Emerald

To provide an overview of a model for clinical governance in the National Health Service that incorporates continuous improvement and innovation as a core theme.

The paper considers the core functions of clinical governance and how these are related to established structures and roles within the modern NHS. A case study approach is used to describe the implementation of a theoretical model in a large teaching NHS Trust.

A clinical governance cycle is described that comprises three functional domains: accountability, assurance, and innovation. For each domain there is a definable outcome and a key role. Critical success factors for implementation of the model are described.

This paper introduces a new model for clinical governance that focuses on continuous improvement. The paper will be of particular interest to managers and lead clinicians responsible for the development of robust systems for clinical governance and modernisation in the NHS.

The current risk management system for community mental health patients in England is based around the Care Programme Approach (CPA). This system is not responsive to changes in risk for community patients. This paper aims to introduce a practical system to manage risk that has been developed for an Early Intervention Service in East London on the basis of need.

Coding of red, amber and green is associated with specific criteria agreed by all disciplines in the team. The change of a code leads to a rapid change in risk level and management. An agreed clinical and non‐clinical action plan leads to a whole team response. The limitation of use is dependent on the size of the case load and the number of clinical staff attending a daily clinical briefing.

Zoning according to the traffic lights system could complement the CPA system and support a clinical governance structure utilising a whole team response.

The risk management system described has not been tested empirically. Currently it has been used in early intervention mental health teams but will need to be adapted for other teams with bigger case loads.

This practical risk management system is aligned with the statuary CPA requirements. A dynamic and flexible management of risk is central to early intervention in psychosis teams but the risk management system described can suit any community mental health team and fits well with the distributed responsibility model of functionalised teams according to new ways of working.

The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology within the Northwestern Deanery of England.

An anonymous questionnaire was circulated among the Specialist Registrar trainees within the specialty attending a regional teaching session. The questionnaire was analysed.

There were 50 responses, of those 45 (90 per cent) had been involved in an adverse clinical incident; 44 had submitted an incident form related to the incident. Three had submitted incident forms without being involved in an adverse incident. Most (80 per cent) had submitted an incident form as well as a related statement. Feedback was available to 23 (51 per cent) of those involved in adverse incidents. More of the senior trainees received feedback than the junior ones. A lecture on clinical incident reporting was available to only 35(70 per cent) of the respondents on the hospital induction day at their latest clinical placement.

This study is limited to adverse clinical incident reporting among the trainees in a single specialty within one deanery in UK; hence the small numbers.

This study demonstrates the presence of awareness regarding adverse incident reporting among the trainees in a high‐risk specialty. It also shows the suboptimal rate of feedback following adverse incident reporting, which does not encourage a learning environment. It is suggested that a lecture should be dedicated to incident reporting at the junior doctors' induction day programme in every hospital.

This paper highlights the lack of adequate feedback following adverse clinical incident reporting.

The purpose of this article is to examine a sample of paper‐based incident reports concerning drug incidents to assess the utility of a reporting system.

A 50 per cent random sample of drug‐related incident reports between 1999 and 2003 (n=1,253) was reviewed. Details of the incident including error type and contributory factors were identified, as was status of the reporter. Content analysis of the free text established whether the data provided could promote medication safety and organisational learning.

The paper finds that all definitive drug errors (n=991) allowed an error type to be identified, but 276 (27.8 per cent) did not include the contributory factor(s) involved. Content analysis of the errors demonstrated an inconsistent level of completeness, and circumstances, causation and action taken were not always logically related. Inter‐rater reliability scores were varied. There was sometimes a significant focus on the actions of one individual in comparison to other factors.

Incident reports can be biased by psychological phenomena, and may not be representative of the parent organisation other than those who report. This study was carried out in a single health care organisation and generalisability may be questioned.

How health professionals interpret drug errors and their reporting could be improved. Reporting can be further developed by reference to taxonomies, but their validity should be considered. Incident report analysis can provide an insight into the competence of individual reporters and the organisation's approach to risk management.

This paper highlights the various data that can be captured from drug error reports but also their shortfalls which include: superficial content, incoherence; and according to professional group – varied reporting rates and an inclination to target individuals.

This paper aims to set out a framework that can be used for locating strategies for incorporating patient and public involvement (PPI) in the wider process of translative healthcare research.

This paper is analytical and synthesizes knowledge from several disciplines in order to provide a coherent framework for understanding the scope and purpose of PPI. The framework sets out four idealised strategies for PPI based on mode and purpose of involvement. The paper concludes by summarising a range of implications for organisations involved in the governance of translative healthcare research.

The framework defines four idealised strategies for PPI in translative healthcare research. The strategies range in purpose from collecting patient data, through to improving public involvement and knowledge with respect to healthcare research.

The framework presented has direct relevance for agencies concerned with the management and governance of translative healthcare research. The framework is relevant when either designing or auditing research pathways in terms of PPI activities. The framework is also important in highlighting to healthcare leaders, researchers, patients and the wider public, the potential role of participation in healthcare research.

This paper's value is that it combines perspectives from the wider literature on innovation, user‐led design and participation, to the problem of translative healthcare research.