Editorial
1
Clinical governance is a major topic in the NHS organisation today, consuming many columns of text and much of people’s time. It has been described as a system through which NHS organisations can be accountable for continually improving the quality of their services and safeguarding that high stan- dards of care are provided by creating an environ- ment in which excellence in clinical care will flourish. It has been put in place in order to tackle wide variations in the quality of care that exist throughout the country and much of the impetus has been in the wake of huge public concern about regional variations in cancer treatment and high death rates for child heart surgery. It has been defined as the corporate accountability for clinical performance and is considered to add the extra dimension that will provide the public with guaran- tees about standards of clinical care. The central concept in clinical governance is that of clinical effectiveness which has been defined as ‘the extent to which clinical interventions when deployed in the field for a particular patient or population do what they are intended to do’, i.e. maintain and improve health and secure the greatest possible health gain from the available resources. It will be the responsibility of all those who provide or manage patient care services in the NHS, i.e. nurses, profes- sions allied to medicine (PAMs), doctors and man- agers. In order to do this, practitioners will have reference to evidence-based guidelines for clinical management, produced by the National Institute for Clinical Effectiveness (NICE). Every hospital and community trust and GP practice will be responsible for the appointment to a post dedicated to the quest of quality assurance. It will be expected that an annual clinical governance report will be produced each year and will be subject to scrutiny by the Commission for Health Improvement and the data within will be used to produce league tables in order to judge clinical performance across a wide range of areas and against agreed benchmarks for clinical standards. Evidence based practice is an explicit and judicious use of current best evidence in making deci- sions about the care of individual patients. It marks a clear shift from a culture of health care provision based on opinions or the attitude that ‘it’s always been done this way’ towards one of making use of research evidence to guide clinical decision making. Although this can be viewed as a highly commend- able goal, it is critically dependent on having appro- priate and robust evidence in order to guide practice. A particular concern for nurses and PAMs is the lack of comprehensive research-based evidence to guide practice. To support this, one only has to consider the vast difference in number of citations in two of the most prominent literature databases, MEDLINE and CINAHL, featuring multidisciplinary and nursing research respectively. The two database systems are not mutually exclusive and MEDLINE certainly does report on issues of relevance to nursing practice, although the greater number of citations in MEDLINE does give a broad indicator of the balance in terms of quality of research evidence that is available to inform effective clinical practice. Many of us have been involved in multi-profes- sional clinical audit and research projects to evaluate the effectiveness of a variety of care interventions and although the information from such work may be available at a local level, it often does not reach the wider public domain. After a project report has been completed it may seem that there is little additional benefit from writing a paper that would be suitable for publishing in a journal. But an important part of the academic process is overlooked; that of the peer review process. It is by submitting work for consideration for publication, having it scrutinized by experts and taking on board their suggestions for revision that we can help ensure that the research evidence that we generate to inform clinical practice is robust. In recognition of many of the small clinical studies that are undertaken at practice level that may not conform to the tradi- tional criteria for an original article, we are encourag- ing authors to submit to a new section within the journal, specially designed for small-scale clinical stud- ies or examples of practice developments that have demonstrated benefits for patient care. Short articles (1000–1500 words) are invited to this section and more details are available in the Instructions to Authors. 1 Editorial Grace Lindsay Coronary Health Care (2000) 4,1 © 2000 Harcourt Publishers Ltd DOI: 10.1054/chec.2000.0065, available online at http://www.idealibrary.com on
-
Upload
grace-lindsay -
Category
Documents
-
view
215 -
download
0
Transcript of Editorial
Editorial
Grace Lindsay
Coronary Health Care (2000) 4, 1© 2000 Harcourt Publishers LtdDOI: 10.1054/chec.2000.0065, available online at http://www.idealibrary.com on
Clinical governance is a major topic in the NHSorganisation today, consuming many columns oftext and much of people’s time. It has been describedas a system through which NHS organisations canbe accountable for continually improving the qualityof their services and safeguarding that high stan-dards of care are provided by creating an environ-ment in which excellence in clinical care willflourish. It has been put in place in order to tacklewide variations in the quality of care that existthroughout the country and much of the impetushas been in the wake of huge public concern aboutregional variations in cancer treatment and highdeath rates for child heart surgery. It has beendefined as the corporate accountability for clinicalperformance and is considered to add the extradimension that will provide the public with guaran-tees about standards of clinical care.
The central concept in clinical governance is thatof clinical effectiveness which has been defined as ‘theextent to which clinical interventions when deployedin the field for a particular patient or population dowhat they are intended to do’, i.e. maintain andimprove health and secure the greatest possible healthgain from the available resources. It will be theresponsibility of all those who provide or managepatient care services in the NHS, i.e. nurses, profes-sions allied to medicine (PAMs), doctors and man-agers. In order to do this, practitioners will havereference to evidence-based guidelines for clinicalmanagement, produced by the National Institute forClinical Effectiveness (NICE). Every hospital andcommunity trust and GP practice will be responsiblefor the appointment to a post dedicated to the questof quality assurance. It will be expected that anannual clinical governance report will be producedeach year and will be subject to scrutiny by theCommission for Health Improvement and the datawithin will be used to produce league tables in orderto judge clinical performance across a wide range ofareas and against agreed benchmarks for clinicalstandards. Evidence based practice is an explicit andjudicious use of current best evidence in making deci-sions about the care of individual patients. It marks a
1
clear shift from a culture of health care provisionbased on opinions or the attitude that ‘it’s alwaysbeen done this way’ towards one of making use ofresearch evidence to guide clinical decision making.Although this can be viewed as a highly commend-able goal, it is critically dependent on having appro-priate and robust evidence in order to guide practice.A particular concern for nurses and PAMs is the lackof comprehensive research-based evidence to guidepractice. To support this, one only has to consider the vast difference in number of citations in two ofthe most prominent literature databases, MEDLINE
and CINAHL, featuring multidisciplinary and nursingresearch respectively. The two database systems arenot mutually exclusive and MEDLINE certainly doesreport on issues of relevance to nursing practice,although the greater number of citations in MEDLINE
does give a broad indicator of the balance in terms ofquality of research evidence that is available to informeffective clinical practice.
Many of us have been involved in multi-profes-sional clinical audit and research projects to evaluatethe effectiveness of a variety of care interventions andalthough the information from such work may beavailable at a local level, it often does not reach thewider public domain. After a project report has beencompleted it may seem that there is little additionalbenefit from writing a paper that would be suitable forpublishing in a journal. But an important part of theacademic process is overlooked; that of the peer reviewprocess. It is by submitting work for consideration forpublication, having it scrutinized by experts and takingon board their suggestions for revision that we can helpensure that the research evidence that we generate toinform clinical practice is robust. In recognition ofmany of the small clinical studies that are undertakenat practice level that may not conform to the tradi-tional criteria for an original article, we are encourag-ing authors to submit to a new section within thejournal, specially designed for small-scale clinical stud-ies or examples of practice developments that havedemonstrated benefits for patient care. Short articles(1000–1500 words) are invited to this section and moredetails are available in the Instructions to Authors.
