RACMA: Re-Negotiating Clinical Governance

Negotiation and conflict management is at the heart of new approaches to clinical governance, according to a report released by the Royal Australian College of Medical Administrators (RACMA) in September 2017.

The report, which proposes a clinical governance training framework for RACMA trainees, is centred on new thinking about the importance of adopting an agile approach to governance which is responsive to complex systems theory, Resilient Healthcare, and working with the gap between work-as-imagined and work-as-done.

What is ‘productive’ governance?

The report presents an original framework which draws a distinction between traditional protective approaches to clinical governance, and newer productive approaches.

Protective governance is about improving safety and quality by reducing variability in a healthcare system, or increasing standardisation. Protective governance methods include check-lists, automation, protocols, clinical pathways, and analysis tools such as Root Cause Analysis.

But what happens when healthcare presents an environment so complex and dynamic that it is not amenable to standardisation? Productive governance is about leveraging this variability to create resilient leaders and systems. Productive governance is about making sure that the right outcome is achieved even thought things will inevitably go awry along the way. Methods of productive governance include simulation, resilience assessments, ‘Ten Cs’ and FRAM analysis, consensus statements and negotiation skills training.

The RACMA report proposes that health services need an agile approach to governance which can move between protective and productive strategies, depending on the task at hand.

Importantly, in productive governance, the safety and quality of healthcare is closely associated with the quality of relationships between clinicians within the system.

RACMA propose the following clinical skills, knowledge and attitudes are core to productive governance:

• Analyse how power works within a healthcare system

• Utilise power judiciously and ethically to improve the quality and safety of care and to reduce harm

• Promote and support teamwork

• Describe negotiation styles of self and others

• Demonstrate skill in negotiation at multiple levels

• Describe a range of conflict resolution methods and their appropriate utilisation

• Demonstrate skill in conflict resolution between staff and patients/carers.

AboutResolution is a healthcare-focused conflict management and resolution consultancy, dedicated to improving clinical governance, patient safety and person-centred care through negotiation-skills training, coaching, mediation and facilitation. www.aboutresolution.com.au

Find the RACMA report here

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