Veenstra Gepke L, Ahaus Kees, Welker Gera A, Heineman Erik, van der Laan Maarten J, Muntinghe Friso L H
Centre of Expertise on Quality and Safety, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Faculty of Economics and Business, Department Operations, University of Groningen, Groningen, The Netherlands.
BMJ Open. 2017 Jan 12;7(1):e012591. doi: 10.1136/bmjopen-2016-012591.
Although the guiding principle of clinical governance states that healthcare professionals are the leading contributors to quality and safety in healthcare, little is known about what healthcare professionals perceive as important for clinical governance. The aim of this study is to clarify this by exploring healthcare professionals' views on clinical governance.
Based on a literature search, a list of 99 elements related to clinical governance was constructed. This list was refined, extended and restricted during a three-round Delphi study.
The panel of experts was formed of 24 healthcare professionals from an academic hospital that is seen as a leader in terms of its clinical governance expertise in the Netherlands.
Rated importance of each element on a four-point scale.
The 50 elements that the panel perceived as most important related to adopting a bottom-up approach to clinical governance, ownership, teamwork, learning from mistakes and feedback. The panel did not reach a consensus concerning elements that referred to patient involvement. Elements that referred to a managerial approach to clinical governance and standardisation of work were rejected by the panel.
In the views of the panel of experts, clinical governance is a practice-based, value-driven approach that has the goal of delivering the highest possible quality care and ensuring the safety of patients. Bottom-up approaches and effective teamwork are seen as crucial for high quality and safe healthcare. Striving for high quality and safe healthcare is underpinned by continuous learning, shared responsibility and good relationships and collaboration between healthcare professionals, managers and patients.
尽管临床治理的指导原则表明医疗保健专业人员是医疗保健质量和安全的主要贡献者，但对于医疗保健专业人员认为对临床治理重要的因素却知之甚少。本研究的目的是通过探索医疗保健专业人员对临床治理的看法来阐明这一点。
基于文献检索，构建了一份与临床治理相关的99个要素的清单。在三轮德尔菲研究中对该清单进行了完善、扩展和限制。
专家小组由来自荷兰一家学术医院的24名医疗保健专业人员组成，该医院在临床治理专业知识方面被视为领导者。
在四点量表上对每个要素的重要性进行评分。
专家小组认为最重要的50个要素与采用自下而上的临床治理方法、自主权、团队合作、从错误中学习和反馈有关。专家小组在涉及患者参与的要素上未达成共识。专家小组拒绝了涉及临床治理管理方法和工作标准化的要素。
在专家小组看来，临床治理是一种基于实践、价值驱动的方法，其目标是提供尽可能高的医疗质量并确保患者安全。自下而上的方法和有效的团队合作对于高质量和安全的医疗保健至关重要。追求高质量和安全的医疗保健的基础是持续学习、共同责任以及医疗保健专业人员、管理人员和患者之间良好的关系与合作。
