Evaluation of the mental health nurse incentive program
5.5 Clinical governance
Clinical governance is the term used to describe a systematic approach to maintaining and improving the quality of patient care within a clinical care setting, health program or health system. It is about the ability to produce effective change so that high quality care is achieved. It requires clinicians and administrators to take joint responsibility for making sure this occurs.20 A clinical governance framework for MHNIP would have the ability to solidify the roles and responsibilities of the mental health nurse and medical practitioner. Self-employed mental health nurses do not have any obvious clinical supervision.
The MHNIP Program Guidelines do not specifically mention clinical governance. However, there is a range of requirements in the Guidelines that relate to clinical governance type activities such as the need for:
"clear lines of clinical accountability (specified in writing), including the responsibilities of the mental health nurse and participating medical practitioner."
While the MHNIP Guidelines do not require that organisations, mental health nurses and medical practitioners establish formal clinical governance arrangements, strengthening them has the potential to improve the quality of services and their processes. Case study sites did not report the existence of any formal clinical governance arrangements. The most common activities respondents provided in relation to clinical governance type activities included:
- sharing of patient records / notes between medical practitioners and mental health nurses;
- regular case conferencing (weekly or more frequently) of a sample of all patients managed under MHNIP;
- regular review of care plans;
- medical practitioner's regular review of their MHNIP patients during appointments for medication management and other physical care needs;
- formal (specific to a patient need) and informal (opportunistic, e.g. during lunch) discussion about specific cases between medical practitioners and mental health nurses; and
- existence of a written 'scope of practice' document that guides what the mental health nurse can and cannot do regarding treatment and support.
The ATAPS framework may not be completely relevant, given a broader scope of eligible organisations under MHNIP than ATAPS (ie only Medicare Locals). Nevertheless, the analysis revealed the potential for improvement in the type of clinical governance arrangements and key resources that could be considered for MHNIP.
Detailed finding #18: scope exists to strengthen clinical governance arrangements to improve the quality of services by providing resources and tools to support: improved case management processes; more systematic approaches to risk management; patient and carer complaint mechanisms; and more uniform access to the program at a population level within a particular geography.
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