Medical Governance
and
Humanistic Medicine
Dr. Myint Oo (GP)
What is Governance?
the terms governance and government
• "governance" is what a "governing body" does
• "government" might be a nation-state, a business
entity, a socio-political entity, a family or any
different kinds of governing bodies
• 'government' is one of the actors in 'governance'
gubernare; gubernator = helmsman
UN ESCAP
Governance
The process of
decision-making and
the process by which
decisions are
implemented
(or not implemented)
UN ESCAP
Good Governance
The process where public institutions conduct
public affairs, manage public resources and
guarantee the realization of human rights in a
manner essentially free of abuse and corruption,
and with due regard for the rule of law
In ‘New Public Management’, Good Governance
means working together coherently without
relying on governments—rather following a
principle of subsidiarity European Journal of Public Health Vol 17-6 Pp. 541
Consensus Oriented
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Participatory
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Follows the Rule of Law
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Accountable/ Responsible
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Responsive
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Equitable and Inclusive
Effective and Efficient
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The United Nations-ESCAP
October 13, 2012, Royal Rose Garden
Organizational Transformation & Future Burma
Key Attributes of
Good Governance
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•
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transparency
responsibility
accountability
participation
responsiveness (to the needs of the people)
Commission on Human Rights- Resolution 2000/64
Transparency
Openness
• operating in such a way that it is easy for
others to see what actions are performed
• information is freely available and directly
accessible to those who will be affected by
such decisions and their enforcement
(Radical transparency is a management method where
nearly all decision making is carried out publicly)
Accountability
Blameworthiness – Answerability – Liability
(to suffer punishment in the case of eventual
misconduct)
• an absence of accounting means an absence
of accountability
• Accountable to the public and to their
institutional stakeholders
• Accountable to those who will be affected by
its decisions or actions
Responsibility
Responsible for responding to the rights and
needs of the population
Participation
• Right to enter/participate
• Freedom of association
• Participation needs to be informed and
organized
Try to serve all stakeholders within a reasonable timeframe
Medical governance
• Effectively guarantees the right to health,
adequate housing, sufficient food, quality
education, fair justice and personal
security
• Organizations must control and proactively
manage medical issues to ensure that the
patients are protected (risk based)
• Organizations ensure consistent global
medical standards are applied
• Medical issues must be addressed before they come to the
attention of the regulators and the general public
Clinical Governance
• Clinical governance is a system for improving the
standard of clinical practice
• is intended to protect the public from
unacceptable care
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Dishonesty or unethical behaviors
Abuse of patients
Failure to provide communication
etc.
Clinical Governance Framework
Health care ensures that:
 Patients are safe
 Risks are managed
 Care is effective
 Quality is continuous
 Staff are competent
Education and Training
Risk Management
Clinical Audit
Openness
Clinical Effectiveness
Research and Development
http://www.medicine.ox.ac.uk
Clinical Governance Model
Clinical Governance: Principles into Practice
Jigsaw Model
Clinical Governance: Principles into Practice
Clinical Governance Leaders
• need skills to assess the nature of the
problem, educational resources to deal with it,
and managerial resources to facilitate the
process
Pillars of Clinical Governance
Clinical Governance: Principles into Practice
Five Cornerstones
• System awareness: no blame approach, what is
wrong, not who is wrong
• Teamwork: cross the boundaries between
primary and secondary care
• Communication: between individuals and
organization
• Ownership: generating the solution during the
meeting and ensuring ownership of those present
• Leadership: success depends on good facilitation
and leadership
Clinical Governance: Principles into Practice
AAAQ Framework
All health related facilities, goods and services
must be available, accessible, acceptable,
appropriate and of good quality (AAAQ)
• Availability
• Accessibility
• Acceptability
• Quality
Availability
• Health facilities, goods and services must be
available in sufficient quantity within the country
• This includes hospitals, clinics, trained health
workers, essential medicines, preventive public
health strategies and health promotion as well as
underlying determinants, such as safe drinking
water and adequate sanitation facilities
Accessibility
• Health services must be accessible to
everyone without discrimination, especially
the most vulnerable people. They must be
physically and economically accessible
• Health services must be designed in a way
that is responsive to local people’s needs.
