How do we improve complex patient care with less money?
With the NHS under pressure, and the need to move complex care patients back to their homes, how can we ensure that the needs of patients are met safely?
Andrew Cook, Interserve Healthcare’s chief nurse, explores the pressures on the NHS, the importance of clinical governance and how healthcare providers can best respond.
Increasingly complex needs
The government’s vision is to move people away from hospital and into home-based care. It benefits both patients and the public purse, allowing people to live lives that they can control, in an environment which is familiar and arguably safer.
There are, already, increasing numbers of people with complex healthcare conditions such as acquired brain injuries, spinal injuries and rare genetic disorders, that are now being cared for at home. But if this solution is going to become more accepted and common in the future, homecare providers need to demonstrate they have the governance, quality and safety standards in place to ensure their patients have access to the very best care in their own homes.
Patients are right to expect that, as their needs become increasingly complex to manage, then the systems and processes employed to keep their care safe will be more robust and sophisticated. Some homecare providers may struggle to develop systems of good governance either because of a lack of resources or because they lack the previous experience to understand what is needed to manage new and more complicated conditions.
Quality and safety has to underpin good clinical governance
At the heart of good clinical governance are the principles of quality and safety. Three simple questions can be posed to formulate thinking about how clinical governance can be developed:
Do we have suitable, qualified and competent staff, and how do we prove it?
Do we have rigorous systems, processes and policies, and how do we prove it?
Do we have appropriate equipment, facilities and environments, and how do we prove it?
For us as healthcare providers, the emphasis on each has to be the ‘how do we prove it?’ element, with evidence at its heart.
Interserve Healthcare has spent three years building a new framework of clinical governance. We used the three questions as a starting place to: analyse what existed; decide what was good and needed preserving; and what had served its time.
A cultural change is needed to respond to complex patient needs
As a result, we now have more focus on achieving the outcomes of quality development initiatives, making sure we not only make plans to improve where we need to but also delivering on those commitments.
So, where we have completed an investigation, for example, we are now more rigorous about understanding where things went wrong, what would have stopped or reduced the problems that occurred and then adapting the systems we use so that these things are less likely to happen in future.
Regulations can all too easily focus our attention on making sure that we have the right paperwork in place, that policies and systems meet the expectations of the regulator, such as the Care Quality Commission (CQC), or comes up to the standards set out in guidance documents such as those published by National Institute for Health & Care Excellence (NICE).
We can be drawn to chase the standard, to tick the box or to do what others ask of us, rather than asking what the impact and benefit is to the experience and outcomes of the people we care for. Databases, policies and standards should never trump the needs, choices and experiences of people.
Therefore, we now we have a solid framework of clinical governance that
Matches the complexity of the clients
Blends quality, safety and value for money and
Puts better outcomes for patients front and centre
With ever tightening budgets within social care, the question is ‘how do we afford to do what is right for our clients in the future?’ Safety can never be compromised but we live in the reality of the real world. Finding clever ways to improve quality whilst working with ever decreasing resources is the challenge. The solutions are in our hands to create.