British Journal of Clinical GovernanceTable of Contents for British Journal of Clinical Governance. List of articles from the current issue, including Just Accepted (EarlyCite)https://www.emerald.com/insight/publication/issn/1466-4100/vol/7/iss/4?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestBritish Journal of Clinical GovernanceEmerald Publishing LimitedBritish Journal of Clinical GovernanceBritish Journal of Clinical Governancehttps://www.emerald.com/insight/proxy/containerImg?link=/resource/publication/journal/909559f5b4220c47c17af8bc797c0213/UNKNOWNhttps://www.emerald.com/insight/publication/issn/1466-4100/vol/7/iss/4?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestLearning from Bristol: reflections from a health economisthttps://www.emerald.com/insight/content/doi/10.1108/14664100210446605/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestThe Kennedy Report will almost certainly become a defining moment in the history of UK healthcare. On the whole the NHS is poor at learning from history and there is a wealth of important information to be drawn from the report and the whole experience of Bristol. This article distils the essential clinical governance messages that risk being lost. While many of the issues can be viewed from an economic perspective, much of what is required is a change in attitude across whole health economies. The contribution that economics can make is to design appropriate incentive mechanisms to bring about desired behavioural change. It can also continue to promote informed debate on the proper meaning of efficiency and to highlight the features required for an appropriate and effective regulatory framework.Learning from Bristol: reflections from a health economist
Brian A. Ferguson
British Journal of Clinical Governance, Vol. 7, No. 4, pp.233-241
The Kennedy Report will almost certainly become a defining moment in the history of UK healthcare. On the whole the NHS is poor at learning from history and there is a wealth of important information to be drawn from the report and the whole experience of Bristol. This article distils the essential clinical governance messages that risk being lost. While many of the issues can be viewed from an economic perspective, much of what is required is a change in attitude across whole health economies. The contribution that economics can make is to design appropriate incentive mechanisms to bring about desired behavioural change. It can also continue to promote informed debate on the proper meaning of efficiency and to highlight the features required for an appropriate and effective regulatory framework.]]>
Learning from Bristol: reflections from a health economist10.1108/14664100210446605British Journal of Clinical Governance2002-12-01© 2002 Brian A. FergusonBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446605https://www.emerald.com/insight/content/doi/10.1108/14664100210446605/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
Nomenclature issues in aseptic preparation of medicineshttps://www.emerald.com/insight/content/doi/10.1108/14664100210446614/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestNomenclature is of fundamental importance in healthcare. Different professionals interpret different terms in different ways. This has implications for measurement, clinical governance, risk management and any comparative studies where clear definitions are not predetermined. A project to determine how aseptic dispensing activity in pharmacies and clinical areas should be measured found this to be the case, primarily between nurses and pharmacists. It was essential to have consistently used terms and definitions for the purposes of the project. A preliminary list was audited with senior staff in clinical areas to ascertain local views and practices. Commonly used alternatives and other relevant terms were identified. The results were validated by a multidisciplinary workshop to determine a final list. Evaluation of these and wider examples highlights the many implications and the need for the issue to be directly addressed, particularly in a multi‐professional environment.Nomenclature issues in aseptic preparation of medicines
Rob Gandy, Karen Kershaw, Ian Beaumont
British Journal of Clinical Governance, Vol. 7, No. 4, pp.242-249
Nomenclature is of fundamental importance in healthcare. Different professionals interpret different terms in different ways. This has implications for measurement, clinical governance, risk management and any comparative studies where clear definitions are not predetermined. A project to determine how aseptic dispensing activity in pharmacies and clinical areas should be measured found this to be the case, primarily between nurses and pharmacists. It was essential to have consistently used terms and definitions for the purposes of the project. A preliminary list was audited with senior staff in clinical areas to ascertain local views and practices. Commonly used alternatives and other relevant terms were identified. The results were validated by a multidisciplinary workshop to determine a final list. Evaluation of these and wider examples highlights the many implications and the need for the issue to be directly addressed, particularly in a multi‐professional environment.]]>
Nomenclature issues in aseptic preparation of medicines10.1108/14664100210446614British Journal of Clinical Governance2002-12-01© 2002 Rob GandyKaren KershawIan BeaumontBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446614https://www.emerald.com/insight/content/doi/10.1108/14664100210446614/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
Online patient support systems – is there a need?https://www.emerald.com/insight/content/doi/10.1108/14664100210446623/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestA survey of cardiac patients, their relatives and friends and local GPs was conducted to establish whether there is a need for an online patient support system. In November 2000, 859 patients, 360 relatives and 160 friends attending cardiac out‐patients completed a questionnaire, 159 GPs were contacted by postal survey. Participants were asked if they use e‐mail and the World Wide Web and if obtaining relevant health information via an online support system would be beneficial. Participants were also asked to select preferred subject options. The survey showed clear interest in the provision of a Web‐based support service for cardiac patients and a pilot would be pursued.Online patient support systems – is there a need?