• Accessibility also includes the right to seek,
receive and impart information on health
Acceptability
• Health services must be respectful of medical
ethics, culturally appropriate and gender sensitive
• Medical treatment must be explained in an
understandable manner and health workers need
to be aware of cultural sensitivities
• Gender discrimination and inequality fuel the AIDS
epidemic, particularly women and teenage girls
• In order for health care to be acceptable, women
need to be empowered and protected and
necessary health services need to be tailored to
women in addition to men
Quality
• Health services must also be scientifically and
medically appropriate and of good quality
• Medical personnel have been compliant in
activities that implement the psychological
and physical torture, which contravene
international law, human rights standards, and
the core principles of medical ethics. This is
clearly a violation of human rights, and health
workers must treat all people humanely
with an appropriate quality of care
Human Dimension
• includes body, mind and spirit; based on a
holistic view of how humans function in a
system
• ensures full respect for human rights and
fundamental freedoms
• abides by the rule of law
• promotes the principles of democracy by
building, strengthening and protecting
democratic institutions, and
• promotes tolerance
Organization for Security and Co-operation in Europe
Tolerance
• A fair, objective, and permissive attitude
toward those whose opinions, practices, race,
religion, nationality, etc. differ from one's own
• Freedom from bigotry (state of mind of a bigot)
Humanistic Medicine
Humanism
Declaration of Geneva
At the time of being admitted as a member
of the medical profession: I solemnly
pledge myself to consecrate my life to the
service of humanity
Service of Humanity
• insight into the human condition, suffering,
personhood, responsibility to each other
• develop and nurture skills of observation,
analysis, empathy, and self-reflection -- skills
that are essential for humane medical care
The Medical Humanities are those disciplines that
inquire into the human experience of illness, healing
and doctoring with attention to meaning, values and
the history of ideas
Humanistic Medicine
• Humanism in medicine describes relationships
between physicians and their patients that are
respectful and compassionate
• It is reflected in attitudes and behaviors that
are sensitive to the values, autonomy, cultural
and ethnic backgrounds of others
• The humanistic doctor demonstrates the
following attributes (“I.E., C.A.R.E.S.”)
The fundamental principles of
humanistic medicine
• open communication
• mutual respect, and
• emotional connection between physicians and
their patients, termed "relationship-centered"
or "patient-centered" care, in contrast to
"case-centered" or "disease-centered" care
IE CARES
• Integrity: the congruence between expressed
values and behavior
• Excellence: clinical expertise
• Compassion: the awareness and
acknowledgement of the suffering of another
and the desire to relieve it
• Altruism: the capacity to put the needs and
interests of another before your own
IE CARES
• Respect: the regard for the autonomy and
values of another person
• Empathy: the ability to put oneself in
another's situation, e.g., physician as patient
• Service: the sharing of one's talent, time and
resources with those in need; giving beyond
what is required
WHO Constitution
Every human being to enjoy "the highest
attainable standard of health"
HR Declaration:Article 25
• (1) Everyone has the right to a standard of
living adequate for the health and well-being
of himself and of his family, including food,
clothing, housing and medical care and
necessary social services, and the right to
security in the event of unemployment,
sickness, disability, widowhood, old age or
other lack of livelihood in circumstances
beyond his control
Article 25
• (2) Motherhood and childhood are entitled to
special care and assistance. All children,
whether born in or out of wedlock, shall enjoy
the same social protection
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Discussion Time
Group Exercises
• What are the challenges in your clinic/ hospital/
organization to the key attributes of "good
governance"?
• Give examples of unacceptable care in medical
practice? Why are they unacceptable?
• How would you apply Humanistic Medicine in
your practice?