Clinical Governance Essay: Quality Of Care In Canada

Question

Task: In the context of the current social and political climate, how can organisationsbe held accountable for the quality of care?
You are required to describe the Canadian health long system in Long Term Care Facility

The assignment: The assignment on clinical governance essay is the opportunity to reflect on the learning from the module, to provide evidence of an understanding of clinical governance and to critically examine how healthcare organisations are held accountable to the public for the quality of care that they and their staff deliver.

Answer

Introduction
The concept of clinical governance explored in the present context of clinical governance essay is considered as the process of assuring quality that has been designed to monitor care and treatment performed in organizations operating in the healthcare sector. The objective of clinical governance is to find out gaps in clinical care and treatment in different hospitals and healthcare organizations and focus on addressing and reducing the gaps. Therefore, it can be concluded that clinical governance will help in improving the quality of services that are associated with the healthcare sector (Fardazar, et.al., 2015). Moreover, it is found that the clinical governance model has been constructed in such a way so that it can help the stakeholders understand the aspects that has to be taken care in a healthcare service. The 3 main pillar of the clinical governance model is defining the quality of the service, assuring accountability on behalf of the organization and constant improvement of the quality of the service. There is no exception in case of healthcare organizations operating in the Canadian region. The aim of this essay is to focus on analysing the context with the help of which clinical governance have been developed in Canada. The essay will also analyse the components of clinical governance that is contributing to the care quality of Canada.

Social and political context
As per Van Zwanenberg& Harrison (2018), clinical governance refers to the system which holds the national health service (NHS) organisations are held accountable for constantly enhancing the quality of the healthcare services extended to the public. In this case, the clinical governance in Canada needs to hold the NHS organisations accountable for providing quality care to the elderly people as well as those suffering from enduring diseases. These organisations are responsible for improving the quality of care to reduce the negative impact of AIDS or immense poverty on the health condition of the mass. There could be several life style issues like low hygiene, addiction or housing crisis which also lead to health problems (Moffa et al, 2019). In such cases, the government has to be involved to extend their social duty towards the public. The clinical governance will ensure that the high standards of health care is maintained at the long term care facilities. The health care system and its related services cannot be carried on in isolation. Thus, the nation’s social and political scenario impacts the system, its policies and operations.

Social Context
As per Mohsin et al (2019), Canada is the world’s second largest country in terms of area. However, the population of Canada is not very huge. The total population of Canada is 37.92 million. The population density of the nation is 4 persons per square km. The country’s population growth has been consistent for the last four decades. The population growth does not seem to slow down. Canada’s society is a home for the newcomers. The society has a dearth of skilled labours. Thus, the growth is stunted. The country has an immigration system which is quiite flexible. To adjust with the inflow of immigrants and the development of its people, the government of Canada has to plan its health care policies approprately. As per Dwyer (2019), Canada has a mixed population. Almost 46 per cent of the Canadians who are aged 15 years and older can be of foreign origin. By 2031, they can at least have one foreign born parent. Canada has one of the world’s highest living standards (Marshall & McPherson, 2019). The customers of Canada are quite confident about their job sustainability. The majority of the population is rich and can afford health care facilities. The poorer are dependent on public funded health care. The influence of addiction on Canada is moderate. The government has to take measures to reduce addiction and prevent unsafe sex. This would prevent many diseases from occurring. The wealth in Canada is in the hands of the rich. The hundred richest citizens of Canada have assets which accout for almost $230 billion. 40 per cent of the country’s wealth is controlled by the 10 per cent of the population (Alstadsæter, Johannesen&Zucman, 2019).

According to Miconi et al (2020), social context of Canada has a huge impact on its health care system. For health care services to be extended as per the need of the people, the society has to be taken into account. The overview of the society directs the health care policies. Through clinical governance, the government needs to create an environment in which the health care services’ standards are safeguarded. The environment or the social structure of Canada should help the clinical care to flourish and excel. The health system is affected by the socio-economic conditions. The social class inequalities affect the health conditions of the underprivileged classes. The people belonging to the lower classes are usually suffering from poverty. Their health condition is poor, mortality rate is high, birth rate and death rate is also high. The government needs to work towards the upliftment of the health standards of these socially backward classes (Drolet, Lewin& Pinches, 2021). This will improve the overall health condition of the nation. The elderly people from the socially backward classes or those suffering from chronic diseases coming from such social backgrounds, will not be able to afford private long term care facilities. These people need the health care assistance and quality care at the facilities sponsored by the government of Canada. The income inequalities among the Canadian population also affects the health care needs of the people. The social structure of the nation needs to be considered while planning the health care policies. The social construct of Canada comprises an ethnically heterogenous demographic composition. The citizens are from diverse cultural origins. The nation also has racism as a social ill prevailing since ages. The health care policies need to cater to the needs of the people irrespective of their social class. Many nations have a specialised medicine or government run health care system. In Canada, the health care insurance is paid via a public plan. The general taxation pays for the health care services. However, the health care services are not delivered by the government employees. The employment scenario of the country also affects the health conditions. The government of Canada needs to make provisions for the poor and socially backward so that they get better health care. The public social expenditure on education and health improves the social condition of the people (Hannouf&Assefa, 2018). Therefore, the social factors affect the health care of the country.