Tomasz J. Spyt, Pamela A.C. Watt, Maria C. Boehm, Paul R. Stafford
British Journal of Clinical Governance, Vol. 7, No. 4, pp.250-254
A survey of cardiac patients, their relatives and friends and local GPs was conducted to establish whether there is a need for an online patient support system. In November 2000, 859 patients, 360 relatives and 160 friends attending cardiac out‐patients completed a questionnaire, 159 GPs were contacted by postal survey. Participants were asked if they use e‐mail and the World Wide Web and if obtaining relevant health information via an online support system would be beneficial. Participants were also asked to select preferred subject options. The survey showed clear interest in the provision of a Web‐based support service for cardiac patients and a pilot would be pursued.]]>
Online patient support systems – is there a need?10.1108/14664100210446623British Journal of Clinical Governance2002-12-01© 2002 Tomasz J. SpytPamela A.C. WattMaria C. BoehmPaul R. StaffordBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446623https://www.emerald.com/insight/content/doi/10.1108/14664100210446623/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
The need for a diagnostic approach in the development of guideline implementation strategies – a qualitative studyhttps://www.emerald.com/insight/content/doi/10.1108/14664100210446632/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestDescribes and analyses the factors limiting the success of implementation of guidelines on management of heart failure using content analysis of structured interviews with nine general practitioners in Wakefield District, validated from hospital records, to generate within‐case displays. Discusses the results and conclusions.The need for a diagnostic approach in the development of guideline implementation strategies – a qualitative study
M.F. Lambert, I.S. Watt, A.M. Woodhouse, S. Balmer, M.R. Robinson
British Journal of Clinical Governance, Vol. 7, No. 4, pp.255-260
Describes and analyses the factors limiting the success of implementation of guidelines on management of heart failure using content analysis of structured interviews with nine general practitioners in Wakefield District, validated from hospital records, to generate within‐case displays. Discusses the results and conclusions.]]>
The need for a diagnostic approach in the development of guideline implementation strategies – a qualitative study10.1108/14664100210446632British Journal of Clinical Governance2002-12-01© 2002 M.F. LambertI.S. WattA.M. WoodhouseS. BalmerM.R. RobinsonBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446632https://www.emerald.com/insight/content/doi/10.1108/14664100210446632/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
Clinical governance and education: the views of clinical governance leads in the south west of Englandhttps://www.emerald.com/insight/content/doi/10.1108/14664100210446641/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestThis qualitative study examined the views of clinical governance leads in South West England on the development of clinical governance, and its relationship to education in primary care. Information was obtained from semi‐structured interviews with clinical governance leads, and supplementary methods were used to confirm key findings. Four principal themes emerged: education, support, barriers, and evolution. Education is central to achieving the clinical governance agenda. There is a range of educational needs within primary care and these must be integrated into practice professional development plans, which will be shaped by national and local priorities. A need for PCG clinical governance tutors to support this process emerged. A range of supporting mechanisms was identified, as were barriers: principally inadequate resources and a rigid agenda imposed from above. Existing educationalists will need to change their role within the new structures, and this should be an evolutionary rather than a revolutionary process.Clinical governance and education: the views of clinical governance leads in the south west of England
Christopher E. Clark, Lindsey F.P. Smith
British Journal of Clinical Governance, Vol. 7, No. 4, pp.261-266
This qualitative study examined the views of clinical governance leads in South West England on the development of clinical governance, and its relationship to education in primary care. Information was obtained from semi‐structured interviews with clinical governance leads, and supplementary methods were used to confirm key findings. Four principal themes emerged: education, support, barriers, and evolution. Education is central to achieving the clinical governance agenda. There is a range of educational needs within primary care and these must be integrated into practice professional development plans, which will be shaped by national and local priorities. A need for PCG clinical governance tutors to support this process emerged. A range of supporting mechanisms was identified, as were barriers: principally inadequate resources and a rigid agenda imposed from above. Existing educationalists will need to change their role within the new structures, and this should be an evolutionary rather than a revolutionary process.]]>
