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29th October 2012

Circles of Governance

QCS expert contributor Dr John Shapter talks about the importance of governance in your clinic.

Whether we are a dentist, a doctor, nurse or any healthcare professional, we operate our clinical lives at the centre of a series of circles spinning out around us.  Our ability to practice personal governance is strong at the centre but our influence decreases with the distance from those with whom we need to interact in our daily lives.  However, our degree of responsibility increases towards the centre where our interaction with patients and clients is strongest.

Governance is about being `safe`, `effective` and `open` within our particular professional practice.  How good we are at this depends on three things.  First, our actions; are the procedures we perform safe and effective?  This is all about using Evidence Based pathways of care and being `risk-aware` in everything we do.  Secondly, our behaviours; are we working with people in an ethical and empathetic way?  This is all about how much we respect and care for those who put their trust in us.  It also means keeping up communication with those around us.   Finally, our competencies; are we keeping up with current knowledge and maintaining training in safety?  This is all about on-going learning.

So, back to the circles.  Right at the centre is a practitioner, you or me, and probably a patient.  We have absolute control over what we do in this area, and we have a responsibility to practice personal governance in this place.  There is no-one else to blame if something goes wrong!  We have to look after the safety in this area and that means both our safety and that of the patient.  Communication with anyone within our circle is paramount.  We are totally responsible for the appropriateness and effectiveness of our performance in the centre of the circle – it`s a lonely place sometimes.

A little bit further out is a slightly wider circle.  This is usually the geographical vicinity around us, the surgery or treatment room, and anyone else assisting us or working nearby.  In this area we still have some degree of influence.  It might be about holding safety or it might be about cooperating with co-workers and being aware of their actions.  Although it`s not in our centre circle, we have some responsibility for this environment.  It`s also our responsibility to speak up if we are not happy with some aspect of this arena and especially what else is happening within it.

Further out still is a much wider circle, this usually represents the organisation we work with (or for) and is all about our interaction with both the other people who work there and the management structure that binds us together.  This is a more two-way, osmotic, movement of information between all the people, departments and us.  Someone out there is giving us instructions or policies to work with, or places to go.  We, on the other hand need to voice worries and concerns or give feedback on our current status.  Our influence reaches out quite a way.

All our actions have consequences which spread out around us.  However, whilst it might feel we are on our own, we needn`t isolate ourselves.

Topics: GPs

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