A patient’s perspective on clinical governance
My view as a physiotherapy patient is that good clinical governance is vital to ensure quality, consistency and safety of physiotherapy care.
Since my life-changing injury eleven years ago, I have been fortunate to have received a number of episodes of physiotherapy care. I have been treated within 3 different hospitals, my GP surgery, a private physiotherapy clinic (but on the NHS) and I have paid for a few private physiotherapy sessions.
Despite my fairly extensive experience as a physiotherapy patient, I know very little about what clinical governance is and how it works to ensure quality and safety of care for me.
I know very little about the performance of the physiotherapy clinics I have attended, or about individual therapists.
This blog has been written in response to a question asked of me about what I know and think, as a patient, about physiotherapy clinical governance. There is absolutely no criticism intended in any of it.
What is clinical governance?
Clinical governance is ‘a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.’ (Scally and Donaldson 1998, p.61)
Although this description doesn’t give me any clue as to how clinical governance takes place in practice, it does firmly set the foundations for it on high standards of care and clinical excellence.
How does this relate in practice for me as a patient though? How do I know if the clinical governance ‘systems’ have ensured that the physiotherapy clinic I am attending is effective or not? What are those ‘systems’? How do I know if the clinic, and the individual physiotherapists themselves exhibit high standards and clinical excellence? How do I know if their practice is likely ‘safe’ and ‘effective’ for me? To me these are important questions.
As an NHS patient I am told very little about the physiotherapy care I’m being referred into. I am usually told the clinic or hospital name, but little else. Once I get an appointment letter from the clinic then I’m usually told the name of the physiotherapist, but not always.
In that first appointment letter I’m not provided with any ‘performance’ data on either the hospital or the clinic. Neither am I told where I could find such information.
When I get to my first physiotherapy appointment and look around the waiting area, there is usually no indication of any quality measures on display. When I meet the physiotherapist they don’t tell me anything about standards of work.
Websites and CQC reports
For NHS referrals there isn’t usually (in my experience) information about the physiotherapy clinic’s quality of care on the hospital, or other, website.
If I wanted to investigate the physiotherapy clinic for myself, I might be able to find a CQC inspection report online. However, not every patient will realise either that you can do this, or know how to.
If I manage to locate the relevant CQC report then I may well find that the inspection has been done on the hospital as a whole, or outpatients as a whole, and there may be no direct reference to the physiotherapy department.
Comparison to schools
If I compare this experience to my experience of schools it is easy, and relatively normal, to view performance data about schools. When you visit a school you will often see information about their performance in the reception area. Ofsted reports are usually available on the school’s website, and are usually simple to find. A range of performance data and information is often provided.
It is therefore not difficult for a member of the public to guage, at least in simple terms, how well (or badly) a school is performing, and to be able to understand what is on offer. This, in my experience, is not true for physiotherapy departments.
At the moment I feel ‘blind’ regarding the quality of my care as a physiotherapy patient in a way that I don’t feel in many other areas of my life.
If I want to buy a car then I can easily find information as to the different types of car and which one might be most suitable for me. I can look at reviews to investigate performance. If I want to buy a phone then there is a multitude of information out there for me to view. If I want to choose a school, or a nursery, or a holiday there is also a great deal of information available to me about them, and in particular about their quality of performance / service.
Making informed decisions
As I can’t easily look at any outcome measures of a physiotherapy department, and therefore be able to guage for myself the effectiveness or safety of a department, then I have no option but to put my complete trust in the physiotherapy department I am being referred to. I have no idea if this trust is misplaced or not.
The lack of readily available information, including outcome measures, means I am unable to make properly informed decisions about the suitability or otherwise of any proposed physiotherapy care.
Once I commence physiotherapy, I am very reliant on the hospital/clinic, and the physiotherapists themselves, to ensure good, safe standards. I have little idea if standards are good or not. As a patient I do not have either the knowledge or skills to properly assess the situation for myself.
I am reliant on the hospital/clinic to provide good line management, good supervision, good training, and good risk assessment procedures. I am reliant on them addressing poor performance and only offering good quality care.
I am reliant on regulatory bodies such as the HCPC to ensure individual clinician standards, and the CQC to ensure organisational standards.
Why is this important?
I know from experience that good quality healthcare can have an enormous beneficial effect on my life. I also know from experience that poor quality healthcare can have potentially fatal consequences for me.
As an uninformed patient I feel totally reliant on the clinical governance systems, and the regulatory bodies, to ensure the quality and safety of physiotherapy care for me. I hope these systems are good!
Going forward, as a patient I would like to see performance data being more accessible to me. I would like to know how my healthcare is measured and assured. I would like more transparency about these processes. I would like to be able to ‘choose’ a physiotherapist by their effectiveness and their ‘match’ to me and my condition. I would like there to be some kind of national measure of quality of physiotherapy clinics (similar to schools or doctor’s surgery).
I know these are not trivial desires!
However, there must be some way to improve the ‘blindness’ I currently feel in my physiotherapy healthcare. Perhaps there is already and I’m just not aware?
Why is clinical governance so important?
If I reflect back on my medical care (not just physiotherapy) I have had some superb care that has been positively life changing, and I have had some negligent care that has literally nearly killed me.
I need good, safe, effective healthcare to improve my quality of life, and to preserve my life. There needs to be good, sound, transparent clinical governance systems in place to ensure this.
As a physiotherapy patient, or indeed a patient in any section of healthcare, I would like assurance that clinical governance is appropriately in place, and fully effective. I would like greater transparency about the performance of clinics I attend and I would like to be better able to make informed choices about my care.
These are only my personal thoughts and as always I’m very happy, and interested, to hear your thoughts.