Clinical governance and education: the views of clinical governance leads in the south west of England10.1108/14664100210446641British Journal of Clinical Governance2002-12-01© 2002 Christopher E. ClarkLindsey F.P. SmithBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446641https://www.emerald.com/insight/content/doi/10.1108/14664100210446641/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
A multi‐district model for the management of disease‐modifying treatments in multiple sclerosishttps://www.emerald.com/insight/content/doi/10.1108/14664100210446650/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestThis paper’s objective is to develop a model for the appropriate and equitable use of disease‐modifying treatments in multiple sclerosis. The prevalence and incidence of multiple sclerosis was established in Leeds. A specialist multiple sclerosis team with two consultant neurologists and a multiple sclerosis support nurse was based at one centre. The team co‐operated with purchasers to develop a model of care. This included a referral protocol, strict prescribing criteria, counselling and education of patients, the use of patient‐centred outcome measures and training and feedback to other neurologists. A total of 217 people with multiple sclerosis were assessed from April 1997 to March 2000. Our experience suggests that a centralised multi‐district clinic developed by close collaboration between clinicians and health purchasers and operating under agreed rules is a feasible and effective model for the managed introduction of new treatments to the NHS.A multi‐district model for the management of disease‐modifying treatments in multiple sclerosis
Helen L. Ford, Michael Johnson, Jon Fear
British Journal of Clinical Governance, Vol. 7, No. 4, pp.267-272
This paper’s objective is to develop a model for the appropriate and equitable use of disease‐modifying treatments in multiple sclerosis. The prevalence and incidence of multiple sclerosis was established in Leeds. A specialist multiple sclerosis team with two consultant neurologists and a multiple sclerosis support nurse was based at one centre. The team co‐operated with purchasers to develop a model of care. This included a referral protocol, strict prescribing criteria, counselling and education of patients, the use of patient‐centred outcome measures and training and feedback to other neurologists. A total of 217 people with multiple sclerosis were assessed from April 1997 to March 2000. Our experience suggests that a centralised multi‐district clinic developed by close collaboration between clinicians and health purchasers and operating under agreed rules is a feasible and effective model for the managed introduction of new treatments to the NHS.]]>
A multi‐district model for the management of disease‐modifying treatments in multiple sclerosis10.1108/14664100210446650British Journal of Clinical Governance2002-12-01© 2002 Helen L. FordMichael JohnsonJon FearBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446650https://www.emerald.com/insight/content/doi/10.1108/14664100210446650/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
Use of a proforma for reporting staging CT scans of the thoraxhttps://www.emerald.com/insight/content/doi/10.1108/14664100210446669/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestThe aim of this study was to devise a simple proforma for reporting staging CT scans of the thorax, to ensure that all essential information is included on the report, in a logical manner, and that a TNM classification and tumour stage is given. Once the design of the proforma had been agreed, its utilisation and effectiveness was audited. In an initial six month period, every proforma filled in had resulted in a TNM classification being given, although in only 20 out of 40 (50 per cent) had a tumour stage been given. In a subsequent six month period, 39 out of 44 patients (89 per cent) with lung cancer undergoing a staging CT scan had proformas completed, and a TNM classification and tumour stage given (95 per cent CI is (0.75, 0.96)). Therefore, a proforma can be a useful aid to reporting staging scans, and is an effective method of ensuring that tumours are staged as fully as possible, radiologically. In addition, relevant information is presented in a clear format that allows accurate collection of data for audit purposes.Use of a proforma for reporting staging CT scans of the thorax
Christopher S. Keeling‐Roberts
British Journal of Clinical Governance, Vol. 7, No. 4, pp.273-278
The aim of this study was to devise a simple proforma for reporting staging CT scans of the thorax, to ensure that all essential information is included on the report, in a logical manner, and that a TNM classification and tumour stage is given. Once the design of the proforma had been agreed, its utilisation and effectiveness was audited. In an initial six month period, every proforma filled in had resulted in a TNM classification being given, although in only 20 out of 40 (50 per cent) had a tumour stage been given. In a subsequent six month period, 39 out of 44 patients (89 per cent) with lung cancer undergoing a staging CT scan had proformas completed, and a TNM classification and tumour stage given (95 per cent CI is (0.75, 0.96)). Therefore, a proforma can be a useful aid to reporting staging scans, and is an effective method of ensuring that tumours are staged as fully as possible, radiologically. In addition, relevant information is presented in a clear format that allows accurate collection of data for audit purposes.]]>
