BRIEF INTRODUCTION OF THE 12-PILLARS OF THE CLINICAL GOVERNANCE PROGRAMME 

For full details readers/visitors are encouraged to attend the HRI Global Monthly Workshops – visit www.hri-global.org for the Workshop Schedule 

►  POLICY / LAW / ACT: Political Will and the prioritizing Health in national development, e.g. Nigeria National Health Act 2014 – Adopt Health in All Policies Policy (HiAPP) for inter-sectoral relations and complementarity for quality health outcomes.

► FUNDING MIX: Model particularly suitable for LLMICs underpinned by Mandatory National Health Insurance/Contributory Scheme. The MIX: raise extra financing i.e. mandatory special health Intervention fund from special taxes, levies from tobacco, alcohol, mineral exploration, and selected high-end businesses e.g. Telecom companies.   Options (but less achieving): decentralized scheme e.g. i) Community-Based Health Insurance Scheme; ii) Private Health Insurance Scheme. EXEMPTIONS: disabled, unemployed, mentally ill. 

 ►  INFRASTRUCTURE: starts from Pre facility, e.g. access roads, water, and other forms of transportation. Functional physical health facilities are designed, constructed, and used with optimal impact on quality patient care and experience.

►  EQUIPMENT: starts from Pre facility preparedness of the population, with Basic equipment ( e.g. AEDs) in strategic public locations e.g. stadiums, etc, and in all levels of health facilities. Advanced equipment in selected facilities. 24/7 nationwide emergency Ambulance Service. 

 ► UTILITIES AND AMBIENCE: mandatory ‘WASH’ Principle -  24/7 Potable Water, Electricity, Clean and Green environment. NB: There can be no Antimicrobial Stewardship without WASH! 

►EDUCATION AND TRAINING: mandatory i.e. Every Health Practitioner must engage in Continuing Professional and Personal Development (CPPD) that is employer-sponsored, management-led in all levels of health facilities, supported by the professions and practitioners, complying to be up-to-date. 

 ► CLINICAL AUDIT CYCLE: mandatory participation by All, ‘’measuring your practice against Best Global / National Standards’’(Clinical Audit Cycle) – the reflective practice by both clinical and non-clinical personnel. 

► CLINICAL EFFECTIVENESS: measure for ‘fit-for-purpose’ (is the intervention appropriate? does the intervention work? and to what extent? does it represent value for money?). Refine practice using emerging evidence for quality indicators:  safe, effective, caring, patient-centered, cost-efficient, timely care. NB: Consultation (incl. communication) enables shared multidisciplinary chronic disease care, ‘One Stop Clinics’.

►  STAFF AND STAFF MANAGEMENT:  ‘No matter how beautiful the buildings in health facilities, and no matter how sophisticated the equipment, the critical factor in delivering quality and safe care, preventing and reducing mortality and morbidity is: the attitude and behavior of the Health care providers, their knowledge, skills, and expertise.’ 

►  PATIENT AND PUBLIC INVOLVEMENT ( PPI): openness and transparency, confidentiality and consent, patients' charter of Rights and Responsibilities, and Practitioners' Charter of Duty of Care and Rights turn the whole facility into a transparency center for public confidence, trust, and support for professions of health and the health system. Staff bad attitude and behavior, and poor practice thrive behind ‘secrecy’ are recipes for dysfunctional patient-practitioner relationships and the consequences.

►  RISK MANAGEMENT:  Proactive and Pre-emptive methods are key. Manage Risks to patients, Risks to practitioners, Risks to the organization/facility, and Risks to Society-Public. Risk Management: Guaranteed by the implementation of the full 12 pillars.

►  INFORMATION / COMMUNICATION MANAGEMENT-  Promote an Electronic Held Patient Record system to manage clinical and nonclinical errors and aid collection, collation, analysis, reports, and dissemination.

 subset: I Equipment, connectivity, competent personnel, and patient records subset II:  RESEARCH FOR IMPROVEMENT (RFI)  Clinical Research and publish, critically appraise research publications for evidence-informed guidelines and protocols and policy.