Northern Doctors Services is committed to increasing  junior doctor involvement in Clinical Governance activities.

The Introduction to Clinical Governance Program offers junior doctors the opportunity to develop valuable skills in leadership, quality improvement, patient safety, and healthcare systems. Participation can strengthen your CV and help distinguish you when applying for future jobs, specialty training, and career opportunities.

The program aligns with the PMCV JMO Curriculum and supports competencies recognised across many specialty training pathways.

By joining the program, junior doctors can contribute meaningful input and feedback to important organisational projects and clinical governance initiatives, while gaining experience beyond day-to-day clinical work.

Northern Health also benefits by creating a broader and more engaging training environment for junior doctors by encouraging greater junior doctor participation in service improvement.

Doctors who complete three of the four program components will be awarded a Northern Health Introduction to Clinical Governance Certificate.

Program Outline 

Domain  Activities / commitment  Outcomes  How to get started 
Committee Participation   Participation in a National Standards or Clinical Improvement Committee  

  • Link up with a medical representative on the Committee for orientation/debrief 
  • Attend at least 3 meetings within a 6- month period  
  • Become familiar with relevant terminology, for example by reviewing National Standards resources, Terms of Reference, Agenda, Action lists and Minutes 

Examples of committees- see Appendix A below

 Write a brief reflection your participation on the committee – for example: 

  • What did you learn?  
  • How do you think the committee/work of the committee could be improved? 
  • How could we improve communication of committee activities to JMS/involve more JMS in Quality activities? 

Receive a Statement of Participation 

  Email: NorthernDoctorsEducation@nh.org.au
Clinical Audit  Undertake a clinical audit  

  • Link up with a mentor familiar with the audit topic and process 
  • Review previous audit findings 
  • Identify dataset and audit questions 
  • Complete audit 
  • Write up findings and recommendations 

Examples of audits – see Appendix B below
  • Work with mentor to write up audit findings in standardised format to be presented to relevant committee 
  • Receive a Statement of Participation
  Email: NorthernDoctorsEducation@nh.org.au
Safety Review  Participate in a Patient Safety activity 

  • Complete 5 Mortality/Morbidity Reviews  
  • Participate in an adverse event review e.g. SCIRT 
  • Attend 3 QRM meetings 

 

 Work with a mentor to complete and present at the Unit’s regular Mortality and Morbidity Review Process  

  • Write a reflection of your participation in a SCIRT or QRM meetings – for example: 
  • What did you learn?  
  • How do you think the committee/work of the committee could be improved? 
  • How could we improve communication of committee activities to JMS/involve more JMS in Quality activities? 

Receive a Statement of Participation 

  Email: NorthernDoctorsEducation@nh.org.au

 

Discuss with your Head of Unit 
Quality Improvement   Undertake a quality improvement cycle  

i.e. Plan, Do, Study, Act 

  • Identify a gap or improvement  
  • Identify a mentor, stakeholders and audit measures 
  • Develop and undertake baseline audit 
  • Develop and implement improvement activity 
  • Undertake repeat audit 
  • Write up findings 
  • Work with mentor to write up quality improvement findings in standardised format to be presented to relevant committee 
  • Receive a Statement of Participation 

 

  Email: NorthernDoctorsEducation@nh.org.au

 

Discuss with Head of Unit 

  

Appendix A – Northern Health Quality Improvement Committees  

Consumer Partnership and Patient Experience

Infection Prevention and Control

Medication Safety

Patient Safety and Clinical Care

Communication and Clinical Information

  • Standard 6 Communicating for safety 
  • Recognising and Responding to Clinical Deterioration
  • Medical Handover Working Group 
  • Healthcare Record Advisory committee 
  • EMR Discharge Summary working group 

Blood Management

Recognising and Responding to Clinical Deterioration

Clinical Review and Oversight

  • Mortality Audit Oversight & Advisory committee 
  • Clinical Variation Oversight & Advisory committee 

 

Appendix B – examples of potential clinical audits and relevant committee 

Audit  Committee / audit owner 
Review of Suicide & Self Harm (SASH) incidents/ identifying gaps in care  Predicting, Preventing & Managing Self Harm & Suicide committee 
Emergency surgery consent documentation   Consent & Shared Decision-Making committee 
VTE   VTE & Anticoagulation committee 
Medication   Standard 4 Medication Safety 
Psychotropic medication consent  Predicting, Preventing and Managing Cognitive Impairment committee 
Delirium Management  Predicting, Preventing and Managing Cognitive Impairment committee 
Goals of Patient Care / Medical Treatment Decision Maker / ACP  End of Life Committee 
Deaths documentation  Healthcare Record Advisory Committee 
Medical handover  Medical Handover Working Group 

 Northern Health resources to support data collection and analysis: 

  • Surveymonkey 
  • Decision support 
  • Reporting portal 

Resources to support quality, safety and research activities: