Over the past few years, the concept of healthcare governance has gained immeasurable popularity. According to Scally and Donaldson (1998, p.61), the concept denotes a large variant of policymaking, steering and related functions that the government, through responsible bodies, carries out in line with the tenets of quality healthcare. The focus of healthcare governance is on improving healthcare activities for the benefit of the public. In some cases, healthcare governance has been considered a political process, which not only encompasses balancing the competing influences, but also competing demands. However, healthcare governance entails much more than that. It includes all the activities that maintain the strategic direction of the development and ultimate implementation of policies, identification and correction of system anomalies, regulation of the practice and behaviour of all the actors involved, and the establishment of effective, efficient and transparent accountability frameworks. In some cases, healthcare governance requires partnerships with sectors such as the civil society and private sector, with a view to promoting and maintaining good population health through inclusive and participatory means and mechanisms. To this end, there are two major branches of healthcare governance, namely corporate healthcare governance and clinical healthcare governance. Corporate healthcare governance defines a set of processes, laws, customs, policies, organisational structures, and regulations that work in tandem to ensure accountability, quality, and effectiveness in a healthcare organisation. On the other hand, clinical governance describes a mechanism through which healthcare and related organisations account for the need to enhance the quality of healthcare services and patient care incessantly. This is achieved through the creation of a conducive environment that facilitates excellence in clinical care. The application of both forms of healthcare governance in concert with Adult Nursing practice is projected to result in improved patient care and high quality population health. Therefore, this essay will critically analyse how health care governance applied to Adult Nursing practice can be used to improve patient care and why nursing accountability is important. In this respect, the influence of governance policies in healthcare will be examined alongside other aspects that are pertinent to this discussion.
In its basic form, governance is based on policies without which it would be inexistent. Policies influence every aspect of governance and determine the outcome of the specific governance practices. However, the specific healthcare policy depends on various political and social factors. For instance, in the NHS, the key political and social elements influencing healthcare include political risks, treaties and agreements, income, employment, and working conditions. Political risks stem from instances such as the Gulf War and terrorism that may result in health crises. In addition, a significant political treaty and agreement that shapes healthcare in the NHS is the Kyoto protocol that has now turned out to be encouraging high levels of carbon emissions, thus, requiring political intervention (Scally and Donaldson 1998, p.61). The NHS healthcare policies also stem from social factors such as the income of a population, with close consideration to the social classes and the employment and working conditions of the people. Clinical governance is a systematic and structural approach to quality healthcare through maintaining and improving the specific healthcare activities with a view to enhancing population health. The philosophy became popular in 1995 following the Bristol heart scandal. At the time, it was described as the mechanism through which NHS organisations would uphold accountability to improve the quality of their healthcare services constantly while maintaining high standards of care. In 1999, the responsibilities of the UK NHS Trust Boards were revised to include financial management and legal responsibilities associated with quality care. Clinical governance was then initiated as the approach to monitor and guide such responsibilities. The aspects of clinical governance relevant to nursing include accountability and the provision of conducive environments that support high standards of patient care. Accountability, in particular, is not only important in nursing care, but also in general healthcare. According to Gastmans (2013, p.142–149), accountability describes all the processes, activities, and procedures through which one party takes responsibility for and justifies their actions. Accountability is of high relevance as it accounts for higher healthcare standards and quality (Fischer and Ferlie 2013, p.30–49). It leads to efficient and smooth operations of healthcare organisations, in that it instils in the professionals the spirit of abiding by all the ethical requirements of their practice. The entire framework for accountability is projected to include both un-ritualistic and stringent measures that aim at assessing the effectiveness of both the healthcare professionals and the procedures geared at improving healthcare standards. Therefore, accountability is a critical part of clinical governance and associated policies.
Another inalienable aspect of healthcare governance is risk management. It entails the identification, evaluation, and the ultimate mitigation of any possible risks or risky behaviours that may lower the projected standards of healthcare. It concerns every aspect of healthcare from technological to human resources that facilitate the dissemination of healthcare activities to the public (Hillson and Simon 2012). Risk management in healthcare covers the risk to patients, practitioners, and the organisation. The impact of risk management on quality care in the NHS can be evaluated based on these three areas of risk. Compliance with the specific policies could help in the mitigation of risks to patients, thus ensuring they receive risk-free quality healthcare services. Nursing and healthcare practitioners are equally a critical element in the healthcare framework. Managing the risk to which they are exposed to has a culminating effect on the standards of healthcare. For instance, immunising clinicians against infectious diseases ensures they maintain optimal health conditions for their operations. Healthy practitioners are highly productive. Poor quality resulting from poor risk management is detrimental to an organisation, which is the immediate environment for patients and practitioners. Through proper risk management, an organisation will be able to conduct operations in a manner that supports quality healthcare in the NHS (Dorfman and Cather 2015). Risk management strategies in a healthcare context include the creation of value through integrated resources, the creation of an established and effective team of personnel who monitor the efficiency of all the risk management frameworks as well as upholding accountability through transparency in the process. The process of risk management is definitive of how the concept can be used to establish quality care for patients. The first requirement is the establishment of the context of care and practice. In this case, the context of quality care, such as Adult Nursing, is identified, followed by the planning of the mitigation processes and activities (Hillson and Simon 2012). At the same time, the responsible team should consider the social scope of the risk management, the objectives of the stakeholders, and the basis of evaluation of the risks. After the establishment of the context comes the identification of the actual risks. This includes all events whose activation is detrimental to the achievement and maintenance of quality healthcare. The team will also create the objectives, set the scenario, and map out the risks for further assessment (Dorfman and Cather 2015). The final process involves evaluation and critical analysis of the risks, including their potential level of severity such as the level of loss or damage. For example, in the context of Adult Nursing, one of the potential risk factors is staff shortage. Thus, the identification of the risk and context-based management will inform the various decisions aimed at structural and holistic management of the risk with the aim of upholding quality care. Systematic risk management ensures the appropriate allocation of resources and other effective activities that lead to the complete eradication of other associated risks, thereby improving the quality of care for patients in both the short and long run.