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Pain is a complex and multifactorial phenomenon, and chronic pain can rarely be eliminated. While pain can be nociceptive or neuropathic in nature – relatable to an identifiable organic cause – a third category of pain, described as ‘nociplastic’, is less well defined, and treatment particularly challenging.

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).

‘Successful integration is the planning, commissioning and delivery of co-ordinated, joined up and seamless services to support people to live healthy, independent and dignified lives and which improves outcomes for the population as a whole.  Everyone should receive the right care, in the right place, at the right time.’

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?
 

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’.

The Royal Commission into Aged Care Quality and Safety noted in its Final Report, presented on 26 February 2021, that aged care ‘should be able to deliver compassionate and kind care built on respectful relationships’. Person-centred care (or ‘consumer-centred’ care) was already central to the way aged care was expected to be delivered, under the Aged Care Quality Standards which have been in effect since 1 July 2019.

The term ‘clinical governance’ was first coined in the context of the National Health Service (NHS) in the United Kingdom, being ‘a system through which NHS 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.'

In thinking about clinical governance, we must also consider the range of factors that impact the safety and quality of care - whether intrinsic or extrinsic to the person. This will inform our approach to clinical governance in any given situation. Intrinsic factors might relate to the person themselves, such as a disability; extrinsic factors might relate to some external condition, such as homelessness and other aspects of a person’s social circumstances.

Compassion is an extension of empathy. It can be defined as ‘the feeling or emotion, when a person is moved by the suffering or distress of another, and by the desire to relieve it’. The desire to help distinguishes compassion from empathy - which, in contrast, may be defined as ‘the ability to imagine and understand the thoughts, perspective and emotions of another person.’

As the COVID-19 pandemic continues to cast a shadow over the health of the world, we continue to learn about clinical governance at scale. We have previously drawn analogies to Australian government responses with clinical governance principles - however the parallels don’t stop there.  Across the world, the economic impact of the pandemic has been palpable and is illustrative of the co-dependent relationship between health and money, where better health outcomes are known to correlate with better economic outcomes.