Clinical performance and effectiveness

The delivery of safe and quality health care is dependent on the effective organisation of the health workforce. The opportunity, and risk, for safe care are executed at the interface between people, whether it is between teams within an organisation, or directly between clinicians and patients.

Health service organisations must have strategies in place to manage workforce issues with a systems focus that ensures excellent leadership and operational processes, a healthy culture, and optimum patient outcomes.

Credentialing, clinical audit, performance review, education and training, compliance with acceptable clinical guidelines and evaluating variation in practice can all assist in the provision of safe, high-quality services.¹

Members of the workforce should:

• Be suitably qualified for the role in which they are employed and only work within their scope of clinical practice
• Complete an orientation program, incorporating workforce cultural capability as relevant to the service
• Complete training relating to occupational health and safety (for example manual handling, fire safety and infection control)
• Complete training relating to safety and quality in health care
• Attend continuing education and skill enhancement programs
• Be competent in basic life support (clinical workforce only).

A range of methods are used to confirm and assess a clinician’s qualifications, experience, professional standing and other relevant professional attributes. These include recruitment processes, registration checks, peer review, oversight and supervision, and competency assessment. For some clinicians, a credentialing process is used.

Credentialing is a formal process used to confirm a clinician’s competence, experience and professional suitability to provide safe, high-quality care. Scope of clinical practice is defined following credentialing. This involves delineating the extent of an individual clinician’s practice within the organisation based on their credentials, competence, performance and professional suitability, and the needs and capability of the organisation.

Performance development programs enable an organisation to ensure that members of its clinical workforce meet their professional registration and continuing professional development requirements. Issues affecting an individual’s performance are identified and addressed as part of the performance development process. Goals for quality improvement, and further education and training are also agreed to.

The values of fairness, accountability and support underpin effective systems of performance development. If underperformance is identified, the first response that is triggered should include increased support, and access to relevant tools, education and expertise. However, patient safety is paramount, and remedial strategies need to protect patient safety at all times.

Health service organisations are accountable for ensuring adequate supervision of the clinical workforce. In particular, junior clinicians who have limited clinical experience require oversight and regular review of their clinical practice. The purpose of supervision is to ensure that the practice of less experienced clinicians is of an acceptable standard, and to identify opportunities for learning and development.

Orientation is an important activity that provides the workforce with the basic knowledge and skills to work safely within the health service organisation. Comprehensive orientation includes an introduction to the organisation’s:

• Model of care
• Policies, procedures and protocols
• Risk management systems
• Quality assurance, improvement and monitoring systems
• Incidents management and investigation system
• Feedback and complaints management systems
• Healthcare records systems
• Performance development and human resources systems
• Information systems.

Health service organisations need to support clinicians to use the best available evidence to provide safe, high-quality care. Good clinical governance promotes clinical practice that is effective and based on evidence.² The introduction, use, monitoring and evaluation of evidence-based clinical pathways support the provision of effective care.

Clinicians are accountable for their practice. This includes compliance with accepted clinical guidelines or pathways. Oversight of clinical practice should enable the early identification and management of practices that place patients at risk of harm.³

Effective quality improvement systems should identify the extent of variation from agreed clinical guidelines or pathways, and how such variation is managed. The Commission’s clinical care standards support the delivery of appropriate care, reduce unwarranted variation in care, and promote shared decision making between patients, carers and clinicians.⁴

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