Political Context
Canada has a strong political standing. They are also the founding member of the United Nations (Salma et al, 2018). The country has good political connections with some of the powerful nations of the world including USA, UK, France and others. The capital of the nation is Ottawa. The nation is a democratic nation which has a parliamentary system. The constitutional monarchy prevails in the country. Canada has good stability in terms of its political situation. The nation is one of the safest in the world. The crime rate is low and the police is trustworthy. Canada emphasizes on global peacekeeping, which has earned the nation a good international reputation (O’Connor & Fredericks, 2018).

The political situation or background of a country impacts the health condition of the people. The nations which have just ended a war or survived an atomic blast, like Hiroshima or Nagasaki, will experience the negative impacts of such political affairs for years. The health of the nation’s mass is affected by these political events. In case of end of colonialism too the free nations’ suffered from health issues as they had been living in deprivation and poverty for years. Thus, political context of Canada cannot be disregarded while discussing the clinical governance and the accountability of organisations. The politics of Canada, for worse or better, will continue playing an important role in the health affairs.

As opined by Vogl (2020), the health problems gradually make into the policy agendas of the nation. The response of the government is highly impacted by the severity of the health problem. For instance, when the government of Canada notices a rising number of diabetic patients, the health policies will focus more on catering to the issue of diabetes. Similarly, when the government notices a rise in the number of HIV/AIDS cases, the mass media will promote government sponsored ads for taking precautions against HIV/AIDS. The government will always take the responsibility of the health problems affecting the population. When a nation’s demography consists of more number of elderly people, the nation’s healthcare policies need to focus on long term care for the elderly people.

The government of Canada through effective clinical governance should hold the NHS organisations accountable for extending best quality of healthcare services to the elderly people or those suffering from chronic diseases (Flynn & Brennan, 2021). The people who usually stay at the long term care facilities are those who need a variety of services both related to personal care and medical care. These people are usually unable to stay independently on their own so they need to live at the long term care facilities. The Canadian system of health care is a hybrid which is carefully crafted. The health care system reflects the political compromises that the nation has made for adopting the social programs even in the face of huge powerful opposition. The health system of which long term care is a part, is basically a public funded, universal and privately provided national health care system. The health care services in Canada are affordable. The single payer health care system is provincially administered.

The clinical governance can hold the organisations responsible for providing quality health care because the health care system is publicly funded. This implies that the government general revenues, which is the taxes, funds the operating revenue of the health care system (Paprica et al, 2020). The health care system in Canada is provincially administered which implies that it is contradictory because the national program’s administration is in the hands of the province rather than the union/center. The power however in Canada are divided among the Federal and the Provincial levels. The provincial government is designated for the health care administration. The Canada Health Act, Federal Legislation, lay down the basic guidelines of the health care system in Canada. The provincial governments in Canada are encouraged by the federal government. The latter pays the former almost 50 per cent of the costs incurred in provincial administration following the national standards. The health care systems are administered in each province of Canada (Himmelstein, Campbell &Woolhandler, 2020). The administration is governed by a single public agency, i.e., the single payer. The single public agency is accountable to the provincial legislature.

The political structure of Canada is such that all the health care plans at the provincial level are completely portable. This implies that there is a reciprocal recognition of the health care coverages among the provinces. The health care system of Canada considering its political context has made the services universal. This ensures that 95 per cent or more population of each province is covered under the health care programs (Azilaku et al, 2021). Most of the hospitals and long term facilities in Canada are non-profit and not privately own. The health care expenses are covered though the health care system.In Canada, the health care system is aligned to its political structure. The Canadian health care system operates like the Medicare. However, it is available for everyone. The medical care in Canada will be free, which covers everything under health care except the glasses, prescription drugs and dental care. The citizens of Canada usually have their supplementary health insurances to cover these things. The decentralised, publicly funded and universal health care system in Canada, known as Canadian Medicare, which is administered and funded by the thirteen territories and provinces in the country. Each of these territories and provinces have their own insurance plan and they get assistance in cash on per capita basis from the federal government (Marchildon&Sherar, 2018).

