Towards Clinical Excellence

Clinical excellence in a hospital involves care pathways leading successful achievement of clinical outcomes. Patient nowadays has become more aware and lays a high value on a clinical outcomes. The Clinical outcomes along with the financial and operational outcomes are the key performance indicator for a hospital. The systematic critical review of the quality of clinical practice by a multidisciplinary team is the key to improving outcomes. Satisfactory achievement of the clinical outcomes ensures high quality of medical care and helps sustenance of the organisation in the long run.

The following narratives describe the three pillars in clinical excellence-

1. Clinical performance indicator
2. Clinical audit
3. Clinical risk assessment  & management

1. Clinical performance indicators

Clinical indicators quantitatively measure the clinical process outcomes. These indicators do not directly measure the quality of services but they serve as tool to bring out the potential problems requiring improvements. Based on the outcomes investigations can be carried out.

Examples of clinical indicators are re-admission rates , Hospital acquired infections, surgical re- exploration rates. These indicators can be collected on a monthly basis and trends in the data can be observed and analyzed.

 2. Clinical audit

 Clinical Audit is a well-established method of reviewing clinical practice against agreed standards with the aim of identifying areas for improvement in quality of care.

The NHS in United Kingdom has defined Clinical Audit as “The systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient” (Swage, 2000;Wright & Hill, 2003).

Stages of clinical audit

1. Preparing for audit – This includes involving users , selecting a topic , identifying purpose and defining the requisite skills.

2. Selecting the criteria-The criteria form the tool by which the quality of care is measured. Criteria includes  deciding the parameters critical to quality.

3. Measuring performance- It consists of planning the data, identifying users, sampling users and finally, handling data

4. Making improvements -This stage is most critical in Clinical audits to demonstrate actual changes and make concrete improvements in care delivery.

5.Sustaining improvement-Any improvements made as follow-up actions in clinical audits must be monitored, evaluated, maintained and reinforced within the hospital.

3. Clinical risk assessment and management

From a clinical perspective patient safety involves ensuring safety in clinical procedures and managing risk associated with the delivery of healthcare. This involves identification of the risk associated with the clinical processes and suggesting possible ways to prevent them .This uses tools like FMEA( Failure mode and effects analysis ) and RCA( Root cause analysis) . FMEA is an effective tool to analyze  clinical  procedures critically. It helps identifies potential failure modes in the current procedures, assesses the effects of the failure modes, then prioritizes the failure modes in order to redesign, implement and monitor the new procedures.

Root cause analysis (RCA) gives a retrospective analysis and is carried out after a sentinel event or near miss has occurred. The purpose of RCA is to identify the underlying causes of any variation in care pathways leading to adverse events.

Ms. Neha   Bhagatkar

Assistant Professor

SIHS