A Clinical Governance Intervention Framework: Empowering Nurse and Clinical Managers to Improve Patient Flow and Reduce Distress in Public Sector Emergency Units in Gauteng
Abstract
Thizwilondi Ananias Magadze
Chronic overcrowding and access block in public sector Emergency Centres (ECs) in South Africa, particularly in academic hospitals like Dr. George Mukhari Academic Hospital (DGMAH), significantly compromise patient safety and staff well-being. This study aimed to develop a practical and workable Clinical Governance Intervention Framework (CGIF) to empower Nurse and Clinical Managers in improving patient flow and reducing distress within the DGMAH EC. Employing a mixed-methods design, the study first quantitatively assessed the correlation between managerial clinical leadership practices and patient flow metrics (e.g., Length of Stay). Subsequently, qualitative interviews explored the barriers, enablers, and effective strategies utilized by managers. Findings confirmed that strong managerial leadership in clinical governance specifically in risk management and inter-departmental liaison was inversely correlated with patient waiting times. The resulting CGIF provides a structured, three-tiered approach focusing on Real-time Data Utilization, Inter-Departmental Escalation Protocols, and UnitSpecific Quality Improvement Cycles. This framework offers practical, low-cost solutions for managerial intervention, which is critical for transforming the quality of care in highly distressed public EC environments.