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Western Health is growing at a rapid rate; the organisation has doubled in size in the last five years and is likely to double again within the next six. This growth is the result of adding new services, such as becoming a designated mental health service by July 2023 and amalgamating with other smaller services, such as Djerriwarrh Health.

Like any organisation undergoing rapid growth, Western Health is focused on the scalability of the organisation, particularly when it comes to clinical governance. 

Surgical site infections remain a problem despite many decades of research and practice change to eliminate those that are preventable. 

Approximately 0.5% to 3% of surgical patients develop an infection. Compared with patients undergoing surgery who do not have a surgical site infection, these patients are hospitalized approximately 7 to 11 days longer.   As we know, longer hospital stays increase the risk for patients and reduce hospital efficiency and effectiveness. Infections are the leading cause of re-admissions following surgery and can add thousands of dollars to the cost of an admission. 
 

One practice the COVID-19 pandemic highlighted from the outset was the importance of hand hygiene in infection prevention and control – a practice that in the past has often been approached with a degree of complacency.  Some of the literature concludes that compliance with hand hygiene has improved during the course of the pandemic, while other studies suggest it has not.

What is the role of clinical governance in a crisis? Does it fall away, or does it become even more important? And what can we learn about clinical governance from a crisis?

Mitigating risk is only one aspect of clinical governance – this is a minimum, since clinical governance is about aspiring to deliver best possible care. But what if circumstances are so dire that providing the best possible care is to mitigate the risk of harm? We might see this in a war zone, for example. Do our aspirations shift with our priorities – or does the way we measure quality completely change?
 

Aishwarya Aswath was 7 years old when her parents took her to the Perth Children’s Hospital on 3 April 2021, with a range of symptoms including diarrhoea, vomiting and fever.  Despite being triaged as a Category 4 and therefore ‘semi-urgent’, Aishwarya rapidly deteriorated into cardiac arrest and died as a result of undiagnosed Group A Streptococcal sepsis.  

Psychological safety is an important tenet of safe and quality care - as is ‘physical’ safety.  In addition to injury from manual tasks, healthcare workers also face a risk of violence and aggression from patients themselves, particularly in emergency departments, mental health services, drug and alcohol settings, ambulance services and remote clinics.

One way we can learn from failings is by drawing parallels and considering how lessons of others might apply to your organisation. A vast amount of work has been done around clinical governance in recent years (particularly in Victoria), from which all organisations can continue to benefit regardless of jurisdiction or sector, through a process of analysis and extrapolation.

The concept of person-centred care in clinical governance includes supporting people in making choices on the basis of their values and preferences within a particular context, founded on their understanding of risk and appetite for it.

Understanding risk and how it applies in any given context is essential when providing informed consent. Therefore, ensuring such understanding is part of our role when delivering any kind of healthcare.

The challenges which COVID-19 presents to clinical governance has required intervention at the government level to promote safe, quality care in the context of a pandemic.