Hi I'm Prateek, a dentist and a specialty doctor. In this video we're going to be looking
at the seven pillars of clinical governance. The seven pillars are really important when
it comes to interviews. It's also quite an important topic to know about when you come
to exam questions. Typically in interview scenarios there will be at least one station
that is involving clinical governance and therefore it's important that you know about
clinical governance as well as having some examples for each of the pillars. So let's move
on to clinical governance and look at these seven pillars. So clinical governance according
to the NHS definition is a framework "through which NHS organisations are accountable for
continually improving the quality of their services and safeguarding high standards of care by
creating an environment in which excellence in clinical care will flourish." Now, that's
quite a wordy definition it's quite a long definition to remember for exam questions
or interview answers. So a simpler way to think of it is the following so clinical
governance is "a quality assurance process to maintain and improve standards of care
for patients with full accountability of the system towards patients". Ultimately the bottom line
is that clinical governance is there in order to ensure our quality of care towards patients
is at the highest standard possible - we're there to protect patients. So we've then
got the seven pillars to look at. Now I'll go into detail about all of these but I will
mention some that are slightly more important than others particularly when it comes to
the situation of interview answers. So we've got the first pillar which is clinical effectiveness
and research; we have audit, risk management, education and training, patient and public
involvement, information and IT and staff management. That gives us the seven pillars.
Arguably the first four are most important so clinical effectiveness in research, audit,
risk management and education and training. And when I'm talking about most important,
I mean in relevance to interviews and exam questions. So now if we look at the seven
pillars in a bit more detail. So the first pillar - clinical effectiveness and
research. This is essentially ensuring that we're using the best available evidence and
research in order to inform our decision making for patients so that patients get the
best available care. So examples of this that we can use include the use of NICE guidelines
for extraction of wisdom teeth or using endodontic guidelines. All of these things have had research
put together in order to provide a guideline for us to care optimally for a patient. Other
examples may include the SDCEP guidelines on anticoagulants and antiplatelets. Other
aspects of clinical effectiveness and research involve actually doing new research to create
new guidelines. This means that our methods and our treatments are up to date and patients
aren't experiencing treatments that are 20-30 years old and may not be as relevant anymore. Again
through all of these methods we ensure that patients are getting the highest standard of care and
therefore get the best outcomes. So then we look at pillar two and that's audit. Following
clinical governance, we're looking at improving the care that we're providing to patients
and audits are integral in order to do this. So with an audit we identify some aspect
of generally clinical care towards a patient that we can then look at improving. So we
identify what we're looking to improve so this may be patient wait times. We then pick
a gold standard of what we want to compare it to. This gold standard may come from existing
research or existing evidence or it may be a gold standard that you create based upon
a vision that you've got of what you want to achieve. You then gather information in
order to do this assessment. You then compare the information you've collected to the gold standard
that you've got and then you look at what the difference is and if there are differences, if
there's a discrepancy in not achieving that gold standard then you put into place changes in
order to achieve that. But the most important part of an audit that often people forget
in interview questions is that you then want to re-audit. So you need to close the loop
or close the cycle of the audit and re-audit to see whether the changes you've put in place
have actually made a difference. Now examples of audits that are very, very common in practice.
Things like smoking cessation advice, looking at comparing radiographic quality based on
the FGDP guidelines. All of these are really easy audits that you can mention when it
comes to an interview question. So we then move on to the third pillar this is risk
management. Risk management involves understanding, monitoring and minimising risks to patients
and staff alike. Additionally it involves identifying problems that have happened and
implementing change in order to minimise those problems happening again. Again ultimately
we're doing this to improve the quality of care we're providing to patients so if patients have
come to harm at some point we can identify that and we can change something so that patients aren't
affected by it again. Examples of this include hazard reporting or incident reporting -
so if someone trips up, if they slip on water, if anything like that happens, it needs to be
reported to the responsible individual and then they can put in change to minimise the risk
of that happening again. It also involves risk assessment so if there is new building
work being done, if new equipment is brought into a practice, it needs to be risk assessed
to see what risks are present so they can be mitigated as early as possible - again
reducing the risk of harm to individuals later on. And we also minimise risk by following
protocols and guidelines that are put in place. Whether this is radiology protection
in the form of IRR or IRMER guidelines or whether it is hand washing guidelines that
we follow. These are there in order to protect us and protect patients. The fourth pillar
is education and training. This is really important - dentistry is a continually evolving
career and you're going to be learning throughout your life and throughout your career. Part
of this under the general dental council in the UK we have what is called continuous
professional development. The reason we have continuous professional development is to make
sure that as clinicians and as healthcare professionals we are providing the best care
for patients. So this links back to the first pillar of clinical effectiveness and research.
