Evaluating the Role of Clinical Governance in Improving Accountability and Quality of Nursing Care

Posted: Feb 28, 2023

• Zara Torres
• Hugo Wallace
• Cole Graham

Abstract

This research presents a novel computational framework for evaluating clinical governance systems in nursing care through the application of distributed ledger technology and multi-agent reinforcement learning. Traditional approaches to clinical governance evaluation have relied heavily on manual audits, retrospective chart reviews, and self-reported compliance metrics, which suffer from significant limitations including reporting bias, temporal delays, and inconsistent application across healthcare organizations. Our methodology introduces a real-time, automated governance assessment system that captures nursing care activities through a combination of electronic health record integration, IoT-enabled medical device monitoring, and natural language processing of clinical documentation. The system employs a permissioned blockchain infrastructure to create an immutable, transparent record of nursing interventions, clinical decisions, and patient outcomes, enabling unprecedented accountability tracking. We developed a multi-agent reinforcement learning environment where simulated nursing agents interact with virtual patient populations under varying governance structures, allowing for the systematic exploration of governance mechanisms and their impact on care quality metrics. The results demonstrate that our computational governance framework identified previously unrecognized patterns in the relationship between specific governance components and nursing care outcomes, revealing that decentralized accountability structures combined with real-time feedback mechanisms produced a 34