A new “comprehensive” national framework designed to strengthen patient safety, accountability and quality improvement across surgical services in Ireland has been published.

A Framework for Surgical Clinical Governance was launched by the RCSI following work by the College’s Expert Group on Best Practice in Clinical Governance Surgical Leadership.

Aligned with international best practice, the framework is intended for use across public, voluntary and independent healthcare settings. It outlines four key domains – morbidity and mortality meetings, multidisciplinary team engagement, patient safety and clinical audit, and the governance of innovation, research and new technologies – which are “central to the safe and effective governance of surgical care”.  

The framework provides a “governance maturity model” that surgical services can use to assess the extent to which their governance arrangements are embedded, reliable and integrated within the wider hospital system, and in planning progressive improvement over time. 

Prof Deborah McNamara, President of the RCSI, said: “Surgeons are privileged to care for people at some of the most vulnerable moments in their lives. With that privilege comes the profound responsibility to learn from our experiences, as enabled by safe, transparent and learning-oriented surgical governance.”

“High-quality surgical care depends on strong clinical governance, clear accountability and a culture of continuous learning,” continued Prof McNamara. 

“The public have the right to high quality and safe surgical care. This framework is RCSI’s constructive contribution to the national effort to improve patient safety and support our surgical workforce, providing practical guidance for surgeons, clinical leaders and healthcare organisations to support patient safety and improve outcomes. In particular, the use of the governance maturity model will support our hospitals in reflecting on the areas of improvement they need to prioritise.” 

Mr David Moore, Chair of the Expert Group on Best Practice in Clinical Governance in Surgery and RCSI Council Member, said: “Surgical teams across Ireland are committed to delivering safe, effective care, often under significant pressure. This framework is designed to support that work by providing a clear, consistent structure for governance that is clinically led, evidence-informed and focused on learning and improvement. Our aim is to help surgical services strengthen governance in a way that is practical and sustainable.” 

The framework is now available on the RCSI website here. 

Surgical hubs and elective hospitals, “will go a long way to address the challenges in elective surgery”, the RCSI President Prof Deborah McNamara told this newspaper.

However, Prof McNamara cautioned that even with this extra infrastructure, there remained “a huge need” for the health service to focus on patients who need a longer stay in hospital.

She said these are patients who require “all of the resources of a bigger hospital in order to get the surgical care that they need”.

“And we have major concern about that, I’ll be honest. So, the elective surgical hubs, and elective hospitals will go a long way to address the challenges in elective surgery. But for some of the most complex, elective operations, they won’t address the totality of what we need.

“That needs to be taken into consideration alongside interventions to protect surgical beds and theatre capacity in our [existing] bigger hospitals that have emergency departments.”

Prof McNamara was speaking to the Medical Independent (MI) at the recent annual Millin Meeting held in the RCSI. (Coverage of the Millin meeting will be carried in the 9 December issue of MI).

Separately the HSE told MI the elective hospitals in Cork and Galway are being progressed first.  The design team are actively working on the design for these hospitals, including carrying out necessary surveys and site investigations to inform the design as it develops toward planning permission applications. 

“A key issue emerging for the Cork site is the road access, and the HSE continues to actively engage with Cork City Council to find a solution,” the spokesperson told MI.

In relation to the two Dublin sites, the demand modelling and validation are underway, along with the assessment of current and planned infrastructure for ambulatory care in the catchment area to underpin the scope and scale required.

A total of nine HSE surgical hubs are also at various stages of development nationally, two of which are operational.