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Introduction
Continuously improving the quality of health and social care services is a laudable aim but difficult to evidence and deliver. Achieving this in an environment of rising demand and limited resources is even more challenging. The UK National Health Service (2014) is working to deliver a Five Year Forward View within which three “gaps” are specifically required to be closed. These gaps are categorised as: health and well-being; care and quality; and funding and efficiency. An important point is the interdependency of these themes. We cannot just focus on efficiency to the detriment of care or well-being. But equally, we cannot improve health for all with no regard to cost.
Health and social care organisations and their multidisciplinary teams must balance a very complex suite of resources and outcomes in order to provide credible evidence of high-quality care. Reviewing the literature, there are many examples of focussed pieces of work showing the benefit of specific quality improvement interventions (Bhutani et al., 2017), often quoting improvement tools developed in other industries (Varkey and Kollengode, 2011). Indeed, the whole NHS is called upon to adopt a systematic approach to quality improvement (Ham et al., 2016). Yet, there are few, if any, examples of simple methodologies that could deliver clinical governance assurance at scale, across teams and across services. Certainly some important ideas about what does work have been explored, for example that giving a team visibility and ownership of comparative data works to drive up performance (Hutchinson and Armstrong, 2009; Copeland, 2002) and that clinical governance dashboard tools can be transferable across disciplines (Guha et al., 2013).
This is a viewpoint paper presenting a suggested clinical governance matrix framework that can be used to provide assurance of quality from an individual and team level up to multiple services and across organisations. It is based on currently understood domains of quality and pillars of clinical governance. The matrix framework is designed to be flexible for bespoke use with agreed measures as well as being a comparable methodology to use across different teams.
Methodology
The aim of all providers of health, social care and local authority services is to deliver personalised care that is...