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This chapter discusses the importance of induction programmes. The induction programme at the organizational level is an essential constituent of the employment process of every doctor. The programme can be used to set out the values of the employers' organization. The importance of a patient safety ethos must be a part of all induction programmes. It is also essential to audit this process to ensure the effectiveness of the induction process.

This chapter presents an overview of clinical governance. It discusses the meaning of clinical governance, origins of clinical governance, and the regulatory bodies tasked with the assessment of clinical governance by regulatory bodies. It then describes the Patient Safety First Campaign, which was launched within the National Health Service (NHS) in England in 2008 to make the safety of patients the highest priority and make all avoidable death and harm unacceptable.

A clinical guideline is a document designed to support decisions regarding the diagnosis, care, and treatment of a particular disease or condition. The National Institute for Health and Clinical Excellence (NICE) is one of the best-known guideline-producing organizations in the world, publishing around twenty clinical guidelines each year covering a broad range of topics from perioperative hypothermia to donor breast milk banks. This chapter discusses the structured approach taken by NICE in developing clinical guidelines.

This chapter discusses training in healthcare organizations. The aim of training in healthcare is to improve outcomes for patients. Training should result in individual learning and enhanced educational performance. Organizations must be able to demonstrate that they train and supervise staff in an ongoing manner. Individuals should be given time to undertake training, but professionalism also implies self-directed development.

This chapter discusses the poor clinical performance of medical staff, which may impact on the quality of care given to patients and may be related to behaviour, conduct, or health issues. Personal and organizational factors affect clinical performance. Approximately one out of 200 doctors are referred to the National Clinical Assessment Service (NCAS) every year for poor performance. The performance of approximately 15% of doctors is affected by ill-health at some point during their working life. The performance of at least 5% of doctors is affected by drugs or alcohol at some point during their working life.

Risk identification is key to a comprehensive risk management program that include clinical, operational, and financial risks. All NHS institutions are required by the National Health Service Litigation Authority (NHSLA) Risk management Standards for Acute Trusts to have a systematic approach to clinical risk management, since it is a fundamental part of the provision of safe, effective healthcare. This chapter discusses patient safety incident reporting, claims and complaints, clinical audits, morbidity and mortality meetings, executive safety walkrounds, proactive risk assessment, national reports and surveys, and patient safety alerts.

A clinical audit can be defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Clinical audits are central to effective clinical governance as a measure of clinical effectiveness. This chapter discusses the history of clinical audits, components of clinical audit, and the steps in performing an audit project.

This chapter discusses leadership in healthcare. Effective leadership in a clinical setting is associated with a range of positive outcomes including better patient outcomes, fewer errors, more innovation, and lower stress among team members. However, clinicians face challenges when taking up leadership roles due to a general lack of enthusiasm for the task, a lack of training and support, and the problems of leading peers who are notoriously bad followers. Numerous theories and frameworks are available for understanding leadership. Transformational leadership and emotional intelligence are two of the most useful approaches to leadership and leadership development in healthcare.

Risk assessments are undertaken to estimate the consequences and likelihood of a particular risk being realized. This chapter discusses risk assessment in healthcare, the risk assessment process, assessing severity of risks, and implementing successful risk assessment.

In tax-funded systems such as the NHS, it is important that money is used wisely. NHS services are accountable to the public for the judicious use of funds. This chapter discusses how money flows round the NHS system, yearly savings requirement, and finance and quality of patient care.

This chapter discusses teamwork in the healthcare setting. There is now sufficient evidence that effective teamwork leads to improved patient outcomes, reduced costs, and improved staff morale. In healthcare, human factors, and thus teamwork training, should be considered to be as important as technical training. The goal should be to introduce such training from the first day at medical school until the last day of a career.

This introductory chapter presents the notion of a philosophical transition as part of a discussion about ideas being the building blocks of health policy. Using the examples of ‘cure’ and ‘care’, it illustrates the ways in which ideas are embedded in healthcare settings and practices and begins to indicate the many broader questions that surround the relationships between medicine and persons. In brief, to talk of ‘curing’ is generally to have in mind some more or less direct physical or biological intervention into the body to counteract the effects of disease; whereas ‘caring’, by contrast, is a more diffuse idea that can embrace ‘cure-type’ responses but extends much more widely to, and emphasises, such things as physical and emotional comfort, and psychological support and responsiveness.

This chapter discusses performance management, which is important in ensuring high standards of clinical governance, which in turn drives improvement in patient safety. Performance management is based on self-assessment, combined with inspections and cross-checking with other sources. It covers compliance with standards, use of a variety of indicators from across the healthcare spectrum, and the meeting of national targets.

The NHS Litigation Authority (NHSLA) is a Special Health Authority established in 1995 to administer the Clinical Negligence Scheme for Trusts (CNST) and provide a means for NHS organizations to fund the cost of clinical negligence claims. It also covers clinical claims arising from incidents occurring before 1995, known as the Existing Liabilities Scheme (ELS). This chapter discusses claims data, NHSLA risk pooling schemes, NHSLA collaborations with other organizations, and the value of the NHSLA risk management standards.

There is currently no universal model of clinical governance (CG) at service delivery level. This chapter discusses a simple approach that allows the concepts of CG to be tailored to various clinical settings. The cycle is designed to ensure clinical services provide care to an acceptable quality. It seeks to compare current practices to reference standards, emphasizing that CG activities are undertaken iteratively, with considerable overlap of each component of the cycle, which may be entered at any point.

This chapter focuses on the revalidation process, where all licensed doctors are required to demonstrate periodically their continued fitness to practise, both clinically and in terms of professional conduct. In addition, specialist doctors need to demonstrate that they meet the standards that apply to their particular medical specialty. The scope of revalidation, standards for revalidation, appraisal, and remediation and support for doctors are discussed.

The aim of risk management is to ensure that effective controls are in place to mitigate identified risks. Previous chapters have identified the preliminary stages of the risk management process including risk awareness, identification, and assessment. Controlling risk is the next phase of ensuring delivery of safe high-quality care. Risk controls, also sometimes known as treatments, can take many forms depending on the location and nature of the risk. This chapter discusses risk control options, contingency planning, evaluating risk control options, and the risk treatment cycle.

National Health Service (NHS) Hospital Trusts are required to have in place systems of internal control which identify and control risks to an acceptable level. This chapter discusses risk management at the organizational level, risk-management performance, and committee structure for managing risk within an NHS Trust.

Complaints and claims in the National Health Service (NHS) are managed in accordance with national guidance and legislation. Analysis of complaints and claims data, together with patient-safety incidents, can provide a valuable source of learning and opportunity for risk identification particularly in relation to patient safety. This chapter discusses the NHS complaints system, clinical negligence claims in the NHS, the Clinical Negligence Scheme for Trusts (CNST). It also considers why patients make complaints and claims, and their implications for clinicians.

This chapter discusses clinical directorates and policy development. Clinical directorates are service delivery units led by a general manager, senior nurse manager, and a clinical director. When directorates function well, they improve quality and safety of outcome for patients. Policy can be made at national, regional, or local levels. Clinical involvement is vital for successful introduction of new processes and procedures. Good management skills and understanding the doctor/manager relationship will increase successful development of process.