LENMED AIR 2019.pdf

Governance structures Illustrated below are the governance structures currently in place — implementation of the clinical governance framework is driven through the appropriate governance structures. Hospital Managers (and elected Chairmen) play a key role in ensuring that these governance structures are targeted at the appropriate audiences and context, that structures are working and functioning effectively, and that regular feedback is provided to the Group Clinical Governance Committee (a Board sub-committee). For this purpose, various clinical policies and documentation have been developed, which will guide the hospital manager and relevant chairpersons. DTC — Drug and Therapeutics Committee AMS — Antimicrobial Stewardship Committee ICU — Intensive Care Unit CLINICAL GOVERNANCE PRIORITIES AND PROGRESS REPORT During the reporting period, the Chief Medical Officer established key clinical governance priorities, which are illustrated below. Progress has been made against certain initiatives; however, more work is required in the financial year to fully embed and sustain improvement. CLINICAL OUTCOMES 03 + Clinical programmes (AMI, stroke) + Mother & child + HAI statistics BEST PRACTICE 04 + Clinical training & development + Nursing quality & staffing + Clinical policy development COMPLIANCE 05 + Clinical governance structures + Compliance audit CLINICAL EFFICIENCY 06 + Hospital CPE management + Group formulary compliance & conversions CUSTOMER EXCELLENCE 01 + Patient experience management CLINICAL RISK MANAGEMENT 02 + Incident & risk management + Infection prevention + AMS Other Physicians Advisory Board Hospital Clinical Governance Committee DTC & AMS Committee Theatre, ICU Users Committee/s Morbidity & Mortality Committee Management Review Committee HAI — hospital acquired infections AMI — acute myocardial infarction CPE — cost per event Group Clinical Governance Committee 57 LENMED ANNUAL INTEGRATED REPORT 2019