Governance & Accountability
True or False: Clinical governance is owned by the Quality Unit.
False. It is everyone's responsibility.
What does SLS stand for?
Safety Learning System.
Which is more valuable for governance: an individual complaint or complaint trends?
Trends.
What process should occur after a significant clinical incident with a patient?
Open Disclosure.
Training compliance is 82%. Operational issue or governance issue?
Governance issue.
A Board report shows deterioration management compliance below target for three months. What should leaders do?
Escalate, review risks, develop actions and monitor improvement.
A near misses, consumer feedback, WHS incidents, security incidents.
Yes.
What does "To Listen, Act, Make Better, Together" encourage?
Consumer partnership in service improvement.
Name two components of Open Disclosure.
explanation, questions, prevention actions.
A risk has been discussed for six months but no action taken. What failed?
Escalation and risk management
A major risk is identified but no incident has occurred. What should happen?
Risk mitigation and proactive management.
Name three things reportable in SLS.
Incidents, near misses, consumer feedback, WHS incidents, security incidents.
Give one way consumers can contribute to service design.
Advisory groups, committees, co-design workshops, surveys.
Who should learn from incident reviews?
Patients, families, staff and the organisation.
Performance data is excellent but consumer feedback is poor. Which data is correct?
Both should be considered.
What is SALHN's consumer engagement principle?
o Listen, Act, Make Better, Together.
Why can high reporting rates sometimes be a positive sign?
Strong reporting and safety culture.
A recurring complaint appears for the third time in six months. What should happen?
Trend analysis, investigation and improvement actions.
What leadership mistake most often prevents organisational learning?
Focusing on blame rather than systems and governance failures.
A SALHN service consistently meets its KPIs, but staff survey results show people do not feel safe speaking up. What is the greatest leadership concern?
A weak safety culture. Risks, incidents, and improvement opportunities may go unreported, reducing the organisation's ability to learn and improve.
Your service meets activity targets but fails safety indicators. What should be prioritised?
Safety and quality outcomes.
Your division reports significantly fewer incidents than similar services. What concerns might this raise?
Under-reporting, poor safety culture, lack of psychological safety.
Before addressing discharge communication concerns, what evidence should leaders review?
Complaints, audit data, incidents, consumer feedback and staff feedback.
After a serious incident, a leader asks, "Who is to blame?" Why is this not a restorative just culture approach?
Because restorative just culture focuses on understanding what happened, who was impacted, and what can be learned, rather than assigning blame.
A high-risk issue was reported and escalated six months ago but remains unresolved. What governance failure occurred?
Failure of accountability, assurance and monitoring.