Clinical governance ethical challenges in oral health services

Abstract

The Clinical Governance framework in Health Services and how it relates to the concept of governance in Oral Health Services in a dental clinical setting, within the local government public hospital, has been discussed in this dissertation. This dissertation also aimed to identify and analyse factors which might contribute to ethical challenges in clinical governance such as political, professional and public factors. A further aim was to discuss whether we now have a more informed consumer-oriented public with greater participation and involvement and therefore greater expectations in the national oral health scheme and in oral health decision-making. This dissertation helped me, as a dental clinician, an administrator and as an academic, to understand and adopt the concept of ethical clinical governance in the pursuit of clinical excellence. Clinical Governance is based on the principle that clinicians and managers are jointly accountable for quality of patient care and for the standards of care delivered. Clinical Governance is the framework by which this accountability is ensured and demonstrated. Oral Health providers are now, more than ever, faced with great challenges, amongst which are ethical challenges. As society and health care change, dentistry continues to advance, therefore any modern oral health organisation must keep up to date with this rapid change and focus on the things that really matter to the public it serves. Oral Health Services must rise to the challenge of servicing a more informed public. Oral Health Care services also face disparities in the provision of dental care. Thus clinical governance in an oral health setting would prove to be a successful venture in the dental field if it is conducted via appropriate mechanisms. There is a vast amount of literature claiming the benefits of implementing an ethical clinical governance framework within health settings. This has been highlighted in the first two chapters of this thesis. In recent years, there has been changing social and public attitudes towards the dental profession, including a growing emphasis on patient choice. It is imperative that oral health professionals develop ethics and value related competencies. In ethics and clinical governance, the key to a strong partnership between oral health professionals, their patients and their families is the ability to combine values with evidence in the clinical environment. In the third chapter, I discussed whether good clinical governance in the local government dental department in a public hospital setting is based on a strong set of values. A quantitative questionnaire based study conducted, showed that oral health managers within the department of dentistry in the local government public hospital are aware that knowledge, skills and training need to be kept updated so as to keep up with standards of care however some areas of concern have been highlighted. These concern the defining of roles and responsibility to engage with the clinical governance framework, the lack of formal training and education in clinical governance and the lack of support and encouragement from other professionals and administrative staff to engage with clinical governance framework. Existing ethical issues highlighted were explored and discussed in view of improving the service within this particular clinical dental practice to better serve the general public’s oral needs. It has been concluded that all health care professionals, including dental professionals concerned with providing the best standards of care to the patients, their carers, other service users and the general public, should willingly take the opportunity to participate in the restructuring of the National Health Service, including Oral Health Services.