Clinical Governance and Assurance

Our statement on quality

Alliance Medical embraces the concept of clinical governance as a multi-disciplinary and multi-professional vehicle to continuously improve the quality of healthcare services.

The Company’s clinical quality and governance framework is intended to demonstrate three key attributes:

• recognisably high standards of care
• transparent responsibility and accountability for those standards
• and a constant dynamic of service improvement.

Clinical governance has been defined by the government as a framework through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in which clinical care will flourish. (A First Class Service – Quality in the new NHS, 1998)

Alliance Medical commits to ensure that systems are in place across the company for maintaining and improving the quality of the service and care that is delivered. These systems are encouraged and supported at all levels by the management structure and the Alliance Medical policies and procedures along with the required resources to ensure deliverability.

Clinical leadership and accountability

Led by the Medical Director, a member of the Alliance Medical Executive Board of
Directors, and supported by the Head of Quality and Education, the company’s Clinical Governance Group provides clinical leadership for the company and establishes effective relationships across all aspects of the business. There is a commitment to deliver high quality services and tangible improvements.

All services and patient care pathways are established with input from key individuals with strong and relevant backgrounds under the umbrella of the Clinical Governance Group. This group provides the Alliance Medical Board with a means of independent and objective review of the company’s processes, policies and service operations to enable appropriate evolvement of service provision; they are independent from the service delivery and commercial targets and have patient representation.

By committing to this clinical governance framework the terms of reference of the Clinical Governance group are:

• Give direction and agree clinical governance priorities
• Agree systems and processes to ensure quality in clinical care
• Integrate clinical, logistical and resource governance issues
• Ensure each department is supported to deliver clinical governance
• Develop and evolve systems for monitoring and assessment
• Ensure that clinical governance issues that cannot be dealt with at service delivery levels are escalated appropriately
• Ensure the patient experience is central to the delivery of services and quality improvement strategies
• Promote a learning culture within the company
• Review the system for detection and reporting of problems in individual performance

The Clinical Governance Group is further supported by a structure of key individuals within groups, namely the Clinical Forum and the Quality Forum. These groups assist in the implementation of procedural changes and actions at a local level related to learning opportunities that have been identified.

Alliance Medical has an established Radiation Protection Committee with representation from the company and External Radiation Advisers. The Committee sets company policies in respect of radiation issues, ensures compliance with best practice guidelines and new legislation as well as delivering consistency across all imaging modalities.

Similarly a Health and Safety Committee provide equivalent guidance to the company. Such advice and subsequent related decisions are reviewed through the Clinical Governance Group and signed off at Director Level.

Where there is a requirement to transfer either staff or activity between Alliance
Medical and another healthcare provider the Clinical Governance arrangements will be agreed by both parties to ensure there is a cohesion of the clinical policies by which staff work and that reporting arrangements are appropriate.

Activity must satisfy the most robust Clinical Governance requirements of either party. Where transfer is taking place there will be a requirement for regular joint Clinical Governance meetings to allow revision, sharing and discussion of the clinical Governance issues.

Where Alliance Medical is using the services of sub-contractors in the delivery of a service the sub-contractors will work specifically within the Alliance Medical Clinical Governance Framework.

Patient, Customer and Referrer Feedback

Alliance Medical undertakes formal patient, customer and referrer satisfaction surveys on a regular basis for all aspects of service delivery. The surveys and results are analysed centrally for trends, benchmarking and learning purposes.

Results are documented in Quality Reports that are shared with the Management team. The limitation of surveys as a meaningful measure of patient satisfaction is recognised and a vast range of Key Performance Indicators are monitored continuously to provide a transparent view of several aspects of our service.

Quality Assurance meetings are held between Alliance Medical and local clinicians and managers on a regular basis at each site of operation. For nationally procured contracts similar meetings are held with the Department of Health.

A standardised format is followed, facilitating benchmarking between units and the sharing of good practice. There are many examples of collaboration between Alliance Medical systems and existing patient feedback arrangements in both public and private sectors.

Professional Development and Performance

A key aim of clinical governance is to ensure that employees have adequate opportunities for professional and self-development, and are fit to practice. Every healthcare professional wishing to work for Alliance Medical is subject to rigorous screening in advance of patient contact.

This screening includes formal interview, taking up references, criminal records bureau check, professional registration and membership checks as well as checking appropriate certificates of qualification.

Alliance Medical has an enviable reputation for its commitment to training its workforce. All radiographers and technicians employed by the Company are subject to a formal process of training, assessment and sign off before operating independently.

All staff are encouraged and supported to partake in regular learning and development activities ensuring compliance with the standards set by the HPC in regard to Continuing Professional Development.

This development is an integral part of the ongoing appraisal system adapted by Alliance Medical. The Company operates an annual appraisal system for all staff involved in the delivery of clinical services.

This process provides a platform for discussions related to identification, evaluation and development potential of an individual's performance.

Clinical Effectiveness and Clinical Audit

Achieving excellence in clinical practice requires practice to be effective, i.e. based on sound evidence. Alliance Medical clinical procedures and processes are formed and constantly evaluated against evidence based practice. Demonstrating excellent practice requires regular clinical audit.

Alliance Medical has implemented well-established and clear quality standards for all aspects of service delivery. These standards are actively undertaken throughout the Company and relate to the patient experience, for instance in relation to access times, report turnaround times and clinical outcomes.

