NUR3605 - Nursing Leadership, Governance and Culture Essay Answer

Introduction

Clinical governance, a framework introduced in England in 1997, has been pivotal in enhancing healthcare quality (Macfarlane, 2019). In Australia, the Australian Commission on Safety and Quality in Healthcare (ACSQHC) took a pioneering role in implementing clinical governance through the creation of the National Safety and Quality Health Service Standards (NSQHS) (ACSQHC, 2021). The National Safety and Quality Health Service (NSQHS) standards are a crucial foundation in the Australian healthcare system intended to ensure safe, high-quality healthcare services. These standards are critical tools for nurses to attain governance compliance in the Australian setting, and they are inextricably linked to the provision of nursing care, as demonstrated by my clinical experience in hospital-acquired infection prevention (ACSQHC, 2021). Drawing from a case study during a clinical placement, this essay critically assesses the impact of clinical governance on nursing care delivery. It also explores how the NSQHS standards are instrumental in assisting nurses to adhere to clinical governance principles. Moreover, it underscores the importance of a safe and supportive healthcare environment in achieving optimal outcomes for patients and healthcare professionals.

Concept of Clinical Governance and Clinical Placement

Healthcare organisations use clinical governance as a systematic framework to ensure and continuously enhance the quality and safety of patient treatment(Mcfarlane, 2019). It covers various initiatives to advance clinical efficacy, patient safety, and excellence in healthcare services (Mcfarlane, 2019). The core elements of clinical governance include

leadership and culture, consumer partnerships, organisational systems, monitoring and reporting, effective workforce and communication and relationships (Australian Government, 2019a). Clinical governance is essential to contemporary healthcare systems as it holds healthcare professionals responsible and emphasises innovation and continual improvement. The culture of responsibility and quality improvement it fosters in healthcare organisations makes clinical governance essential (Mcfarlane, 2019). Clinical governance prevents medical errors, enhances patient outcomes, and improves patient experience (Kaini, 2019). It combines several elements, including clinical audit, risk management, training and education, patient feedback, and clinical efficacy, to guarantee high-quality, safe, and patient-centred healthcare services (Michael & Loh, 2023).

I experienced how clinical governance concepts positively impacted nursing care when preventing hospital-acquired infections during clinical placement in a hospital. One instance was the introduction of stringent guidelines for putting on and taking off personal protective equipment (PPE). To reduce the danger of contamination, nurses were expected to follow precise instructions when donning and taking off PPE. Regular training sessions and audits served to emphasise the significance of this protocol. This strategy considerably decreased the risk of hospital-acquired infections by ensuring nurses followed the best infection control measures (Infection Control Guidelines Advisory Committee, 2019). Another crucial component of infection control in the hospital was mask fit testing. The use of masks that fit well and create an airtight seal was ensured by applying clinical governance standards (Xu et al., 2021). Regular fit testing was done, and nurses received instructions on how to use masks properly. Respiratory infections were less likely to occur by taking preventative measures and safeguarding patients and healthcare professionals (Xu et al., 2021).

Clinical governance also strictly regulated the use of hand hygiene techniques. Before and after patient encounters, nurses must follow stringent hand hygiene guidelines, which include washing hands with soap and water or using hand sanitiser (Australian Government, 2019b). The hospital's dedication to these procedures was apparent from the supplies for good hand hygiene that were easily accessible, and the frequent reminders posted all over the place. The hospital's attention to patient safety and high-quality care was shown by its adherence to hand hygiene, which also decreased the incidence of infections. Lastly, clinical governance was critical in ensuring the nursing staff delivered high-quality treatment while reducing the risk of hospital-acquired infections (Australian Government, 2019b).

Impact of Standards (NSQHS) in Australian Setting

Clinical Governance (CG) is a comprehensive framework that forms the backbone of healthcare quality and safety. This framework consists of six essential principles, each of which plays a critical role in ensuring the delivery of safe and high-quality healthcare services (Australian Government, 2019). These principles also play an essential role in the NSQHS standards for quality care and better health outcomes.