It means that we're not providing patients with treatments that were good 30 years ago
but actually are now very outdated. If we look at things like antibiotic prophylaxis
for patients - that's something that has changed quite significantly just over the
last 10 years and so it's important we stay up to date with the latest research and latest
evidence. For dentists on the general dental council requirements, we have to complete
100 hours of verifiable continuous professional development over a five-year period. This education and
training can be done through study clubs, it can be done through reading journals, online
webinars. We've had a lot of online webinars during the COVID pandemic. It can also be in-house
training with other members of staff and on top of this we can also have work appraisals.
Dentists can appraise each other and this way we can learn
from each other. Now like I mentioned the first four pillars are arguably the most important
when it comes to interviews. We can summarise these first four pillars in an easy to remember
mnemonic. The mnemonic being CARE. So clinical effectiveness and research, audit, risk management
and education and training. So if you're struggling in an interview situation you
just have to remember the word CARE and hopefully you'll remember these four
pillars. Now we move on to the other pillars. So the next pillar is public and patient
involvement. This is the aspect of ensuring that patients are actively involved in decisions
that are made regarding their care so we get a patient's perspective on exactly what is
happening with their care and we may see a perspective that we wouldn't have understood
before. So examples of patient and public involvement include the NHS friends and family
forms. It includes direct feedback we get from patients and we also often have patient forums
where patients can turn up within their local community and feedback information and this could
be one of the ways we can gain information about the local healthcare services. More
and more recently, patients are involved on hospital boards so again they can provide
their input to ensure that the care is maximised and the outcomes are the best they can be
for patients. Now let's look at information and IT. Information and IT essentially is
looking at how patient information is handled, stored and moved from one place to another.
A lot of the information that we have on patients is confidential and we have to make sure it's
treated like that. We have lots of legislation in place including things like the GDPR legislation
which is there to protect patient's information and also looks at how we use the information.
This also becomes important when we consider things like audit. Typically for an audit
we're going to have to gather patient information and so we need to ensure that this is done
in a confidential manner and their data is protected. In information and IT, we're also
looking at the systems that are used to store it patient information so what software is
used, how is the software managed. We then move on to the final pillar and that is staff
management. The bottom line for staff management is ensuring that the right members of staff
are employed in the right jobs doing what they're trained to do. Through this we can
ensure that patients are getting the best care that's possible because we've got the
right individuals doing the right bits of work. Additionally in staff management, we
also consider the employer making sure that the environment is a safe, nurturing and friendly
environment that members of staff can raise concerns if they have any. Under this pillar
it is also a requirement for the employer to provide good and safe working conditions as
well as appropriate management of staff that are employed. Now that's quite a lot of information
and like I said there are certain aspects of these pillars that are really important.
Those first four are probably the bulk of what you would ever get tested on but if
you want to remember all seven an easy mnemonic to remember it by is PIRATES. So patient
and public involvement, information and IT, risk management, audit, training and education, evidence-based
practice or clinical effectiveness and staff management. We've discussed some examples
in this as well for each of the pillars so it's important that you look at your own
work and you can provide examples when it comes to exam questions or interview questions
it's the examples and the application of these pillars to a real life scenario that will get
you the extra marks. And get you those bonus points because that ultimately demonstrates
that you understand the pillars and you understand the relevance to patients and the relevance
to care. Now my recommendation in this video is of another YouTube channel called theDentlyf.
Now this is run by Komal and it's been run for the last four years where she's provided
videos on a whole host of topics but most importantly and the aspect I really like about
this channel is that it shows a progression through university as well as advice of applying
to university and applying for dentistry. I'll provide the links in the description.
So that's it in this video. I hope you found it useful and I hope you're a bit more aware
of the seven pillars of clinical governance if you did find this helpful please make
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then please leave a comment or contact me on one of those various social media handles.
Take care!