochrane Library provide a robust evidence base
  • Organisations such as NICE provide authoritative guidance on current best practice.

Risk management

Risk management aims to reduce the chance of adverse events. Examples include:

  • Following local safety policies
  • Learning from complaints
  • Using the correct PPE
  • Creating a safe working environment (Health & Safety at Work Act 1974).

Significant event analysis

Unlike risk management, which involves assessing potential consequences before they occur, significant event analysis involves reflecting upon an event after it has occurred.

Monitoring standards

The CQC monitors healthcare providers to ensure that they are carrying out clinical governance, as specified in Regulation 17 (Health and Social Care Act 2008).

Audit

NICE defines audit as: ‘A quality improvement process that seeks to improve patient care and outcomes through systematic review of care and the implementation of change.’

An audit is therefore carried out as follows:

  1. Propose a topic for your audit – eg cross-infection control
  2. Collect baseline data
  3. Select an accepted standard – eg HTM01-05
  4. Analyse data
  5. Implement changes – eg creating a local policy
  6. Complete a second audit cycle to assess if the changes led to quality improvement.

Education

As stated in the GDC standards 7.3: ‘You must update and develop your professional knowledge and skills throughout your working life…’

In January 2018, the GDC introduced enhanced CPD and included in it are new development outcomes named A, B, C and D.

A is for communication.

B is for business, management and leadership.

C is for development of knowledge.

D is for professionalism.

The new minimum requirements for verifiable CPD and all CPD is now verifiable over five years is:

  • Dentist 100 hours
  • Dental hygienist/therapist 75 hours
  • Dental nurse/technician 50 hours.

Plan: a personal development plan (PDP) must be created to help identify professional needs.

Do: you must complete your CPD regularly, with a minimum of 10 hours every two years. Each CPD activity must address at least one of the GDC’s development outcomes.

Reflect and record: you should reflect on your CPD activity. And also at the end of each year, you must declare the number of CPD hours you have completed and provide evidence of this.

Peer review

  • Sharing experiences between peers and reflecting on how to improve the outcomes
  • Can be used to identify CPD needs or deficiencies in policies.

Public involvement

  • Eg patient satisfaction surveys, like the Friends and Family test.

To conclude, clinical governance plays an important role in improving the quality of services and patient outcomes. Therefore, it is essential that all members of the dental team are aware of how to implement the framework within their practice.

References

Scally G and Donaldson LJ (1998) Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 317(7150): 61-5

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