Leadership and culture are foundational in any healthcare organisation. They set the tone and drive the overall commitment to safety and quality (Brown, 2020). Within the NSQHS framework, Standard 1.01 strongly emphasises leadership commitment to safety and quality (ACSQHC, 2021). Effective leadership fosters a culture that encourages open communication, learning from mistakes, and continually pursuing excellence (Brown, 2020). In my clinical setting, leadership and culture influenced every aspect of healthcare, particularly in infection control. Strong leadership helped in setting clear expectations for the proper use of PPE, like gloves, gowns, masks, and face shields, and reinforced the importance of adhering to rigorous guidelines for donning and doffing. The hospital prioritised patient safety and ensured that healthcare workers understood the significance of these practices, reducing the risk of hospital-acquired infections.

Secondly, involving patients and consumers in their care and decision-making is pivotal to achieving quality healthcare outcomes (Hughes et al., 2018). NSQHS Standard 2.06 underscores the importance of patient-centred care and patients' active involvement in making informed health decisions. It also advocates for open, honest, and effective communication between healthcare providers and patients (ACSQHC, 2021). Patient engagement was fundamental in my clinical placement regarding discussions about infection prevention, such as hand hygiene practices, This was crucial in empowering patients and creating an effective strategy for reducing the risk of hospital-acquired infections.

Thirdly, organisational systems are the backbone of healthcare quality and safety (Mannion & Davies, 2018). NSQHS Standard 3.02 addresses this aspect by preventing and controlling healthcare-associated infections. It outlines the need for healthcare organisations to develop and maintain effective infection prevention and control systems (ACSQHC, 2021). In my clinical context, these systems played a role through policies and procedures for infection control, including meticulous training on donning and doffing PPE, mask fit testing, and hand hygiene protocols. These standardised systems provided a structured approach that minimised the risk of errors and helped ensure consistent infection control practices.

Furthermore, continuous monitoring and reporting of clinical outcomes are essential for driving improvement in healthcare (Basch et al., 2018). NSQHS Standard 3.05 is closely related to this principle and deals with the healthcare organisation's surveillance systems for safety and quality. Effective monitoring and reporting allow for the early identification of issues, enabling prompt corrective actions (ACSQHC, 2021). I had the opportunity to participate in routine audits, monitoring, and reporting of infection rates in compliance with infection control protocols and standard procedures. These activities served as vital early warning systems for potential issues, which, when addressed promptly, helped prevent hospital-acquired infections.

In addition, the competence and proficiency of healthcare professionals are central to delivering quality care (Schrimmer et al., 2019). NSQHS Standard 1.20 emphasises the need for healthcare organisations to ensure their workforce is skilled and competent. Training and education programs are vital for maintaining the proficiency of healthcare workers, as they are on the front lines of infection prevention (ACSQHC, 2021). In my clinical placement, the organisation invested significantly in training and education programs to ensure its workforce was proficient in infection control measures. This included thorough training on donning and doffing PPE, mask fit testing procedures, and hand hygiene protocols.

Effective communication and teamwork among healthcare staff are critical for ensuring patient safety. NSQHS Standards 6.04 and 6.08 underscore the importance of clear and effective communication during transitions in care and clinical handovers. Strong relationships among healthcare teams encourage collaborative efforts to maintain infection control protocols (ACSQHC, 2021). Open communication regarding infection prevention and control measures was essential in my clinical practice. This involved discussing best practices, clarifying doubts, and encouraging an atmosphere where healthcare professionals feel comfortable raising concerns or reporting lapses. Strong relationships among team members fostered a culture of mutual support and accountability, ultimately contributing to improved infection control.

