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Engaging the Elements of Clinical Governance: its Necessity for Quality Dental Care Services in India

Chitta Ranjan Choudhury, PhD (Japan), FFDRCS (Ireland), MPH (UK), FRSH (UK); and Anil Kohli, MDS, DNBE (USA), FDSRCS (UK)

Abstract
Clinical governance in dental care services is essential for maintaining quality dental practice and patient care. Good governance of clinical practice is an important determinant to provide cost-effective care services for a population. Cost-efficient oral healthcare services (general and specialized) are vital in all healthcare services of a country. Good clinical governance not only provides improved quality of life in terms of healthy dentition and appearance but also reduces the risk for systemic diseases linked with oral health conditions. Thus, clinical governance helps ensure an appropriate treatment protocol for patients and compels dentists to perform quality dental practices, which in turn helps maintain their competency. Many countries have clear, authoritative directives to control clinical practices for assurance of quality services for their patients. The direc tive is based on an agreed framework, which is approved by the regulatory bodies of the countries. ^1-3 The definition of clinical governance varies by country, and the operational methods differ.

Clinical governance is the system through which healthcare organizations are held responsible for continually improving their services and protecting high standards of care. They do this by establishing through a regulatory body an environment that fosters clinical excellence. The process involves a clinical audit that is regulated by a measured outcome of systematic review of care against explicit criteria. As a result, an authentic change occurs. Tools such as clinical audits, as well as measurements of treatments, are required to understand for every detail of the mechanism. The method aims to close the gap between the best care given by the dentists and the treatment that patients receive.

Importance of Clinical Governance

Essentially, clinical governance ensures that all patients receive the most current, effective, and appropriate treatments provided by dentists who are equipped with the proper abilities and training. The rules of clinical governance are designed to improve the quality of these healthcare services. This benchmarking process helps practitioners excel, and enables them to identify and eradicate poor practices.

How it Works and the Benefits of Clinical Governance

The clinicians or healthcare team members aim to exercise the operational elements of clinical governance of their clinical setting (eg, academic hospital or service hospital dental departments) and/or community care settings (eg, outreach or rural/remote dental care services), including private practices. The concept of clinical governance is not new; however, its modernized operational approach creates more opportunities to share clinical experiences with colleagues and others in healthcare. The practice of clinical governance helps a clinician to develop a sense of appropriate responsibility and accountability and provides a mechanism for implementing rational approaches to treatment planning, services, and monitoring of the effort for cost-effective treatments for patients. Clinical governance may appear to offer several barriers to providing a quality service; however, the clinician may easily overcome them by avoiding biasness regarding diagnosis, developing appropriate treatment plans, providing timely referrals when needed, and establishing follow-up schedules (for both preventive and prognostic care). Clinical governance provides the opportunity to a dentist to network with colleagues and share validated clinical skills. In addition, the practices of clinical governance activate the process of developing clinical solutions, helping to prevent and control diseases, including disease conditions in a population.

Clinical governance helps dentists and dental team members exercise effective and appropriate treatment procedures and facilitates colleagues’ experiences and skills, to share evidence-based practice.

Elements for the Operational Methods of Clinical Governance

Several mechanisms are used for establishment of the operational methods of clinical governance: these include structured questionnaire investigations, clinical trials, translational basic research for clinical applications, meta-analyses, evidence-based practice investigations, and interactive discussions for agreement and recommendations.

Cycle of Clinical Governance View Figure

Quality Measures of Clinical Governance

Quality measurement of clinical governance is essential because clinical quality is based on evidence-based knowledge and skill is necessary. Implementation of good clinical governance in oral healthcare services (for all the dental specialties) could be a daunting task. Rejection of complex protocols may occur; therefore protocols need to be established by a consensus opinion. The agreement of a new or revised treatment protocol will be based on solid evidence and tested methodology with the support of peer reviewing and published researches.

The Seven Pillars of the Clinical Governance,^4,5 which was a model devised by the NHS Clinical Governance Support Team in 1999, can help ensure quality governance of good clinical practice (Table 1). These pillars were also created to strengthen the relationships between patients and healthcare providers. The model maintains that the patients should be fully engaged in decisions that may affect their care.

These pillars are supported by five interdependent foundational stones: systems awareness, teamwork, communication, ownership, and leadership. These components must be reviewed and maintained periodically. If any of the stones are weak or omitted, the structure will crumble.

Conclusion

Many clinicians know the term clinical governance but may lack a clear understanding, which potentially results in inadequate patient services. Therefore, the concept of clinical governance and audit among healthcare providers (eg, dentists, physicians, and allied health professionals) should be clarified to ensure efficient application. It is a continual process to preclude any negative attitudes of healthcare providers toward its practice. Regulatory bodies have the responsibility to introduce and implement clinical governance with consistent vigilance, as well as provide proper monitoring and evaluation. In India, it may be wise to introduce the concept and operational mechanism of clinical governance complying with the Indian context and within the existing regulatory framework.

References

1. World Health Organization. The Ottawa Charter for Health Promotion. First International Conference on Health Promotion. Ottawa, Canada. 21 November 1986 - WHO/HPR/HEP/95.1.

2. Wanless D. Securing Good Health for the Whole Population. Final Report. 2004, DoH, England. http: //www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf. Accessed November 9, 2009.

3. Agency for Healthcare Research and Quality. Advancing Excellence in Health Care. US Department of Health and Human Services; 2008.

4. NHS Clinical Governance Support Team Web site. http://www.cgsupport.nhs.uk/About_CG/FAQs.asp#seven_pillars. Accessed November 9, 2009.

5. NHS Clinical Governance Support Team Web site. http://www.cgsupport.nhs.uk/About_CG/FAQs. Accessed November 9, 2009.

6. Clinical governance. BGS Newsletter. http://www.bgs.org.uk/PDF%20Downloads/99issues.pdf. Accessed October 9, 2009.

	Table 1
Adapted from British Geriatrics Society Newsletter.6	Adapted from National Health Service Clinical Support Team.4
About the Authors Chitta Ranjan Choudhury is a Professor, Department of Oral and Maxillofacial Surgery, PHT and PG Medical Centre, Bournemouth University, United Kingdom; and Oral Biology, Genomic Studies, ABSMIDS, Nitte University, Mangalore, India. Anil Kohli is President of Dental Council of India, New Delhi, India.