Components of clinical governance
The primary objective of organizational leaders operating in the healthcare sector is to focus on “patient centric” service and engage more number of public in the healthcare sector. With the increase in engagement of public in the healthcare the rate of healthy population in a nation increases. In Canada, more number of public is getting engaged in the Long Term care unit because they are in real need of patient centric services. According to the study conducted by Manafo, et.al., (2018), the Canadian government has increased its healthcare expenditures to increase the Long term care facilities for old people within the nation. Investments are made to implement advanced technology in the core process of treatment and to make the service better. The author states that the clinical governance of Canada emphasizes on engagement of patients. Engagement of patient in the process of health research and empowering them to provide opinions have resulted in high standard outcome in terms of healthcare services. Finally, it is found that successful engagement of patients in the process of clinical research and treatment has helped the organizational leaders and the researchers understand the needs and expectations of the patients when it comes to healthcare services. However, as argued by Cheng, et.al., (2016), care givers often face difficulties in treating old patients who are suffering from Alzheimer’s disease. A huge section of caregivers often fails to develop their personality, that can help them to provide effective and long term care to these patients. Caregivers also require support from the family members of these patients to provide effective support. Therefore, lack of support from the family members of these patients also reduces the efficiency of caregiving. Furthermore, lack of awareness among the caregivers in the Canada-based healthcare organizations is also making the service not patient-centric. Old patients who suffer from Alzheimer’s disease often suffer from depression and anxiety. The fear of loneliness affects the psychology of these patients. Caregivers who have lack of awareness about this disease and the symptoms of this disease often fail to provide effective care to the patients. This is considered to be one of the major violation of the rules and regulations that are set by the government in the Canadian healthcare setting. Thus, from the work of this scholar it can be said that clinical governance components are not considered effectively by the members of the organization and this needs to be changed. Thus, it is the responsibility of the healthcare sector to gain knowledge about long term care and involve public in the process of treatment. In addition to this, according to the study conducted by Smith-MacDonald, et.al., (2019), Long-term care (LTC) is considered to be important in Canada because senior citizens of Canada tend to live more and have chronic healthcare issues. LTC residents in Canada are suffering from Alzheimer’s diseases and issues of dementia. Thus, to focus on patient-centric services, health-care organizations operating in Canada is shifting from tradition healthcare system to more humanistic approaches. The healthcare system of Canada is also focusing on initiating palliative care. The objective of this care is to serve the emotional and physical needs of the patients. Thus, the author states that increase in the quality of services to old patients in Canada depicts that the healthcare organizations of Canada is complying with the components of clinical governance model. On the contrary, as argued by Francesca, et.al., (2011), system fragmentation within the healthcare organizations operating in Canada is considered to be one of the significant barrier in LTC care and patient-centric services. Information Communication Technology (ICT), is not capable of linking healthcare and social settings. This is creating disruption in communication among the patients and the nurses or other healthcare providers. This often decreases the engagement of public in the healthcare settings of Canada. Thus, from the above analysis it is clear that few scholars think that healthcare organizations operating in Canada has been successful enough to consider public involvement and patient-centric approach as one of the major element of clinical governance. On the other hand, few scholars think that Canadian government and the organizational leaders of the healthcare sectors should focus on improvement of the LTC care unit by engaging more number of skilled caregivers in the healthcare sectors.

