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District health boards work to improve clinical governance

Health professionals and district health boards working to improve clinical governance

One of the largest and most complex surveys of New Zealand’s health workforce shows district health boards (DHBs) are increasingly working in partnership with the health professionals they employ.

The Clinical Governance Assessment Project (CGAP) was commissioned by the Ministry of Health’s National Health Board, the Health Quality & Safety Commission, and DHB Shared Services (DHBSS) on behalf of the DHBs, and carried out by Otago University’s Centre for Health Systems between April and November this year. The survey was released at a seminar on clinical governance, being held in Wellington today and opened by Minister of Health, Hon Tony Ryall.

Clinical governance has been defined as “a system through which health organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”.

The survey followed up earlier research which looked at implementation of the 2009 In Good Hands report of the Ministerial Task Group on Clinical Leadership.

Otago University completed a survey of members of the senior doctors’ union, the Association of Salaried Medical Specialists on behalf of that union, while the study carried out this year asked questions of a wide range of health professionals employed by DHBs.

About 3500 written comments were received in response to the survey, in addition to the 10,303 completed surveys which represented a response rate of about 25 percent. The researchers also conducted site visits and interviews with 165 managers and health professionals in 19 of the 20 DHBs. Canterbury DHB did not participate due to the demands of its earthquake recovery work.

The study found the majority of health professionals:

• viewed themselves as working in partnership with management, with shared decision-making, responsibility and accountability
• believed their DHB was working to enable strong clinical leadership
• saw quality and safety as important goals within their DHB
• believed responsibility was being given to their teams to make clinical service decisions in their areas of expertise.

It also found there was variation across DHBs in how clinical governance was approached.

Those surveyed were also asked three questions specifically about quality and safety:

• 57 percent believed health professionals in their DHB worked well together in a team
• 70 percent agreed health professionals in their DHB involved patients and families in efforts to improve patient care
• 69 percent found it easy to ‘speak up’ when they saw problems with patient care.

The study found DHBs had made solid progress on clinical governance in a relatively short period of time, with scope for further progress.

It suggests:

• developing a better definition of clinical governance to provide consistency
• putting in place arrangements to share information about clinical governance and leadership development
• developing dedicated training for clinical governance and leadership, and providing more training in the tools of quality improvement
• looking at ways to further engage health professionals in clinical governance and leadership.

DHBs will use the results to further improve clinical governance and leadership by their health professionals.

Jim Green, the lead Chief Executive for the DHBs, noted the good work done by DHBs and their clinical staff in advancing clinical governance for the benefit of patients.

“DHBs value the active engagement of their clinical staff in achieving real gains in health outcomes for patients, looking at how systems can be improved to achieve this. Only through such engagement can increasing and lasting success be achieved.”

Chai Chuah, the National Director of the National Health Board at the Ministry of Health, says the overall results of the survey are pleasing as they clearly indicate DHBs have made considerable progress developing clinical leadership initiatives in the last three years, and are strongly committed to clinical governance and on-going quality improvement.

“Going forward, DHBs need to accelerate and increase these activities. The challenges of the health sector can be met as clinicians are fully engaged, lead changes and provide clinical governance over the triple aims of quality, access and remaining within existing resources.”

Dr Janice Wilson, Chief Executive of the Health Quality & Safety Commission, welcomed the responses to the three quality and safety questions.

“Every patient has the right to the best and safest health care, and it is good to see health professionals feel they are actively defining what that is, involving patients and their families, and speaking out when they need to,” she says.

“Improving quality and safety means better, safer health care for patients but it also improves staff satisfaction, reduces costs and can lead to money being available to spend elsewhere in the health sector.”

Copies of the report are available at and


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