Benchmarking is undertaken against industry standards and internally against those achieved elsewhere in the Company.

Alliance Medical has a systematic approach to clinical effectiveness and audit.
The Company’s multidisciplinary Clinical Governance Group reviews clinical audit and effectiveness.

The Group meets quarterly and provides a constructive challenge to all clinical and operational policies across the Group. It also advises on how Alliance Medical should implement recommendations and requirements emerging from the healthcare industry – including National Service Frameworks, Medical Devices Agency and NICE.

Many of the subjects for clinical audit have originated from issues raised in the risk management programme or are being used to test evidence-based practice. It is company policy that the clinical audit programme should reflect key issues and concerns of the organisation.

Alliance Medical has developed integrated clinical audit across organisational boundaries.

Clinical risk management

Alliance Medical operates a wide-ranging risk management function led by the Company’s Medical Director with support from the Head of Quality and Education.

The risk management function within the Clinical Governance group is well established and review of risk assessment is undertaken from the perspective of clinical and non-clinical risk, infection control, safety procedures within patient care pathways and  compliance with all relative statutory regulations.

Alliance Medical believes risk management of staff is an important part of quality assurance and ensures that clinical staff are appropriately immunised against infectious diseases, work in a safe environment and are provided with appropriate information related to changes in practice.

A clear and robust process of Incident Reporting is supported by a specifically designed database allowing in depth reporting and comprehensive learning from incidents and near misses documentation to be created and shared with all departments and staff on a monthly basis. This is led by the Head of Quality and Education and the Health and Safety Manager.

The company has an established Complaints Procedure whose aim is to encourage patient feedback and to respond swiftly and openly to any issues raised. Complaints are increasingly used to monitor clinician and systems performance as each case is reviewed centrally to build a profile of incidents that allows particular risks to be addressed. Complaints handling training is delivered to all staff at induction.

Where appropriate Alliance Medical will advise all patients of their right to access to an appropriate Patient Advice and Liaison Service (PALS). Although not currently permitted to be assessed by the Health Care Commission, Alliance Medical works within the guidance of the Commission in aligning their complaints management to that of the NHS.

There is a formal process to ensure that the Company responds and acts in accordance to safety ALERTs issued by the MHRA and the NSPA. This process guarantees that ALERTs will be reviewed, categorised and distributed in a timely manner so that clinical risk is limited.

There is a co-ordinated approach to benchmarking of practice to identify units, and individual professionals, where performance is at variance from their corresponding service delivery departments or peers.

The Clinical Governance group ensures that where the company is expanding its services to offer new diagnostic procedures or staff are working in extended roles that there are robust mechanisms in place to manage any additional risks to patients, staff and the organisation.

Statement on Care Quality Commission accreditation

The Diagnostic Imaging Services provided by Alliance Medical are not registerable with the Health Care Commission (HCC).

Alliance Medical can however confirm that every effort has been made to ensure that its services do fulfil the criteria to be registerable with the Care Quality Commission.

Currently the Care Quality Commission has indicated they will provide assessment and accreditation for companies providing imaging services in early 2010.  

Alliance Medical has therefore also aligned its services with the relevant aspects of Care Standards Act 2000 and Standards for Better Health, both in detail and in the principle of the spirit of the criteria and legislation. Where necessary and appropriate, all facilities will be registered prior to service commencement. 

Alliance Medical successfully achieved a high pass in Clinical Negligence Scheme for Trusts Level One status in 2008, one of the first independent healthcare providers to have done so. 

In 2008, after being selected to take part in the pilot study for the new Radiology Accreditation Programme, Alliance Medical has been invited by the accrediting body to be one of the first imaging providers to undertake the accreditation process.

Record keeping and Caldicott principles

Alliance Medical implements record keeping aligned with the recommendations of the Caldicott commission, as adopted by the NHS, and the Data Protection Act.

A comprehensive system to ensure confidentiality and security arrangements for all company information has been adopted and the Company has the accreditation of British Standards relating to Information Security (currently ISO27001). Mr Simon Mellor, the Medical Director, is the appointed Alliance Medical Caldicott Guardian.

It is a requirement of Alliance Medical’s employment policy, that all employees, on induction, sign a comprehensive confidentiality and information security agreement.

All records are kept in accordance with the Data Protection Act and stored safely for a minimum period of 10 years. Access to these records is strictly monitored and overseen by the company’s Legal Adviser and the Caldicott Guardian.

Systems for monitoring and reporting

Alliance Medical ensures that the information for each clinical procedure which is undertaken is accurately recorded and able to be reported in a standardised format to support the clinical governance agenda.

Well-established and robust data reporting processes combined with a culture of openness has enabled meaningful benchmarking of performance to be undertaken by the Company.

Reporting of key performance indicators (KPIs) faciliates collaboration and sharing of good practice across the Company.

Evaluation and analysis of all quality data is reported to the Alliance Medical Board within a monthly ‘Quality Report’. This report contains information derived from the outcomes of the Clinical Governance Group activities which are supported by the Clinical and Quality Forum groups, Radiation Protection Committee and the Health and Safety Committee.

Wherever necessary Alliance Medical reports all appropriate governance information at any Joint Service Review or Investigation.