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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. As Adjunct Professor Shane Crowe, Executive Director, Nursing & Midwifery identified, “Not only are we practising clinical governance within Western Health, but we are also having to embed it in new services. It has been imperative that we get this right to ensure our growing number of patients are receiving treatment in a safe environment”.

Barriers to sustaining rapid growth

Shane reflects that from a clinical governance perspective, Western Health was doing ok. The health service had their Best Care framework in place for approximately 10 years, and clinical governance was tight, but capability wasn’t embedded in the quality team. These skill deficiencies became noticeable particularly around accreditation when most of the work was done by people outside of the quality and safety team. Understandably, this was impacting the culture of the organisation, with some staff feeling like they were operating outside the scope of their role. “The capability wasn’t in the right places, so staff with clinical governance and quality experience and expertise needed to step up and lead this work despite it not being their primary role. I knew that there had to be a better way.”

Building capability from the ground up

Clinical governance capability shortcomings are not unique to Western Health. In fact, many healthcare sectors have experienced lapses in patient care that have resulted in inquests and Royal Commissions (the Royal Commission into Aged Care Quality & Safety, Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability and Targeting Zero to name a few). Notably, all these reports contained recommendations around improving clinical governance, not just at the board level, but also building capability within frontline staff.

The challenges Western Health staff faced from the organisation’s clinical governance capability shortcomings meant that when change was proposed, it was met with little resistance. “Everyone knew it needed to be better than what it was” Shane explains.

Western Health implemented a “people and systems” approach to building clinical governance capability within their workforce.

The right leaders

Shane admits that the openness of Western Health CEO, Russell Harrison, to address the systemic clinical governance issues was a big part of launching the clinical governance transformation. As part of shifting the accountability for clinical governance to Shane, he was tasked with developing a business case for investing in clinical governance, and, with the support of the CEO and the Board, was able to demonstrate that there was an underinvestment in this area and that outcomes could be improved through investing in people and systems.

Clinical Governance Framework

Western Health had a well-established Best Care clinical governance framework, which has strong support and commitment from leadership, and was initially developed through significant consultation with the broader workforce. Shane explains that the framework “works well because it resonates with the staff, it’s simple to understand and it’s less around compliance and more around what we’re trying to achieve as a healthcare organisation”. As part of the review of systems and processes, Shane and his team reviewed the way the framework was operationalised and where necessary tweaked elements to ensure that there were no gaps and that it was meeting the needs of the growing health service.

Creating a culture of ‘Best Care’

Over time the collaborative approach to ‘living’ the Best Care Framework embedded the framework pillars into the culture of the organisation. By doing so, the process of accreditation could change from burdensome, and compliance focussed to having clear, non-negotiable expectations. “We’re trying to make accreditation non-burdensome by being ‘accreditation-ready’ all the time” explains Shane. “By doing so, our work becomes less reactive and allows us the space to start thinking about how we can continuously improve”.

In addition to streamlining accreditation, Western Health also structured its committees to ensure everything maps onto the framework, thus removing silos and improving collaboration between departments.

Investment in systems and education

Western Health has invested in technology to support staff to deliver on the Best Care framework. Specifically:

• Western Health worked with external consultants and vendors such as Cerner which resulted in tools such as performance dashboards so that staff could access real-time data. While the volume of data has never been an issue, the ability to meaningfully use that data to improve decision-making was difficult. These tools now allow staff to improve their decision-making to provide better outcomes for patients.
• They also worked with a provider to develop software that assisted in delivering on recommendations that came out of adverse event investigations, monitoring auditing schedules and actions, overseeing consumer feedback themes and recommendations, and morbidity and mortality recommendations. This allowed them to develop improvement plans that the recommendations could be mapped against and hold themselves accountable to timelines.

In addition to investing in technology, Western Health also engaged the Australasian Institute of Clinical Governance (AICG) to deliver education to build staff capability in clinical governance. Shane reflects that “previously Western Health had been person-dependent in staff education. Our fear was that if we relied on internal experts, they’re not only already busy, but there was a risk that educators could settle for the status quo instead of constantly questioning and enhancing the curriculum. We want our staff to be able to think critically and solve problems. By using external expertise, we could ensure that staff were educated in a multi-dimensional way and could understand that there is more than one way to do things”.

The benefits of Best Care

The investment in clinical governance at Western Health over time has led to a number of positive changes, particularly around the culture of the organisation. Here are some of the benefits that Shane has observed.

Low attrition

Investing in staff education and improving the staff’s ability to deliver Best Care has led to Western Health becoming an employer of choice. “We are renowned for our good culture now and our attrition rate is good. Ultimately, people want to do good work, so by making it easier for them to do that, they can get more meaning and fulfilment from their employment with us”.

Accreditation-ready

The collaborative approach to initially building the Best Care Framework, and then having a sustained focus on making it central to how the health service operates meant that it became tangible and meaningful to the Western Health workforce. The pillars of the framework “have worked their way into how staff talk about delivering care in a genuine way”, which is being supported by senior leaders right through to frontline staff. “It’s effective because it resonates with will all levels of healthcare workers” explains Shane. Shane believes the framework has been highly influential on the culture in the organisation and highlights that it has been commented on by surveyors in the past who were impressed when staff members were conveying everything in the context of their framework instead of in the context of standards. “The feedback we are receiving from surveyors indicates we are on our way to being a health organisation that is always accreditation-ready”.

Good patient outcomes

Safe, patient care and good outcomes are the goal of every health service; however, it is evident that by investing in people and systems, delivering better care becomes easier to achieve. While financials are not a primary driving factor, it can be shown that better care equals cheaper care which benefits everyone.

If you would like to invest in clinical governance education for your staff, contact Richard Huysmans at rhuysmans@heal.edu.au