Spirituality and Clinical Governance (CG) are not two concepts we expect to see linked. How strange this seems depends on how you look at clinical (or quality) governance.

Many see CG as a set of systems that promote accountability for care and manage risk. And yes, those are the original pillars of clinical governance, born of the recognition, in acute care originally, that there was no governance over how clinical care was delivered. As always seems to be the case, it took an ‘event’ for the acute health sector to realise this. In the 1990s, a series of large-scale studies on patient harm in the care process held up an inconvenient mirror to the health sector. What we saw was not what we expected, nor was it pretty. After the usual grief reaction: lots of denial and anger and blame, we eventually realised that there was serious work to do to change our mindset, behaviour and outcomes. We had to recognise and manage our clinical risks. We needed to go beyond assuming that everyone understood and enacted their role in high quality care and get proactive about ensuring it. And we recognised that care must be governed as rigorously as finances had long been. Clinical Governance was born.

Aged care is going through its own ‘event’, in the shape of a Royal Commission. My hope is that, working together, we can save the aged care sector from some of the blind alleys and rabbit holes the acute sector has stumbled into in the pursuit of effective clinical governance over the past two decades.

One of the deepest rabbit holes, from my perspective, is presenting and implementing clinical governance in a vacuum. If CG it is seen by staff as a series of tasks, focused on standards, it immediately loses its power and becomes perceived as ‘extra work’ to be ticked off, rather than systems and data that are useful supports for doing good work. This is the rabbit hole of clinical governance without purpose, where organisations put in enormous amounts of energy and work, and still have problems with poor care. The fact that boxes have been ticked, but systems are ineffective at point of care, takes many by surprise, and we saw this played out during the height of the COVID-19 pandemic.

So, how to avoid the rabbit hole? And what does this have to do with spirituality?

The most successful organisations I know of in terms of the quality of their care, implement clinical governance as a means to an end. That ‘end’ is creating great point of care experiences that support consumers to fulfil their potential for quality of health and quality of life. Too often, this connection between clinical governance systems and point of care is assumed. But in the complexity of the human services’ sectors, where there are so many confounding factors, it has to be deliberate, planned, focused and well-led to have a positive impact.

Clinical governance should be implemented to achieve a definition of high-quality care that covers the dimensions we know are desired by both consumers and staff: care should be safe – free from care-related harm; effective – the right thing with the best possible outcomes; connected – ensuring everyone is on the same page about the plan and implementation of care, and consistency in staff providing care; and personal – preserving and building a person’s dignity, potential, independence and wellbeing through compassion, respect, inclusion, meeting needs and partnerships.

Organisations that implement clinical governance systems – not just to stop things going wrong, but to support them to go right by pursuing these high-quality care goals for every person – find that their clinical governance systems are more effective and less resisted by staff. If CG provides systems and leadership that help staff create the kind of care they want to create; enables more meaningful connection with consumers and leaves them going home each day feeling that they’ve achieved something positive in someone’s life, they will experience greater job satisfaction. This makes for happier staff and consumers, and frames clinical governance as something supportive and useful. Standards are still important – but in this approach they’re implemented as a means to an end – supporting staff to do the good work they want to do – not an end in themselves.

Those who place their lives in our care place their whole lives in our care. When we talk about meeting needs under the ‘Personal’ dimension of high-quality care, this includes spiritual needs. For some, this is a religious dimension. To others, it’s something different, or both. I’ve always considered ‘spiritual’ to be whatever gets me out of my head, lifts my spirits and gives me a feeling of connecting with a greater whole. That can be a simple as watching the cows in our paddock and enjoying their quiet patience and contentment – encouraging me to learn from them! It can be feeling the energy in a workshop when we suddenly realise we all ‘get it’ – and we share one happy moment of connection and possibility. It can be sparked by a great conversation, an inspirational book, walking in a national park or that first hit of warm sand between the toes on a beach. Whatever catches and lifts my spirit beyond the intellectual, colours the world and connects me with something bigger. Good for the soul. Without this, my days at the computer can end up being grey and prosaic – and so can I!

So, to achieve a high-quality experience in the ‘Personal’ dimension, clinical governance must support the spiritual health of those we serve. But how? The National Guidelines for Spiritual Care in Aged Care¹ provide a great framework, showing that building spiritual wellbeing lays the foundation for providing a ‘Personal’ Care experience. As a bonus, the Guidelines demonstrate how to fulfil this aspect of our high-quality care commitment to consumers using accreditation standards, including clinical governance, as enablers. Following this framework would ensure your organisation is not just enriching spiritual wellbeing but creating all aspects of the ‘Personal’ care goal.

But where to start? Something that would build a lot of momentum in a short space of time is an increased focus on compassion as part of the care process, as an enabler within the ‘Personal’ dimension of high-quality care. Research shows that compassion can be taught – and that a little goes a long way. Simple things such as statements of understanding and support and the right body language, have been shown to measurably reduce consumers’ anxiety and increase their sense of being cared for. Embedding these meaningful interactions as part of the care process are important contributors to spiritual health.

It seems that something we often perceive as ‘soft’ has some hard advantages as well. Showing compassion as part of the care process demonstrates evidence-based, physical, psychological and financial benefits such as:

improved quality of care through reduced adverse events
reduction in specific clinical problems such as pain and depression
increased self-care in residential aged care
reduced staff stress and burnout
improved financial sustainability of healthcare organisations, given that a lack of compassion is associated with increased resource utilisation and health care spending.²

Achieving even one of these benefits would create more time and opportunity to contribute to the spiritual component of ‘Personal’ Care and support an environment where spiritual health can flourish.

Clinical governance does focus on clinical care. However, we know, through the literature and our own experience, that physical health cannot be separated from other aspects of health. Physical, emotional and spiritual care are interdependent and clinical governance should support each, enabling the people we serve to fulfil their potential and live their best life.

Notes

Meaningful Ageing Australia, (2016). National Guidelines for Spiritual Care in Aged Care. Meaningful Ageing Australia, Parkville https://meaningfulageing.org.au/wp-content/uploads/2016/08/National-Guidelines-for-Spiritual-Care-in-Aged-Care-DIGITAL.pdf
Stephen Trzeciak and Anthony Mazzarelli, (2019). Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. Fire Starter Publishing, USA.

Adjunct Professor Cathy Balding GAICD, FCHSM

Cathy is the Director of Qualityworks PL, dedicated to ‘making quality make sense’ for health, aged and community services. Over three decades, Cathy has worked in healthcare quality and executive roles, and in accreditation and government policy development. She’s been involved in the development of state and federal quality and clinical governance frameworks, standards and measures, and conducted clinical governance training in Victoria for the Department of Health and Human Services for a number of years. Cathy is also a past acute healthcare accreditation assessor and current aged care board member.

Over the past 10 years, Cathy’s work with organisations has centred on implementing quality and clinical governance as organisational strategies for success. She has a particular focus on supporting boards and executives to lead and govern for a high quality point of care experience for all consumers. Her ‘strategic quality and clinical governance system’ supports boards and executives to plan and implement purposeful and practical systems that make a real difference for consumers and staff.

Cathy has also conducted published research on effective clinical governance and quality systems and is the author of three books on the topic. She provides a number of resources to support high quality care, including her No Harm Done podcast, online courses and ‘QNews’ bulletin, all found at: www.cathybalding.com