Solutions to the barriers associated with implementing 127 acknowledge the potential barriers to improving the quality of the service-user experience and provide solutions.
Solutions to the barriers associated with implementing clinical
Table 10.1 Barriers and suggested solutions associated with the implementation of clinical governance in learning disability service settings.
Barriers Apathy
Short-termism
Poor awareness of clinical governance
Misinterpretations
Fashion
Poor leadership
Leadership Leaders as role models
Transformational leadership Act as motivator Identify processes to meet longer term goals
Inform staff regularly about clinical governance projects
Reassure and inform
Demonstrate commitment
Identify leaders for individual projects
Management Personal development Reviews
Explicit guidelines
Provide direction and set short- and long-term goals Inform and monitor
Reassure and inform Honesty and transparency
Issue long-term guidelines
Allow leaders to lead
Education Programmes to educate staff about the value of clinical governance
Educate all staff and give regular updates
Regular updates and information exchanges Mechanisms
Portfolio development
Clearly define organisational goals
Develop robust communication network – newsletters and resource packs Develop explicit information on clinical governance Inclusion
Apathetic staff to be listened to
Include staff in decision-making forums
Expose staff to clinical governance agendas
Listen to staff and users Cooperation
Involve staff in projects and working parties Invite staff on to working parties
Network with other services who can demonstrate the efficiency of clinical governance
Limited research base
Resources
Fragmented multi-disciplinary working
Poor information systems
Poor
communication
Change burnout
Identify current research base and gaps
Identify efficient working practices
Draw terms together
Visible leadership, regular dissemination of information
Identify potential burnout victims and offer coping mechanisms
Allow staff to research pertinent areas
Provide for the implementation of clinical governance by managing resources Demarcate staff responsibilities
Provide resources for information systems
Develop communication systems
Set achievable short- and long-term goals
Raise awareness of research and induct staff into the process
Joint training sessions
Team staff IT skills
Regularly disseminate latest research and journals
Regular team meetings,
consensually agreed modus operandi and goals
Develop IT systems and sites
Regular dissemination of written information Listen to the
concerns of users and staff
Listen to staff’s concerns Conduct research
in tandem with other agencies Encourage networking Use external resources to access expertise
Encourage team building
Access the information systems of other agencies Identify communications networks between agencies
Theory–
practice gap
Scepticism
Maintaining motivation Fragmented partnership working
User and carer involvement
Quality of life issues
Act as role model and link between the two
Act as role model Motivate and encourage Offer supervision
Inspire and energise
Joint leadership
Inspire and motivate
Firmly place clinical governance in the care area
Regular personal development
Encourage and set goals
Joint management
Representations in management teams
Allow for democratic agreement on what constitutes quality of life
Provide examples of the effectiveness of clinical governance
Joint training days
Joint training
Educate staff about their role in enhancing the quality of life of users Demonstrate via
documentation examples of theory–practice link
Joint investment plans
Shared budgets, partnerships, boards
Representations on all decision-making groups
Development of meaningful evaluation documents Listen to the
views of staff and provide solutions to their scepticism Include staff in project work Multi-agency representation in planning
Listen to and respond to views Demonstrate that the views of users are incorporated into service delivery Access
theoreticians and include them in the large area
Multi-agency working groups
Utilise advocacy services Table 10.1 (cont’d )
Barriers Leadership Management Cooperation Inclusion Mechanisms Education
Conclusion 131 The RAID approach offers an overarching model for implementing clin-ical governance. For clinclin-ical governance to flourish broad systems and specific mechanisms can be employed to overcome the barriers identified previously in Boxes 10.1 and 10.2. Table 10.1 outlines barriers and some proposed solutions associated with the implementation of clinical governance in learning disability service settings.
The causes of the barriers identified in Table 10.1 are multi-factorial and therefore any response to them will necessitate a multi-factorial response.
The table demonstrates that clinical governance should permeate all elements of a service in order that coordinated responses can be developed. The identification of the challenges to implementing clinical governance demon-strates that instigating clinical governance is a complex and potentially difficult process. This daunting process can, however, be overcome by the use of the RAID approach and systematic, coordinated service responses. The benefits derived from implementing clinical governance are manifold and therefore the effort entailed in implementing this approach must be made.
Clinical governance should not be implemented as a ‘top-down’ system as this can result in it remaining an abstract, theoretical concept that is resisted and rejected by staff. Clinical governance is a recognised mechanism for improving service provision. Nursing staff are accountable for their practice and therefore they should embrace clinical governance in their attempt to demonstrate accountability of their practice.
Conclusion
We have argued that the issues of accountability and clinical governance are particularly relevant to nurses who work with, and support people with learning disabilities and this is because of the potential for abuse, prejudice and discrimination. In learning disability contexts, clinical governance and the exercise of accountability have the potential to transform the care of people with learning disabilities in ways that can significantly impact on the quality of life for people with learning disabilities.