How do we know we are delivering safe and effective care? How do we ensure that care meets high quality standards? What do we need to do to develop a culture of continuous healthcare improvement? This is what clinical governance is all about.
Having been pioneered in the UK in the mid-90s following a review of post-surgery mortality outcomes at a leading hospital, clinical governance, of which clinical audit is a key pillar, is now an established practice in mature healthcare systems. Designed as a systematic approach to improving and maintaining the quality of patient care, this framework is now an integral aspect of service provision for both NHS organisations and clinical practitioners alike.
In developing healthcare systems, like that in Rwanda, health governance predominantly focuses on the application of health policies and law (1). There is, however, an increasing recognition of clinical governance as a health systems strengthening tool in the low-to-middle-income country hospital setting (2).
As part of our sustainable health system strengthening philosophy, we are supporting our long-standing partner in Rwanda to build up a robust community-based palliative care service. As with any good clinical service, organised and standardised documentation not only improves communication between healthcare practitioners but it also directly improves patient care (3). Last month, we helped the organisation complete their first clinical audit loop successfully.
References:
- Brinkerhoff DW, Fort C, Stratton S. Good governance and health: assessing progress in Rwanda. TWUBAKANE Decentralization and Health Program Rwanda Report. 2009 Apr.
- Kamanzi J, Megentta A, Nsabiyumva W, Sendegeya A, Wong R. Improving clinical documentation through monthly audits in Butare teaching hospital, Rwanda. Journal of Service Science and Management. 2015 Nov 19;8(6):860-7.
- Zierler-Brown S, Brown TR, Chen D, Blackburn RW. Clinical documentation for patient care: models, concepts, and liability considerations for pharmacists. American Journal of Health-System Pharmacy. 2007 Sep 1;64(17):1851-8.