Use of a proforma for reporting staging CT scans of the thorax10.1108/14664100210446669British Journal of Clinical Governance2002-12-01© 2002 Christopher S. Keeling‐RobertsBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446669https://www.emerald.com/insight/content/doi/10.1108/14664100210446669/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
A structured examination in labour improves documentationhttps://www.emerald.com/insight/content/doi/10.1108/14664100210446678/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestA structured sticker for examination of women in labour was introduced at Arrowe Park Hospital in 1998 to improve documentation of examination findings. This study was undertaken to assess whether the use of the sticker improved documentation of examination findings and second, compliance of sticker use. A retrospective analysis was performed on 64 cases randomised by random number generated on Arcus Quickstat from 470 women who were induced by prostaglandin during 1 January 1998 to 31 December 1998 at Arrowe Park Hospital. Women were induced by prostaglandin were chosen as the study population to obtain data from early labour. A total of 229 examinations were performed in these areas. Statistical analysis was undertaken on Arcus Quickstat, and χ2 and Fisher’s exact tests were applied to check for statistical significance.A structured examination in labour improves documentation
Sudipta Paul, David J. Rowlands
British Journal of Clinical Governance, Vol. 7, No. 4, pp.279-281
A structured sticker for examination of women in labour was introduced at Arrowe Park Hospital in 1998 to improve documentation of examination findings. This study was undertaken to assess whether the use of the sticker improved documentation of examination findings and second, compliance of sticker use. A retrospective analysis was performed on 64 cases randomised by random number generated on Arcus Quickstat from 470 women who were induced by prostaglandin during 1 January 1998 to 31 December 1998 at Arrowe Park Hospital. Women were induced by prostaglandin were chosen as the study population to obtain data from early labour. A total of 229 examinations were performed in these areas. Statistical analysis was undertaken on Arcus Quickstat, and χ2 and Fisher’s exact tests were applied to check for statistical significance.]]>
A structured examination in labour improves documentation10.1108/14664100210446678British Journal of Clinical Governance2002-12-01© 2002 Sudipta PaulDavid J. RowlandsBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446678https://www.emerald.com/insight/content/doi/10.1108/14664100210446678/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
Beware of the patient safety juggernautshttps://www.emerald.com/insight/content/doi/10.1108/14664100210446687/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestPatient safety and medical error have become prominent issues following publication of Institute of Medicine reports in the USA. The USA, Australia, and now Canada have followed a national “medical error” studies path that uses language rejected by the interdisciplinary group of experts described previously in this column, and continues using methods considered seriously flawed as well as incomplete by noteworthy hospital epidemiologists. Preliminary review of British hospitals by similar methods also has been published. Proven and more cost‐effective surveillance methods are pertinent methods developed over the past several decades by hospital epidemiology and infection control professionals who have more experience, but this heritage has been ignored in recent patient safety juggernauts. It is time to question why retrospective physician chart review approaches remain in vogue with national bodies to enumerate adverse patient outcomes and attribute them with “medical error” when better alternatives exist.Beware of the patient safety juggernauts
David Birnbaum, William Scheckler
British Journal of Clinical Governance, Vol. 7, No. 4, pp.282-285
Patient safety and medical error have become prominent issues following publication of Institute of Medicine reports in the USA. The USA, Australia, and now Canada have followed a national “medical error” studies path that uses language rejected by the interdisciplinary group of experts described previously in this column, and continues using methods considered seriously flawed as well as incomplete by noteworthy hospital epidemiologists. Preliminary review of British hospitals by similar methods also has been published. Proven and more cost‐effective surveillance methods are pertinent methods developed over the past several decades by hospital epidemiology and infection control professionals who have more experience, but this heritage has been ignored in recent patient safety juggernauts. It is time to question why retrospective physician chart review approaches remain in vogue with national bodies to enumerate adverse patient outcomes and attribute them with “medical error” when better alternatives exist.]]>
Beware of the patient safety juggernauts10.1108/14664100210446687British Journal of Clinical Governance2002-12-01© 2002 David BirnbaumWilliam SchecklerBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446687https://www.emerald.com/insight/content/doi/10.1108/14664100210446687/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