Furthermore, accountability is considered to be another important element of corporate governance. Performance accountability is considered to be one of the major aspect under the accountability segment. Performance accountability helps in measuring the performance of the caregivers when it comes to meeting their respective goals and standards. According to the study conducted by Denis&Van Gestel (2016), professional autonomy in a healthcare organization is exercises with the help of accountability maintained by the medical staffs and practitioners. It is found that Canadian medical professionals are accountable with Long Term Care facilities and this has helped healthcare organizations to use the to leverage the leadership skills and abilities. It is also found that the government of Canada has constantly pressured the organizational leaders of the healthcare sector and this has helped them to modify their initiatives. This has improved their accountability towards the sector which has also enhanced the performance standard of the medical practitioners. However, as argued by Mukhi, Barnsley&Deber, (2014), several medical professionals performing in the healthcare sector of Canada has faced several barriers while focusing on accountability in their core performance. It has been found that there are several senior management team of healthcare organizations who have not focused on forming PMS strategy. The objective of the PMS strategy is to define the scope the organization has and it also focuses on directing the employees of the organization so that they can achieve goals and objectives in a significant way. Thus, due to absence of PMS strategy it is found that employees are not well-aware of the exact performance standard that they have to maintain. This makes them less accountable in the sector. Non-compliance with this clinical governance model is considered to be one of the major disadvantage for all the organizations operating in the healthcare sector. This has also disrupted the Long Term Care unit segment where nurses or care givers have to take care of patients who are old and suffering from deadly or chronic disease. In addition to this, according to the study conducted by Deber, (2014), in Canadian healthcare sector accountability is considered to have several number of dimensions. The first one is clinical accountability. The objective of this accountability is to provide high quality care to the patients by the nurses, mid-wives and doctors. It has been found that the LTC care unit in Canada has evolved and the stakeholders of this unit is highly satisfied with the performance of the healthcare professionals. The primary reason behind this is high level of clinical accountability among each and every stakeholder of the clinical sector. The author also states that Canadian government has made sure that the care givers should be answerable for any kind of failure while serving old and sick patients. Moreover, it has also been found that the government of Canada asks the care givers into an agreement. The agreement says that each caregiver or medical practitioners should be responsible or accountable for their wrong-doings while serving or providing care to the patients. This increases the standard of performance of the medical practitioners. On the contrary, as argued by Baumann, et.al., (2014), maintaining accountability is considered to be one of the major challenge that are faced by the Canadian healthcare sector and stakeholders involved in this sector. The healthcare organizations often disagreed to be accountable with any kind of wrong doings. A certain section of stakeholders operating in this sector thinks that it is their responsibility to be financially accountable with the government and they are not responsible for any kind of other issues. Thus, from the above discussion, it can be said that if the firms are not accountable for their clinical practices then it can result in decrease in performance efficiency of the Long-term care unit.

The final clinical governance component that has been taken into consideration is clinical effectiveness. The components that are associated with the safety of patients is known as clinical effectiveness. When it comes to LTC, it can be found that individual living and assistant from nurses both come under the settings of clinical effectiveness. Senior management team and other external and internal stakeholders of the healthcare sector is focused on achieving clinical effectiveness because it is considered to be responsible for increasing the performance of the organizations and the sector as a whole.According to the study conducted by Veillard, et.al., (2012), the healthcare system of Canada is always focused on patient safety. Patient safety is considered to be one of the major part of clinical governance. The healthcare organizations operating in Canada is primarily focused to provide safe and smart care to the old patients who are suffering from chronic diseases. Furthermore, senior management team of healthcare organizations in Canada is constantly focusing on improving the quality of treatment and implement innovative technologies to make the care service better. The healthcare firms have made sure to focus on measuring the patient outcomes. Number of patients are getting admitted to the hospitals even after receiving assistant from nurses and improvement in the physical and the mental health conditions of the patients are measured. This helps the organizational leaders understand whether the performance of the medical professionals is helping the organization to achieve clinical effectiveness or not. However, as argued by Munene, et.al., (2020), it is getting difficult for the medical professionals and the senior leaders of the healthcare professionals to provide Long term care to patients who are suffering from chronic diseases. One of the major reason behind this, high rate of increase in patients who are actually demanding for long term care. The author states that the medical professionals or the care givers are not understanding the needs and desires of the old people as they are unable to express their feelings. Lack of understanding the needs of the patients is leading to decrease in clinical effectiveness. Furthermore, the author also states that inefficient utilization of the resources required for palliative care is also one of the major reason behind decrease in clinical effectiveness and Long term care in Canada. Moreover, if the Canadian healthcare sector is taken into consideration it can be seen that Long term care not falls under this act. This is one of the reason long term care is not provided to the older people of Canada on universal basis. Therefore, from the above discussion it can be understood that two different group of scholars are arguing on the fact that clinical effectiveness is achieved in the Long term care unit in Canadian healthcare sector.

Conclusion
In health care system of Canada, the different facets of safety and quality are given importance. However, the quality, safety, accountability and other aspects will be clear once the current status of the clinical governance is clear. In this paper, the social as well as the political context of Canada has been discussed with reference to its link with the health care system. The government determines the politics of the country and the people make the society. The health care can never run without these two crucial aspects. Thus, the political structure impacts the health care policies, while the social structure impacts the health conditions of the people for whom the health care services are required. There have been many recent advancements in the clinical governance in Canada. The focus on the patient which is the first component, has improved over the years. The patients are getting better access to care at the long term facilities. The involvement of the public in health care has been increased. The clinical service has to be made more effective. This makes the NHS organisations more accountable. The accountability which is the third component of clinical governance has improved drastically over the years, with better policies of the government. However, in Canada there is huge scope for improvement. The safety as well as the quality of health care services can be improved if the health authorities’ government boards take better and more effective initiatives. The provincial authorities are held responsible for health care services in Canada. They should collaborate with the national boards and agencies to deliver better services to the public.

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