Clinical Governance

“Clinical governance is about a culture shift to a patient –centred, accountable, safe and high quality service in an open and questioning environment. Realising the potential of clinical governance involves a substantive shift in culture, questioning traditional structures and ways of doing things and creating an understanding of why a consistent and sustained approach to improving the quality of healthcare is necessary.”

Hallett & Thompson 2001

Clinical governance is the term given to the sets of systems and processes that are put in place to ensure that patients receive the highest quality care possible.

The remit of clinical governance is of necessity a wide one, which touches on at least seven areas of working practice. We call these the “seven pillars” and they are:

• Clinical audit
• Patient and Public Involvement
• Risk Management
• Clinical Effectiveness (standards)
• Staffing and Staff Management
• Education, Training, and Continuing Professional Development
• Use of Information

A trust’s strategic capacity, i.e. high level planning and capabilities as well as the patients experience are also considered to be important to clinical governance, although they are not counted amongst the seven pillars.

It is important to realise that the separation between the pillars is something which is done for convenience sake. I does not necessarily mean that in practise, these areas are discrete. For example, clinical audit is an aspect of clinical effectiveness. Evidence or results of clinically effective practise or audit, may rely on information mechanisms and/or education and training sessions for dissemination. Clinical governance represents, therefore, a holistic approach to patient centred practise.

Another definition

Clinical Governance is defined as a 'framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in healthcare will flourish' (DoH 1997).

To put this more simply, Clinical Governance is about the patients and their carers receiving the right care at the right time by the right person in a safe environment.

Safety and quality are key priorities for the NHS. Safety is the 'absence of unacceptable risk'. Clinical Governance ensures that we focus on delivering high and continuously improving standards of care and service. It is the framework to guide everyone in the Trust to work towards delivering better, safer services to the patient.

Clinical Governance was introduced to help to address

• the issues of differences in the quality of care existing throughout the country
• the public concern about well publicised cases of 'poor professional performance'
• the greater expectations of the NHS by the patients.

Clinical quality and continuous improvements in healthcare delivery can only be achieved in an open and honest culture and environment that supports, values and develops its staff. We aim to celebrate what is done well and learn from what is done less well.

Clinical Governance cannot be successfully implemented without the support of the non-clinical aspects of healthcare delivery. Consequently, implementation of aspects of Clinical Governance apply to all non-clinical support services, such as administration and clerical, estates, domestic, catering and portering staff, human resources, finance and information. Successful healthcare delivery is dependent on good teamwork, effective leadership and commitment to providing high quality services.

There are seven key components of Clinical Governance, known affectionately as 'The 7 Pillars'. These are:

1. Risk Management
2. Clinical Audit
3. Education, training and continuing personal and professional development
4. Research and Development
5. Information
6. Patient and Carer experience and involvement
7. Staffing and staff management