Melanie Tan
Dr Melanie Tan Consulting
Health is a broad concept, influenced by a range of determinants – psycho-social, environmental, cultural, spiritual (for example). Any care or services can impact a person’s health. Therefore, the concept of clinical governance (which aspires to achieve optimal health outcomes - and therefore quality of living) is as relevant to home care as it is to residential aged care, despite different contexts and priorities. Vulnerable people relying on services at home are entitled to expect their provider will ‘look out’ for them.
The terms ‘care governance’ or ‘quality governance’ may be preferred over ‘clinical governance’. The principles are the same, as reflected in the ‘core elements’ identified by the Aged Care Quality and Safety Commission - namely leadership and culture, consumer partnerships, communication and relationships, monitoring and reporting, effective workforce, and organisational systems. [1] A framework (building on such domains) sets clear expectations and avoids ad hoc approaches to care.
The draft Revised Aged Care Quality Standards (Strengthened Quality Standards) support a broad approach to clinical governance, recognising that ‘[c]linical care encompasses prevention, treatment and management, optimising quality of life, reablement and maintenance of function’ (Outcome 5.4). [2] This is a welcome shift from the current Aged Care Quality Standards which restrict the definition of ‘clinical care’ to ‘[c]are provided by doctors, nurses, pharmacists, allied health professionals and other regulated health practitioners’. This limitation results in a narrow definition of clinical governance that fails to resonate with providers of home services – who nonetheless owe a duty of care (legally, and ethically) to avoid or mitigate the risk of harm.
A clinical governance framework should, at a minimum, reflect the Strengthened Quality Standards - through overlapping and intersecting requirements in relation to the Person (Standard 1), the Organisation (Standard 2), Care and Services (Standard 3), the Environment (Standards 4), and Clinical Care (Standard 5). These align with components of the National Model Clinical Governance Framework, [3] which centres on ‘partnering with consumers’ – and includes governance, leadership and culture; patient safety and quality improvement systems; safe environment for the delivery of care; and clinical performance and effectiveness.
Further, Standard 5 recognises that effective clinical governance relies on ‘systems and processes from Standards 1-7’. The Strengthened Quality Standards, therefore, provide a framework. Whilst Standards 6 and 7 apply to residential care only, their principles are translatable to home services – since clinical governance goes above and beyond minimum standards mandated through compliance, and is about delivering the best care possible. Standard 6 (Food and Nutrition) supports nutrition and positive experiences (and hence outcomes) in care. Standard 7 (the Residential Community) requires that ‘[o]lder people get services and supports for daily living that optimise their quality of life’, ‘enable them to do the things they want to do’, and ‘feel safe in their service environment.’ Clinical governance also supports these outcomes.
The potential impact of non-clinical care on consumers’ determinants of health must be understood and managed, to ensure all services are safe, effective and person-centred. The privilege of assisting vulnerable people in their homes attracts significant responsibilities, articulated in the Aged Care Quality Standards. A clinical/care/quality governance framework (even where clinical care is not provided) will not only enable compliance, but continuous improvement (beyond a minimum standard) – supporting optimal outcomes, including positive experiences in care.
*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.