The Holland Bloorview Team’s Clinical Governance project within the HMC Pediatric Rehabilitation Team was led by Mr. Keith Adamson, Senior Director for Collaborative Practice, and Ms. Nicole Thomson, Collaborative Practice Leader. It has three primary overarching objectives that relate to establishing a clinical governance framework for the clinical staff and leadership team at HMC pediatric rehabilitation, which includes implementation of a clinical governance structure that uses professional meetings as the focus, and looking at the evaluation and sustainability of that structure. In general, clinical governance is the implementation of tools, processes and mechanisms to support clinicians in providing safe, high quality care. It involves the creation of an environment in which clinicians can do their best work by providing them with the tools and resources necessary to streamline and enhance processes. Clinicians learn about accountability, responsibility and authority.
At the conclusion of the work, Keith’s description of his experience of working with the HMC team is notable. He says: “The HMC staff are absolutely wonderful. Their ability to open up their practice, share their knowledge, reflect on their practice, and work with us as partners to change anything that they think needs improvement is absolutely what we want in clinical governance, in terms of moving practice forward. It was indeed a pleasure to work with clinicians who are openly reflective and open to constructive feedback. Not once did I ever think that they did not want to move forward.” Nicole also added that the clinicians always met them with a certain kind of excitement and initiative, and that they are the most gracious group of people they have worked with. They stated that it also helped that this project grew out of previous projects; hence there was an evolution that had already started to happen initially, and this project continued with that momentum of practice change.
After a thorough review process, the Clinical Governance Project assisted in the development of pediatric practice forums. These forums were developed to enhance communication and strengthen partnerships between the clinicians within the same profession. The focus of the forums includes standards of practice and providing practice information dissemination and discussion. Each forum is chaired by the supervisor, and utilizes standard meeting tools to ensure that the approach is more systematic and coordinated across the different professions. In the new model, there are clear roles, responsibilities and accountabilities that will ensure the long-term sustainability of the changes in practice. It also helps in driving systemic change as clinicians are given the opportunity to discuss their practice collectively as a profession, and move forward in making decisions that would uphold their practice. Keith stated that HMC now has a forum within the system that is completely dedicated to practice. “If we exert more energy and give more time for practice issues, we will see and hear people speak more about their practice, and eventually behave differently in the care that they provide.”
“Now, there is a capacity to move broad initiatives whether it is within one discipline, or across more than one. The power created here is exponential – whatever you put through it will definitely grow.”
Impact of the Clinical Governance Project
On Pediatric Rehab Leaders
Speaking on what has been reported to them by the leaders themselves, Keith says that the leaders and clinicians are now more aware of the importance to separate operational issues and practice issues, which is the key in any clinical governance framework. They also talked about immediate benefits in relation to the structure of the meetings itself. Clinicians feel it is now more focused and that they feel more able to talk about things that are relevant to their practice.
On Inter-Professional Practice
Inter-professional practice is a priority at HMC. Keith stated, “If you have strong intra-professional ties within your discipline, it will help you have better inter-professional ties because your role and contribution in healthcare as a professional is clear to you.” The new model supports this as the clinicians now have the opportunity to come together and discuss their practice collectively as a profession.
On Patients and Families
There is a direct impact on professional practice and standards. Communication and collaboration in relation to best practice minimize variations in clinical practice as they can discuss and make decisions collectively as a profession. This also allows for commitment in what they do because they own their practice. Patients also benefit right away from those decisions that the clinicians make. Most importantly, when you have active conversations about evidence-based best practices, the outcome is up-to-date practice.
When asked what they would expect to see in six months, Keith and Nicole said that they would like to see more cohesive meetings throughout the professions. Since it is still a new concept, they would still have time to evaluate and continuously develop. Generally, they aspire for the HMC teams to move forward with one strategic initiative of their choice, using the new clinical governance structure.
