The first in a series on developing safety in general practice from Catherine Auden at VetLed
Clinical Governance.
It’s not a set of words that get your toes tingling with excitement. It’s certainly not the sort of CPD I’d be clamouring to sign up for. But is there something to be said about this for the general practice vet?
What does it mean? And what does it mean for you in your practice?
As vets we are all interested in providing the best clinical management possible for the patients under our care. So if patient safety and best patient care are our goals, then Clinical Governance must become part of practice life.
Let’s imagine an old Greek temple, the sort held up by huge marble pillars. The temple is the CLINICAL GOVERNANCE temple. If the roof is BEST PATIENT CARE, such care is upheld by seven supporting columns.
Before we get lost in the lingo, let’s apply this to a common workplace situation...
How does Clinical Governance affect how I spay a bitch?
I offer the client the option of laparoscopic spay or laparotomy (research). A full range of options means that their consent to a procedure is fully informed.
My surgical skills are based on research and as a practice we like to ensure we are up to date with most recent research in any given area. I’ve learnt from some great tutors back at university, I’ve gone on a practical surgical skills workshop (professional development), and honed my skills over the years alongside my colleagues.
Over time, in our practice we’ve tried to record post-op complications (audit). We decided as a practice not to routinely use antibiotics after a spay after reading up on antimicrobial resistance (professional development, research). We found a tiny percentage of our post-op complications were due to post-op infection (audit).
I make sure to phone the client with an update once the bitch is in recovery (client experience).
We use an anaesthetics checklist prior to induction to reduce human error. If mistakes (big or small) are made then they are recorded and we talk about them at the practice meeting each week (risk management). I’m not afraid to talk about my mistakes because we all talk our mistakes over, even my boss. We’ve even realised that there’s usually a string of issues that led to a mistake, and I didn’t have control over many of them (open-ness and transparency). There are myriad Human Factors that lead to how we work, both good and bad! We can all learn from each other’s experiences and we are better clinicians as a result.
Perhaps this seems a bit idealistic. Or maybe it sounds quite familiar. The reality is we could probably all do with sorting out our clinical governance. It takes a bit of thinking about, and takes a bit of time but if we are serious about best clinical practice then perhaps we should be more serious about clinical governance.
Here’s a few starting questions to get your mind whirring, if not quite your toes tingling!
· Are we up to date with current research? What IS the best patient care currently available?
· Are we offering a full variety of treatment options to the client so their consent is truly informed?
· How is our practice performing against the guidelines set out in the Practice Standards Scheme or our own practice protocols?
· Is there a culture of seniors teaching juniors within the daily walk of the practice?
· How is CPD fed back to the team?
· Are we managing foreseeing risks and managing them? Could checklists be useful?
· Are we keen for client feedback and recording/processing it effectively?
· Is there a workplace culture in which mistakes are managed well and learnt from? Is this evident at all levels in the hierarchy?
· Do my staff feel psychologically safe? And how might this affect patient safety?
Interested? Need some help? Want to build a culture where your team report their victories and their errors? Develop yourself to lead your team from the front. Find out what stops your team from “speaking up” and ensure that your practice is delivering that temple rooftop of the Clinical Governance “BEST PATIENT CARE”.
Discover more here on our website about what training we offer to general practice vets to develop your team and help you provide best patient care!
So Clinical Governance…boring? Or surprisingly relevant and worth investing some time in?
Cat Auden graduated from Royal (Dick) Veterinary College in 2010 and worked in both small animal and equine practice for a number of years. She takes her veterinary practice experience and passion for people into her current role having diversified into the growing field of veterinary human factors. As Head of Collaboration for VetLed, Cat works to develop the performance of veterinary teams across the country through an understanding of Human Factors. She is delighted to also be part of the VetMINDS team working to support employers and employees suffering pregnancy loss. Out of work Cat likes spending time in the great outdoors with her young, energetic family and mischievous Border Terrier.