Delivering continuity of midwifery care to Queensland women

Section 6
Clinical governance
Elements of clinical governance
Research and
development
Consumer
participation
and informed
choice
Risk
management
Clinical
Governance
Continuous
professional
development
Clinical audit
Credentialling
Clinical practice
guidelines
Evidence based
parctice
Overview
Clinical governance is defined as ‘the system through which health services are accountable
for continuously improving the quality of services and safeguarding high standards of care,
by creating an environment in which clinical excellence will flourish’ (Forster 2005).
An appropriate clinical governance structure is essential to the success and safety of
any model of care, including continuity models. A state-wide clinical governance policy
(Queensland Health 2007) was implemented for all health areas following a review of
Queensland’s public health system (Forster 2005). The National Health Service (NHS) in
the United Kingdom uses a very similar version of this framework for the entire service
(Department of Health 1998; Scally & Donaldson 1998; Starey 2001 ).
A significant emphasis within the NHS and this guide is the engagement of consumers in
the governance of care. Levels of consumer engagement range from the system level, where
consumer representatives contribute to the development of the model, to the woman who is
engaged at an individual level in a partnership with the midwife providing her care.
Risk management
A robust system of risk management is required. In midwifery continuity of care models
a foundation stone is the partnership between the midwife and woman. Communication
between the midwife and woman, ensuring informed choice, is the foundational strategy for
risk management in midwifery continuity of care models. There are also numerous issues
that can impair the ability to develop and sustain midwifery models.
Queensland Health (Queensland Health 2008c) adopted a generic risk management
framework (Standards Australia and Standards New Zealand 2004 AS/NZS 4360) that
indicates the process of risk management is:
• communication and consultation
• establishing the context
• identifying the risk
• analysing the risk
• evaluating the risk
• treating the risk
• monitoring and review (Homer, et al. 2008).
Communication and consultation must occur at every level. The requirement for
communication and consultation includes mechanisms to ensure that all stakeholders have
been involved in risk management for the new model.
38
Delivering continuity of midwifery care to Queensland women