What does clinical engagement look like in practice?

The term of clinical engagement came to me very early in my safety and quality (S&Q) endeavour, my very first S&Q role almost 11 years ago. Two occasions taught me lessons and offered me lived experience.

First one was a real lesson. I was new in the role and I was asked to follow up with audit completion by clinical areas per hospital plan. Most of them responded in some sort of forms or at least made polite promises, although universally everyone stated, “too busy to do audit; we have to prioritise patient safety and quality not audit”. There was one area simply answered no for this. So, I thought maybe I could help and conducted the audit for them. However, when I presented the findings, I was told by the manager the result was different from theirs, therefore they were not going to accept the recommendations. Imagine how I felt… It was clear that the purpose and value of the audit plan and audit itself was not well communicated.

Second one was sharing of life experience by a hospital executive who commended me being able to connect with people, especially clinical teams, and keep them engaged. She said, “In safety and quality roles, having clinical engagement means half of the job is done”. I have remembered that since.

The importance of clinical engagement is well recognised in the literature for influencing on successful implementation of S&Q programs in healthcare and achieving targets. Engaged clinicians are willing to exceed the expected level of effort and feel inspired to do their best work. They are personally motivated to help an organisation succeed and feel a sense of being part of a greater whole and being valued for their contribution. Using my own experience again when I was a clinical nurse, it was my position portfolio to audit compliance with the management of Schedule 8 and Schedule 4 medications in our department. I loved my job, was always motivated and encouraged by my manager to learn new skills and strive for excellence. I was an engaged employee. I never felt lack of time to complete this monthly audit. In fact, as soon as a new month started, I would find a quiet half hour to go through the register and completed the audit for my manager with recommendations.

Over the last 11 years, I have always reflected on the above and other experiences in my different S&Q roles and studied about clinical engagement. I have been fortunate to have the opportunities working with so many amazingly intelligent colleagues to achieve S&Q goals and deliver better patient outcomes. For example, we have worked together and achieved 30% reduction for hospital acquired complications (HACs), and 48% reduction in healthcare-associated Staphylococcus aureus bloodstream infection (HA-SABSI) in our hospitals. The journey has never been straightforward, and our clinical teams are much busier than 11 years ago, yet we have the courage and determination to improve. For example, we had the courage to commence a Comprehensive Oral Care to Reduce Hospital Acquired Pneumonia project despite the pressure and challenges that COVID has brought to the system. As a result, we have seen significant reduction in hospital acquired pneumonia in those vulnerable elderly patients. Our teams are engaged and motivated for better patient outcomes. Here are the reasons:

First, we made efforts to know them and understand them; the nature of their everyday business, workflows, strengths and weaknesses.

Second, we listened to them and worked with them in partnership for strategy development and implementation.

Third, we held the principles to support not to police and held data-driven evidence-based conversations for problem-solving and value-adding activities.

Fourth, we established structures, processes and tools to enable and empower, simplify steps involved as much as possible.

Fifth, we created clinical communities and forums to enable information sharing and peer support, such as forum for Best Practice Facilitators and Annual IMPROVE Conference.

Sixth, we provided constructive feedback when things were not going as planned and worked together to learn and re-engineer a new path.

In my professional life, I have enjoyed working with all teams and individuals that I had the opportunity to meet and collaborate. As long as we stay focused on patient safety and genuinely mean for better patient outcomes, our words and actions will resonate with the professional values of others in healthcare, and together, great things can be achieved. 


Qun Catherine Li is the Program Lead - HACs Reduction at Fiona Stanley Hospital in Perth, Western Australia. Catherine is a committed advocate and practitioner for knowledge translation, quality improvement, and evidence-based clinical care, with published practical successful experience in leading organizational changes for patient safety, and insights on hospital clinical governance systems, quality improvement systems, clinical audit programs, and performance benchmarking and monitoring.
Catherine focuses on leveraging resources and strength for efficiency and effectiveness, through collaborative teamwork for outcome oriented improvement in healthcare.


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