Law and clinical governance

Legislating for 24-hour nursing support in residential aged care (maybe)? That would be wonderful if it can be achieved in practice (where will we get the nurses from?). Let's wait and see what happens...

Our legislature plays an important role in supporting clinical governance - a concept now embedded in regulation (such as through the Aged Care Quality Standards). But clinical governance encompasses so much more than what we can possibly do within the rigidity of legal frameworks, or on the advice of lawyers. Fundamentally, clinically governance goes to the very essence and culture of care. It must be real, flexible, and responsive to care itself - and to the individuality of consumers at the end of that care.

The term 'clinical governance' emerged in the 1990s following a series of high-profile healthcare failures in the UK.?While it might be legislated for, it is not a legal concept.?Put as simply as possible, clinical governance is about how we can deliver the best care and support we possibly can; how we can optimise clinical outcomes, and the health and well-being of every person.?It is about constantly striving to improve the way we deliver care (and manage risk), and the way we holistically support those for whom we provide that care.?Hence clinical governance requires an authentic understanding of how it translates in practice.?

Yes, good clinical governance will reduce legal risk (whether in terms of claims, conduct or compliance), however it should not be approached through a legal lens alone. This is far too narrow.?Compliance can support clinical governance (and clinical governance should be mindful of compliance), but only to some extent - it is not the panacea to it.

Understanding clinical governance entails knowing what it's like to stand in front of a person needing care and support.?It's about understanding the nuances in care delivery, the complex dynamics between the consumer, the team, the environment - and of course, 'management'.?It requires understanding what it’s like to feel psychologically unsafe, or burnt out - and the consequences that ensue. Clinical governance involves truly understanding the competing tensions inherent to a care environment, the challenges in communication and in keeping good records - and other difficulties in putting theory into practice.?There is a richness in first-hand experience, and in the insights and perspectives derived from this experience - which inform how care (and risk) might be more effectively managed on a day to day basis, and ultimately governed.??

So clinical governance is not just about compliance. Nor is it just about systems, processes or frameworks. Clinical governance is a lived experience - for ultimately it concerns what happens at the point of care and beyond. This is why we must work with clinicians and consumers to continually improve clinical governance (and there are so many out there who genuinely want to make a difference!) – the law is secondary.

Australia is in the midst of important regulatory evolution, particularly in the aged care sector - but we must take care not to miss the wood for the trees. We must always remember why we do what we do - to help people. Hence we should not be waiting for the legislature (or royal commissions) to tell us what to do (or how to do it); we should always be thinking about how we can do things better, because this is what we do.