Learning by doing: training general practitioners to be appraisershttps://www.emerald.com/insight/content/doi/10.1108/14664100210446696/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestEffective appraisal is one of the key underpinning systems to allow the practical implementation of clinical governance. Between March and July 2002, over 800 GPs have attended the national GP “Training the Appraisers” Programme, funded by the Department of Health, and run by the NHS Clinical Governance Support Team (CGST) in partnership with Edgecumbe Consulting Ltd. The one day programme, which includes practical “real life” appraisal sessions for GPs, is well on the way to meeting its remit of training 900 GP appraisers (an average of three appraisers per PCT) in 2002. Once they have completed the course, trained appraisers can begin the process of conducting the first round of appraisals in their local primary care organisations. The GP Appraisal Programme recognises the potential of an effective system of appraisal to develop over time, so that patients can be confident that their family doctor is supported in taking regular, structured steps to ensure they are identifying and fulfilling their professional development needs and thereby enhancing the delivery of high quality care.Learning by doing: training general practitioners to be appraisers
Debbie Wall, Maurice Conlon, Ron Cullen, Aidan Halligan
British Journal of Clinical Governance, Vol. 7, No. 4, pp.294-298
Effective appraisal is one of the key underpinning systems to allow the practical implementation of clinical governance. Between March and July 2002, over 800 GPs have attended the national GP “Training the Appraisers” Programme, funded by the Department of Health, and run by the NHS Clinical Governance Support Team (CGST) in partnership with Edgecumbe Consulting Ltd. The one day programme, which includes practical “real life” appraisal sessions for GPs, is well on the way to meeting its remit of training 900 GP appraisers (an average of three appraisers per PCT) in 2002. Once they have completed the course, trained appraisers can begin the process of conducting the first round of appraisals in their local primary care organisations. The GP Appraisal Programme recognises the potential of an effective system of appraisal to develop over time, so that patients can be confident that their family doctor is supported in taking regular, structured steps to ensure they are identifying and fulfilling their professional development needs and thereby enhancing the delivery of high quality care.]]>
Learning by doing: training general practitioners to be appraisers10.1108/14664100210446696British Journal of Clinical Governance2002-12-01© 2002 Debbie WallMaurice ConlonRon CullenAidan HalliganBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446696https://www.emerald.com/insight/content/doi/10.1108/14664100210446696/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002
Using clinical risk management processes to develop the national service framework for coronary heart diseasehttps://www.emerald.com/insight/content/doi/10.1108/14664100210446704/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatestThis article discusses the role of clinical risk management in the implementation of the National Service Framework for Coronary Heart Disease (NSFCHD). It considers the practical difficulties faced in meeting NSF standards, and proposes a combined, complementary approach involving primary and secondary care. While the NSF makes no explicit reference to clinical risk management, the risk manager has an important role to play in ensuring that an adverse event reporting system is in place and its role fully accepted by clinicians. From a medico‐legal standpoint, a commitment to auditing outcomes and maintaining good clinician‐patient communication is viewed as essential. It concludes that doctors’ and patients’ interests are best served by clinicians adopting a clinical risk management approach to implementing the NSFCHD.Using clinical risk management processes to develop the national service framework for coronary heart disease
P. Jane Cowan
British Journal of Clinical Governance, Vol. 7, No. 4, pp.299-302
This article discusses the role of clinical risk management in the implementation of the National Service Framework for Coronary Heart Disease (NSFCHD). It considers the practical difficulties faced in meeting NSF standards, and proposes a combined, complementary approach involving primary and secondary care. While the NSF makes no explicit reference to clinical risk management, the risk manager has an important role to play in ensuring that an adverse event reporting system is in place and its role fully accepted by clinicians. From a medico‐legal standpoint, a commitment to auditing outcomes and maintaining good clinician‐patient communication is viewed as essential. It concludes that doctors’ and patients’ interests are best served by clinicians adopting a clinical risk management approach to implementing the NSFCHD.]]>
Using clinical risk management processes to develop the national service framework for coronary heart disease10.1108/14664100210446704British Journal of Clinical Governance2002-12-01© 2002 P. Jane CowanBritish Journal of Clinical Governance742002-12-0110.1108/14664100210446704https://www.emerald.com/insight/content/doi/10.1108/14664100210446704/full/html?utm_source=rss&utm_medium=feed&utm_campaign=rss_journalLatest© 2002