Editorial

Citation

Gillies, A. and Harrop, N. (2012), "Editorial", Clinical Governance: An International Journal, Vol. 17 No. 3. https://doi.org/10.1108/cgij.2012.24817caa.001

Editorial

Article Type: Editorial From: Clinical Governance: An International Journal, Volume 17, Issue 3

This issue of Clinical Governance an International Journal contains seven papers: from Ghana, India, New Zealand, the UK, the US, Ireland and Vietnam.

Emanuel K. Sakyi, Roger A. Atinga and Francis A. Adzei discuss the problems that have confronted hospitals in Ghana following the introduction of its National Health Insurance Scheme. By decoupling access to healthcare from its direct cost to individuals, this innovation has created supply-induced inflation of demand and has exposed both funders and providers to moral hazard: the retrieval of benefits disproportionate to contribution or comparative need. For hospitals in Ghana, the problems of supply are augmented by inflated demand so that the consequences of delayed and inaccurate reimbursement are amplified. The symptoms of inability to retrieve costs are similar to those of failing to use resources efficiently. They include overcrowding of workspaces, extended waiting times, demoralisation of healthcare staff and the deterioration of facilities and standards. These symptoms are worsened when funds destined for any part of the service fail to reach their allotted destination because of unaccounted interference or delay. Accreditation schemes can help if the criteria for accreditation strongly support the modernisation of accounting systems to assure the timely (“Just-in-time”) linkage of reimbursement with disbursement. Current paper-based accounting systems are painfully slow. Computerisation is proposed as a solution but rationalisation of data flows, transparency and the accountability of individuals must surely be deliberately allied.

The “Just-in-time” delivery of resources to operations is key to modern ideas about process quality. Rajeev Chadha, Anuta Singh and Jay Kalra present an account of a related quality strategy, “lean” process redesign, to the resource-efficient pursuit of shorter treatment times in an emergency department.

For Sakyi et al., the transition to a National Health Insurance Scheme was one from a “cash and carry” approach to a needs-based approach. How can need be assessed transparently, fairly, and consistently and with outcome validity? Paul Hansen, Alison Hendry, Ray Naden, Franz Ombler and Ralph Stewart from New Zealand describe a rational approach to case selection and prioritisation for surgery that has been adapted and applied across a range of clinical conditions with approval from patients’ groups, ethicists, ethnic groups and those interested in human rights.

Their paper is complemented by that of Nicholas Parfitt, Alison Smeatham, John Timperley, Matthew Hubble and Graham Gie. The supply of secondary care specialists in a nationally funded healthcare system can never be matched perfectly against demand and, in the UK NHS, it has become the norm to redefine professional responsibilities; so that the application of access filters that combine assumptions of high sensitivity and high specificity can be delegated to non-medical professionals. As an example, Parfitt et al. report the delegation, to physiotherapists in a primary care setting, of responsibility to select patients for direct addition to the orthopaedic surgical waiting list at a specialist hospital.

David Birnbaum, William Jarvis, Peter Pronovost and Roxie Zarate switch the emphasis of this edition towards issues of safety: specifically, rates of bloodstream infection associated with the presence of a central venous catheter in ICU patients. The publication of comparative charts and rankings helps mobilise public, political and managerial pressure for institutions to modify practice in order to escape the lowest end of the distribution. What gets measured gets changed; but what ought to be measured and what ought to be the measure? Some patients have more than one central line and some central lines have more than one lumen (channel). Should we measure infection rates per patient with any line; per line; or per lumen? Birnbaum et al. ask whether it makes a difference to comparative rankings and whether the denominator ought to be changed.

Most editions of this journal have finished with a North American Perspective. On this occasion, we present an Asian Perspective and we welcome the paper by Luu Trong Tuan, which describes the impact of the introduction of a clinical governance initiative, in a specific cultural setting, upon ethical leadership, the form of organisational culture, knowledge sharing and the basis of trust between individuals and groups. This paper is a “must read”: not only for those interested to know how clinical governance is developing in other countries, but also for those interested to read a theoretically rich account of the social, organisational and cognitive bases that contribute to the theory of clinical governance.

Alan Gillies, Nick Harrop