The concept of candour is not new. Being candid means being honest, which includes ‘complete openness and transparency.’ Exercising candour in healthcare is challenging for multiple reasons.
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Medical error remains rife. The Australian Institute of Health and Welfare reported 26,995 potentially avoidable deaths in 2020 among people under the age of 75 in Australia. While this ‘age-standardised’ rate has been the lowest reported in 10 years, there is clearly room for improvement.
Authentic ‘person-centred’ care involves truly understanding a person’s preferences, wishes and values. But what if that person is no longer able to decide what they want, or communicate this? In Australia, most states and territories (with the exception of NSW and Tasmania) have enacted legislation to support the creation of, and reliance on, advance care directives (also known by other names, such as advance care plans).
Robust clinical trials drive learning, innovation and hence continuous improvement in evidence-based care. Not only do clinical trials promote good clinical governance in this way, but good clinical governance must underpin clinical trials.
Prof Andrew Wilson walks us through and reflects on some of the clinical governance challenges that emerged and were observed during peak COVID times. What areas were impacted, is there an indication of recovery, and what does it mean for the future of clinical governance?
The term clinical governance was first coined in the context of the United Kingdom’s National Health Service - specifically, in a white paper endorsed by then Prime Minister Tony Blair entitled ‘The new NHS: modern, dependable.’ Now, 25 years later – where are we at?
Saying sorry is an important element of open disclosure and psychological safety – and therefore clinical governance. It is also an extremely powerful yet simple way to make people ‘feel better’. Saying sorry conveys empathy, compassion, and respect towards the person receiving the apology, not to mention remorse. It acknowledges an acceptance that your actions (or words) can adversely impact others, and is the opposite of defensiveness (which is counter-productive). Apologising is not taking the blame, nor is it an admission of liability. Saying sorry is about being accountable, accepting responsibility, and restoring trust in a relationship.
It’s not just what we say, it’s how we say it. We know effective communication is key to patient safety and quality, and person-centred care. But it is also crucial to psychological safety and the extent to which we support each other in speaking out, or in asking questions. This in turn will impact patient care.
Professional boundaries in healthcare delineate the therapeutic relationship. They have been defined as ‘parameters that describe the limits of a relationship in which one person entrusts their welfare to another and to whom a fee is paid for the provision of a service’ - or, more broadly, as the ‘edge of appropriate clinical care’.
- Acute care
- Advance Care Directives
- Aged care
- Clinical trials
- Continuity of care
- Continuous improvement
- COVID-19/Infection control
- Directors’ Duties and Responsibilities
- Duty of care
- Incident management
- Lessons from other industries
- Lessons from overseas
- Mental health
- Negative behaviours
- Occupational Health
- Open Disclosure
- Patient safety
- Person-centred care
- Professional Conduct
- Psychological Safety
- Quality indicators
- Regulatory reform
- Restrictive practices
- Risk management
- Roles and responsibilities
- Safety Culture
- Social Care
- Speaking Out
- Speaking up
- Substitute Decision-Making