Read Standard 3: clinical effectiveness

Clinical Governance Standards
National

Standard statement

People receive timely, effective, personalised and evidence-based clinical care. 

Rationale

Clinical effectiveness is centred on providing evidence-based care with positive outcomes for individuals and populations.26 Comprehensive clinical care is where interventions are provided to all who could benefit. It includes avoiding interventions when they are likely to provide little or no benefit to a person.27 Evaluation and outcome frameworks can be used to determine effectiveness. Considering the context and wider impact of a clinical intervention can give a clearer indication of its effectiveness.28 

Effective clinical care ensures people receive the right care at the right time.8, 15 Personalised or person-centred healthcare ensures that individual clinical interventions or treatments are based on a person’s specific context, values and preferences. Treatment and care tailored to a person may improve their clinical and self-reported outcomes.8 Implementing the principles of Realistic Medicine can reduce unnecessary interventions that, while clinically indicated, may not be effective in terms of an individual’s particular circumstances or choices. 

Clinical services are required to ensure that people are fully informed about their individual benefits and risks when consenting to interventions.29 Staff should fully explain the situation and options and support people to make decisions about their healthcare.30 Shared decision making can reduce harm and improve the quality of care.31, 32 Clinical services should make reasonable adjustments to ensure people who are protected under the Equality Act (2010) can access care and participate meaningfully in discussions. 

To ensure their human rights and patient rights are fully upheld, people require timely information in a format and language that meets their communication needs and level of understanding.33 Inclusive information is sensitive, accessible and clear to meet the differing needs of individuals.27, 34 All communications, including online clinical information, should meet accessibility standards and public sector requirements under the Equality Act (2010).35  

Effective research governance, knowledge exchange and assessment of healthcare interventions enable organisations to continue to deliver clinical services that reflect changes/improvements in practice and maximise outcomes. Collaborative efforts, including joint global efforts, ensure that research and data is accurate, equitable and meaningful.36 NHS Scotland supports involvement of organisations in  multicentre research trials. This requires robust research governance frameworks that support participation of people and communities. Regulated authorisations and assessments from the Medicines and Healthcare products Regulatory Agency (MHRA) should be met for medicines and medical devices where they apply. 

References

Criteria

3.1

Organisations have systems and processes to ensure clinical services are aligned with all relevant national standards and clinical guidance, including benchmarking and monitoring progress towards full implementation.   

3.2

Organisations have effective oversight and governance mechanisms for the use of evidence-informed clinical interventions, including but not limited to: 

  • medicines 
  • medical devices 
  • non-pharmacological interventions, including techniques validated or recommended by professional organisations. 
3.3

Organisations enable staff to develop their clinical knowledge, skills and understanding through partnership working with other providers and with academic, research, third sector and commercial partners, as appropriate. 

3.4

Staff have time, resources and support to: 

  • participate in knowledge development and exchange  
  • remain up to date with current clinical best practice and evidence, where relevant. 
3.5

Organisations deliver safe and effective healthcare that is:  

  • personalised  
  • in the right place at the right time 
  • informed by current evidence and best practice. 
3.6

The clinical effectiveness of care and support is maximised because staff develop an understanding of: 

  • what and who matters to the person 
  • the person's circumstances, experiences and any additional support needs 
  • how the person is affected by their condition(s) or treatment 
  • the person’s goals and outcomes 
  • the importance of the person’s autonomy  
  • how to support people to uphold their rights to make informed decisions. 
3.7

People are actively enabled to develop the knowledge, skills and confidence to manage their own clinical care and treatment, where relevant. 

3.8

People are actively enabled to make decisions and choices about their healthcare because they have timely access to:  

  • inclusive, relevant and easy to understand information  
  • information on the purpose, risks, alternatives and benefits of any clinical treatment or intervention  
  • appropriately knowledgeable, trained and unbiased staff to discuss options, including being able to seek a second opinion 
  • support to set and review personal goals and outcomes  
  • additional support, including translation services and communication aids, where appropriate. 
3.9

Clinical care and treatment plans: 

  • are based on early discussions about the person’s values, needs and circumstances in line with Realistic Medicine 
  • are developed in partnership with the person and, where appropriate, their care partner 
  • integrate information and input from all relevant services to put the person at the centre, reduce duplication and support safe transfer of care 
  • are reviewed and updated as required 
  • are accessible to all members of the care team, the person and, where appropriate, their care partner. 

 

What does this standard mean for....

What does the standard mean for people?

  • You will be actively involved in making decisions about your healthcare. 
  • The healthcare you receive will be personalised and based on what is right for you. 
  • You will receive information that is right for you to help you make decisions or choices about your healthcare. 
  • Staff will listen to you, your needs and what matters to you. 
  • You will have access to healthcare including assessments, tests, treatment and medicines that are effective and are in line with current best practice and evidence. 

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:  

  • provide personalised and evidence-based clinical care in line with Realistic Medicine 
  • consider a person’s experiences, values and priorities at all stages of care planning 
  • recognise the importance of autonomy and the right of the individual to make informed decisions about their healthcare 
  • work to the relevant legislation, standards, clinical and practice guidance 
  • have access to evidence-based techniques, medicines and technologies
  • work across different disciplines and organisations to coordinate healthcare
  • have time to develop and expand their specialist knowledge. 

What does the standard mean for the organisation?

Organisations, in line with their respective governance and delivery structures: 

  • ensure people are cared for in the right place at the right time 
  • demonstrate alignment of practice with relevant legislation, standards and clinical guidance 
  • provide staff with adequate time to develop and expand specialist clinical knowledge and skills 
  • work in partnership with research organisations and universities to contribute to knowledge and define best practice where applicable  
  • provide opportunities for staff to take part in evaluation and research  
  • support the development and implementation of evidence-based technology assessments and guidelines. 

Benchmarking and measuring performance: Examples of what meeting this standard might look like [linked criteria]

Examples may vary according to the size and scale of the service, NHS board, organisation. 

  • Self-evaluation and assessment against national standards and clinical guidelines. [3.1] 
  • Nominated leads for identification and circulation of new guidelines and standards. [3.1] 
  • Local protocols for the introduction of new medicines, guidance, standards and  technologies within a clinical service. [3.2] 
  • Minutes from area advisory committees. [3.2]  
  • Conference presentation or posters outlining multidisciplinary or multiagency improvement projects or practice. [3.3] 
  • Implementation of multidisciplinary knowledge exchange work to translate research into practice. [3.3, 3.4] 
  • Existence of formal research partnerships, joint funding bids and research collaboratives. [3.3, 3.4] 
  • Use of disability passports or key information summaries detailing a person’s communication or accessibility needs. [3.6, 3.8, 3.9] 
  • Use of the Realistic Medicine – National toolkit for professionals. [3.6] 
  • Access to tools and information to support self-management. [3.7] 
  • Use of tools to support conversations, shared decision making and document individual needs for example, ‘What Matters to You.’ [3.5] 
  • Access to patient advocacy services. [3.8] 
  • Feedback from people using services and, where appropriate, their care partners, on their experience of shared decision making. [3.8] 
  • Use of alternative and augmentative communication systems or communication aids. [3.6, 3.8, 3.9] 
  • Proactive sharing of care plans between organisations and providers. [3.9]