My Learning Journey and Clinical Governance
As some-one with a lengthy career in health, I have had governance in my roles as both a nurse, doctor and in strategic leadership.
My first experience of governance was being the COSHH representative on ITU and being part of the implementation team for closed suction systems in the early 90s. We followed pre-prepared written policies, developed education programmes for people to be informed and demonstrated evidence of successful change being embedded through ongoing audit.
I had the support of the team leaders and used positive energy to sell the changes and had easy topics to disseminate so negotiation was minimal and change was easy.
My next career move was to a research sister and the development of the nurse practitioner role which led to more governance conundrums. Many people felt nurses should not be undertaking roles which included clinical examination and differential diagnosis. This was outside our traditional competencies and core training. Interestingly the debate is ongoing today, thirty years later!
In order to establish the new service model which was transformational in nature, the business case for the role was established by the consultant and I was recruited. My job description included these new areas of development and I was supported by the Consultants to run a number of ‘nurse led services’. I did not think of my role as governance, however it was important to demonstrate that service outcomes were not detrimental to patient care and that the addition of nursing roles within the medical team freed capacity rather than increased workloads such as supervision. Medicines prescribing limitations were problematic and I was completed the pilot MSc in Advanced Nursing Practice at Essex University to further evidence the capabilities needed to undertake this role.
Policies and protocols were written, proformas designed, new pathways communicated to GPs and wider teams and audit underpinned practice. These included demonstrating how accurate my digital rectal examination and detection of abnormalities was compared to the medical team. Volumes of patients seen was monitored and and how waiting lists were minimal with the new services was a positive outcome. We published our findings which showed safe and effective services and monitored any concerns and identified gaps and led to the potential for research – https://pubmed.ncbi.nlm.nih.gov/11119092/
On reflecting, I recognise that despite a solid evidence base of safe and effective practice, that we did not appreciate the possible unintended consequence of specialist roles removing nurses from the wards and the shift of nursing towards the medical model rather than advocacy.
Moving into primary care, occupational health, forensic healthcare and out of hours care, alongside training as a doctor, my roles included performance management of individuals and services, supervision and appraisal, disciplinary investigations, serious incidents and case reviews, root cause analysis and quality improvement building from audit to educational frameworks, policy development and implementation of services. https://pubmed.ncbi.nlm.nih.gov/20851355/
Governance was at the heart of everything I did, as a golden thread, ensuring that our patients were safe and that we were current in our practice and that our staff were competent.
How Passion Based Learning enabled me to Discover My Purpose
My initial career pathway had little formal leadership or management education. My learning journey explored new topics through trial and error, with a leadership style where I wanted to befriend the world, avoid confrontation and achieve success despite lack of delegation and goal orientated behaviours.
My values were always shining bright and I believed that we all came to work to do a good job. If things went wrong, our systems had let us down. I recognise that I demonstrate values based servant leadership, with psychological safety and creation of ‘a just culture’ as principles of practice throughout my career.
As I have become a strategic leader and a healthcare entrepreneur, understanding leadership, management and skills in governance are passionate topics and I try and ‘do something better every day’ as part of my routine.
I have needed coaching, undertaken many courses including the FMLM Tomorrows Strategic Leadership course which I highly recommend: https://www.fmlm.ac.uk/tsl and explored new ideas to discover how to be better today than yesterday.
My new ventures, The Maslow Foundation and Nurture Health and Care Ltd mean that I continue to have an exponential learning curve and now include considering philosophy as part of my practice as my latest passion.
My inspiration comes from being able to support amazing people and enabling them to be the very best they can.
My current exploration is to shift away from the ‘one Job Description fits all’ to enabling people to focus on things they are naturally good at. We need to create teams that embody a learning culture to move systems forward.
Passion-based learning is meaningful and by sharing our ideas with others we create collaboration. By asking for help, co-creating and co-innovating and learning organically through action and reflection, we can deliver the new generation of services to the best of our ability.
People should follow their own learning journey and style, ensuring everyone has their perspective acknowledged and equity of voice is important, by sharing our mistakes, successes and unlearning, governance will naturally flow without a policy or procedure written or an audit being undertaken.
By creating a purpose-inspired learning community I continue to be inspired by others every day.
