Dr Melanie Tan
What Does Clinical Governance Mean in Aged Care in 2022?
Friday 14 October 2022
11:30am – 12:00pm
Dr Melanie Tan is an Independent Clinical Governance and Medico-legal Consultant. With diverse experiences as a medical practitioner (in acute care) and lawyer (in aged care, health and medical negligence), Melanie offers a unique and well-rounded perspective to contemporary clinical governance. Melanie has a keen interest in how digital health can support clinical governance, and vice versa (through a clinical, consumer and medico-legal lens).
Her LinkedIn profile can be found here: https://www.linkedin.com/in/dr-melanie-tan-37305829/
Declaration of conflicting interest: Dr Melanie Tan works with the Australasian Institute of Clinical Governance (AICG) and receives fees from the AICG under a contractual arrangement to contribute written content and articles of interest (including blogs and directed content). Melanie is also a Graduate of the AICG Certificate in Clinical Governance for Patient Safety and Quality Care (AICGG).
While the Aged Care Quality Standards prescribe a specific requirement for clinical governance in Standard 8, this alone does not suffice. Clinical governance should be understood to underpin all the Aged Care Quality Standards, and all care.
Under Standard 8, governing bodies of aged care providers are accountable for the delivery of safe and quality care and services. Specifically, Standard 8(3)(e) (as currently drafted) requires organisations to demonstrate:
“Where clinical care is provided – a clinical governance framework, including but not limited to the following:
(i) Antimicrobial stewardship
(ii) Minimising the use of restraint
(iii) Open disclosure.”
In this context, ‘clinical care’ is defined as “care provided by doctors, nurses, pharmacists, allied health professionals and other regulated health practitioners.”
From a clinical governance perspective, Standard 8(3)(e) casts its net too narrowly. Firstly, it emphasises three very discrete components of clinical governance, detracting from the bigger picture. Secondly, by limiting clinical governance to clinical care, and then defining the latter as care provided by registered health practitioners only, Standard 8(3)(e) overlooks the fact that any care – whether clinical or not – can impact a person’s health and well-being, and that providers owe a duty of care (at common law) to mitigate or avoid the risk of harm. The Aged Care Quality and Safety Commission has itself acknowledged that good clinical governance is important even where clinical care is not being delivered.
Therefore, although the term ‘clinical governance’ emerged in the context of healthcare, we should now be embracing it more broadly (in contemporary terms), to encompass the concept of ‘care governance’ which was identified by the Royal Commission on Aged Care Quality and Safety.
While some of the aged care reforms seek to enhance clinical governance, it is important that everyone – including the governing body – understands what clinical governance truly means in their organisation, having regard to their consumers, and their workforce. This requires thinking farther than traditional notions of clinical governance, yet adopting its fundamental principles.
Finally, it is important to recognise that clinical governance is not just about minimising risk. It is about constantly asking ourselves how can we do the best we can, for those who have entrusted us with their care -for is this not what we ought to be doing? Is this not our moral obligation?
Clinical governance is not just about compliance – because it’s up to us to do things better.