The challenges of clinical governance in primary healthcare in Portugal
DOI:
https://doi.org/10.32385/rpmgf.v41i2.14033Keywords:
Clinical governance, Primary healthcare, USF, ACeS, ULS, Performance metricsAbstract
Clinical governance in primary healthcare is essential to ensure the quality, efficiency, and safety of services provided to patients. It is considered a multidimensional approach, involving the establishment and improvement of performance indicators, continuous monitoring of outcomes, constant engagement of healthcare professionals, and adoption of practices based on the best scientific evidence. Multiple barriers have been established to the effective implementation of clinical governance in Portugal, across various sectors. Organizational and management challenges include the need to foster a culture that values this practice, as well as making changes to the structure and functioning of healthcare units. Active involvement of healthcare professionals is crucial, but resistance to change and fear of loss of autonomy can hinder organizational success. Interconnection with other levels of care, such as hospitals and continuing care, becomes crucial to ensure continuity and quality of services provided. The complexity of performance metrics is another well-known challenge. Selecting relevant and appropriate indicators to measure the quality of care is a complex process, as choosing the wrong indicators can lead to incorrect conclusions about the clinical performance of professionals. Regional inequalities in resources and infrastructure can also affect the implementation of these measures. Additionally, the COVID-19 pandemic has exacerbated existing weaknesses in healthcare systems, highlighting the importance of having a strong public healthcare system. In summary, implementing clinical governance in primary healthcare is a complex task that encompasses organizational, financial, and cultural challenges. An integrated and comprehensive approach involving all stakeholders in the healthcare system is necessary to achieve sustainable and effective clinical governance that improves the quality of care for patients in Portugal.
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