Catherine Scott

Sundale Ltd

There is increasing demand for elderly care services, and the types of care are becoming more intense and complex as people live longer, have more complex co-morbidities, and expect higher levels of more advanced care. A system of clinical governance ensures all the elements that create the care and support for our residents are considered and work effectively.  

But there is complexity in how the system of clinical governance works because care is delivered by teams. And teams can be unpredictable which means care outcomes can be unpredictable if there is not a system in place that supports consistency. An effective clinical governance system will increase the reliability of the care provided. An effective clinical governance system will additionally put the care recipient and the team members providing care at the centre of the system. Every other part of the system is designed to enable safe and high-quality care to be delivered. 

An important part of clinical governance is to understand how the care is delivered and how it is perceived by care recipients and their families.  Communication between managers and direct caregiving team members is important to ensure expectations and delivered care are aligned.  Teams will work differently depending on team culture, the team’s history, and previous experiences, and how the team interacts with the environment they work in.  These human aspects of teams need to be understood so the clinical governance system can adapt to ensure the delivery of highly reliable care.

The purpose of a clinical governance system is to standardise systems, processes, team member capability and continuous improvement mechanisms to increase the likelihood that in the same scenario, two different residents will receive the same level of high-quality care. A provider’s goal is to have a system of clinical governance that creates highly reliable care for all residents and participants in an aged care or in-home care community. 

While team members have always had a role in leading aged care organisations, increasingly involving team members in governance processes began in the 1990s in response to a series of safety incidents in the US, UK, Australia, and Canada. Over the last two decades, clinical governance has evolved to include accountability, performance, and appropriate culture and workplace behaviour. More recently, there has been a greater understanding of the human aspects of care and the need to adapt to the different ways teams work and to respond to the preferences of care recipients. For organisations to perform at high levels these human aspects need to drive the systems that support good life and clinical outcomes.  

Each provider’s system of clinical governance will look slightly different from another’s and needs to reflect their priorities identified as contributing most greatly to highly reliable care. Considering this, clinical governance will include either separately or combined the following ‘pillars’:

• Audit
• Clinical effectiveness and research
• Education and training
• Resident and family engagement
• Risk management
• Staffing and staff management and
• Using information and information technology. 
   

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Professor Claire Donnellan

Professor of Nursing Research, Edith Cowan University, Perth, Western Australia
Adjunct Associate Professor, Trinity College Dublin, Ireland

Population ageing was one of the most distinctive demographic events of the 20th century and refers to the process by which older individuals become a proportionally larger share of the total population. Longevity figures globally not only show us that more individuals are surviving to old age but once there, they tend to live longer, meaning there are expected relative gains in life expectancy. We know life expectancy tells us about the status of population health because it captures mortality along the entire life course and the average age of death in a population. This dramatic rise in life expectancy has resulted in increasing interest in promoting healthier ageing and the study of how people actually age successfully. Despite it being proposed as a field of great interest in gerontological research and as a challenge for the design of health and social policy and practice, the concept of healthy ageing still needs to be incorporated into healthcare provision and for healthcare professionals to actively promote it as part of their practice.  

Healthy ageing as a concept is primarily concerned with increasing the quantity and quality of life of older adults. It also implies a focus on the maintenance of health, often through lifestyle choices and preventive measures. Havighurst wrote back in 1963 that it was essential for gerontology to have a theory of successful ageing. He defined this as a statement of the conditions of individual and social life under which the individual person gets a maximum of satisfaction and happiness, and society maintains an appropriate balance among satisfactions for the various groups which make it up—old, middle-aged, and young, men and women. [1]

Rowe and Kahn (1987, 1997) reintroduced the concept and defined successful ageing as multidimensional, encompassing the avoidance of disease and disability, the maintenance of high physical and cognitive function and sustained engagement in social and productive activities. [2, 3] In 2015, WHO’s World report on ageing and health outlined a policy framework for healthy ageing that centres on the notion of functional ability. [4] It refers to healthy ageing as a combination of the intrinsic capacity of the individual, relevant environmental characteristics and the interactions between the individual and these characteristics.

Because many older adults see themselves as active and healthy, (including older Australians aged 65 and older who indicated their health as good, very good or excellent in the 2017-18 National Health Survey [5]), it is important to focus on promoting and maintaining these healthy states in an ageing population. In our research work, we have devised a program of care called REsources And LIfe Strategy Management (REALISM) based on a theory of successful ageing [6-9] that aims to support older adults engage with healthy behaviours.  

Havighurst referred to ‘adding life to the years.’ WHO has reworded this phrase as ‘adding health to the years’ because promoting healthy ageing involves influencing and encouraging older adults to make better decisions related to diet, exercise and managing their overall health and wellbeing while also enjoying all life has to offer.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.