Surveying the implementation of 'In Good Hands'
Article by Angela Belich, Assistant Executive Director - The Specialist, Issue 85, December 2010
The In Good Hands statement was developed by a group of health professional appointed by the Minister of Health, including ASMS President Dr Jeff Brown in early 2009. The Minister of Health has adopted it as policy and asked all DHBs to implement it although commitment and progress has been variable ranging from slow to non-existent.
In Good Hands requires
- DHB Boards to establish governance structures ensuring partnership of clinical and corporate management
- The DHB chief executive to enable strong clinical leadership and decision making throughout the organisation
- The DHB at the governance level to promote and support clinical leadership and clinical governance at every level
- That clinical governance must cover the whole patient journey, with decisions devolved to appropriate levels
- That DHBs identify actual and potential clinical leaders and support their development
Reporting on implementation has fallen into a black hole with DHBs very unclear as to even when they are required to report on the implementation of the policy so when Associate Professor Robin Gauld of the Centre for Health Systems at the University of Otago approached ASMS asking whether we would help in surveying our membership on the implementation of In Good Hands we were very keen to help.
A survey (with 11 fixed response questions plus provision for comments) was sent to all DHB ASMS members in June this year. There were two follow up requests plus a follow up web based survey. The survey questions were directly related to the key policy directives. The survey achieved a 52% return rate out of the over 3,400 DHB employed members that the survey was sent to.
The ASMS Annual Conference last month heard a fascinating presentation by Dr Gauld on the results of the survey. Some of it was ‘hot off the press’ so to speak. He will be further analysing the results and also working on an article for publication in an international journal.
What is clinical governance and what is clinical leadership?
Dr Gauld, in his presentation talked about clinical governance as an indistinct concept which developed partly as a response to managerialism. He sees it as attached to ideas of quality improvement by health professionals and health professionals leading in service redesign and developing accountability mechanisms.
He referred to research which shows that hospitals with clinically trained leadership are more likely to have standardised processes in place and are more likely to have better patient outcomes. He also tied clinical leadership to concepts of greater productivity in the National Health Service in the United Kingdom and at the Geisinger group.
The Clinical Governance Development Index (CGDI)
Dr Gauld has developed an index from the seven survey items representing aspects of clinical governance implementation. The extent to which a board and management fostered the development of clinical leadership was related to the CGDI score. This result was both independent and statistically significant.
The mean for all DHBs using this index was 5.41. As you can see from the diagram below the worst performing DHBs over the range were Taranaki, Bay of Plenty, Southland, West Coast, Nelson Marlborough, Whanganui and Otago (Southland and Otago were treated as separate DHBs for the purpose of the survey given their recent merger). The best performing DHBs were Lakes, Tairawhiti and Capital & Coast.
Dr Gauld commented to the ASMS Conference that though there were clearly some DHBs who could be picked out as performing below the mean on implementing clinical leadership the mean itself was disappointingly low. This has implications for the quality, safety and efficiency of the system as international evidence shows that clinical leadership is the single most important ingredient for a high performing health system.