Importance of Safety Culture

A robust safety culture within a healthcare organisation is the foundation for delivering high-quality patient care while ensuring staff well-being. Safety culture encompasses the collective values, attitudes, and behaviours of healthcare professionals, leadership, and the organisation concerning patient safety (Lu et al., 2022). It is an environment where open communication, error reporting, and continuous improvement are encouraged, and its impacts on patient outcomes and staff are profound (Kilcullen et al., 2022). Foremost among the advantages of a strong safety culture is its ability to reduce medical errors. In an environment where staff feel comfortable reporting errors and near misses without fear of reprisal, errors are more likely to be promptly addressed (Rodziewicz & Hipskind, 2020). This reporting culture emphasises learning from mistakes and identifying system weaknesses rather than assigning blame. By pinpointing the root causes of errors, healthcare organisations can swiftly implement preventive measures to reduce the recurrence of similar mistakes. This directly benefits patient safety by minimising harmful medical errors, thus improving patient outcomes (Singh et al., 2022).

Open and effective communication is another crucial element of a safety culture. It promotes better collaboration among healthcare teams, ensuring that critical information is shared promptly and accurately (Kwame & Petrucka, 2021). Enhanced communication leads to better patient care by allowing healthcare providers to identify and address potential issues before they become patient safety risks. When information flows freely, each team member is well-informed, enabling well-coordinated care that optimises patient outcomes (Agency for Healthcare Research and Quality, 2021). Moreover, a culture of safety contributes to increased patient satisfaction. Patients who perceive a strong safety culture within a healthcare facility are more satisfied and confident in their care (Noviyanti et al., 2021).

The knowledge that their healthcare providers prioritise safety instils trust in the healthcare system, enhancing the overall patient experience. This increased trust encourages patient engagement, compliance with treatment plans, and a willingness to seek care when needed, all of which contribute to improved patient outcomes (Hannawa et al., 2022). Additionally, a safety-focused environment promotes better adherence to established protocols. The staff members are likelier to follow protocols and guidelines consistently. This consistency reduces practice variations and ensures patients receive standardised, high-quality care (Morikane et al., 2021).

Conversely, a poor safety culture can harm patient outcomes and staff well-being. In such an environment, staff may hesitate to report errors or voice concerns, leading to increased medical errors. When errors are underreported due to fear of reprisal, they may go unaddressed, potentially causing harm to patients (Lu et al., 2022). The lack of transparency and accountability can foster a culture where errors are overlooked, compromising patient safety. Employee burnout is another typical result of a poor safety culture (World Health Organisation, 2021). Staff may feel unsupported, underappreciated, and overburdened by the stress and frustration of their jobs in such an environment (Garcia et al., 2019). Burnout can lower staff morale and have a detrimental influence on patient care. This can also lead to mistakes, lapses in decision-making and lower quality of treatment, compromising patient outcomes (Garcia et al., 2019).

Conclusion

In summary, a robust culture of safety is a fundamental pillar in healthcare organisations, essential for delivering high-quality patient care and safeguarding the well-being of healthcare professionals. This culture, characterised by open communication, error reporting, and continuous improvement, brings numerous advantages that directly impact patient outcomes. It significantly reduces medical errors by promoting the prompt identification of mistakes and system weaknesses, thus enhancing patient safety and results. Effective communication within a safety culture enhances collaboration among healthcare teams, ensuring the timely sharing of critical information for optimised patient care. Patients who perceive a strong safety culture are more satisfied, engaged, and confident in their care, ultimately leading to improved outcomes. Conversely, a poor safety culture can lead to increased medical errors, staff burnout, reduced staff engagement, and diminished patient trust, all of which compromise patient care and outcomes. Therefore, nurturing and upholding a safety culture remains a top priority in healthcare organisations to benefit patients and healthcare professionals.

References

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Australian Commission on Safety and Quality in Healthcare [ACSQHC]. (2021). National Safety and National Safety and Quality Health Service Standards (2nd ed). https://www.safetyandquality.gov.au/sites/default/files/2021-05/national_safety_and_quality_health_service_nsqhs_standards_second_edition_-_updated_may_2021.pdf

Australian Government. (2019a). Core elements of clinical governance . https://www.agedcarequality.gov.au/sites/default/files/media/Fact_sheet_3_Core_elements_of_clinical_governance.pdf

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