The National Institute for Health and Care Excellence (NICE) in the UK aims to “improve outcomes for people using the NHS and other public health and social care services”. NICE uses evidence-based data in their guidelines. They also study “performance metrics” to publish standards and desirable outcomes.
These methods are highly desirable in macromanagement of healthcare.
But there is another side to Clinical Excellence.
IV cannula…but wait, there’s more
This other side occurs at the one-to-one level between healthcare worker and patient. My example is that of putting up an IV line as an elective (not emergency) procedure. It’s a skill. You need to know when, how and what. There will be an algorithm for this procedure…somewhere. Done properly, it’s an example Clinical Excellence. But only of one domain of Clinical Excellence.
The Miller-Coulson Academy of Clinical Excellence at Johns Hopkins has promulgated a superb series of Clinical Excellence domains. In brief, these are:
1) communication and interpersonal skills
2) professionalism and humanism
3) knowledge
4) diagnostic acumen
5) exhibiting a passion for patient care
6) skillful negotiation of the health care system
7) scholarly approach to clinical practice
8) modeling mastery to medical trainees
9) collaboration with investigators to advance science and discovery
So, coming back to our example, the person inserting the IV, whether medic, nurse or doctor, cannot claim clinical excellence just by running a successful IV drip. That person needs to communicate the procedure to the patient, display empathy, be believable (passionate) in their communication, ensure the patient understands what is happening in the health institution where he or she lies (provide information about environments and outcomes), understand themselves the subsequent pathway of this patient, analyse the clinical indicators and relevant practical aspects of the procedure, perform the task skillfully, engage trainees who are present, and collaborate with colleagues in an appropriate manner.
And that should be repeated with every patient encounter.
So, in Clinical Excellence, remember: Wait…There’s more!
Can you think of any other positive attributes that make up an excellent health care professional?
