Clinical governance: a fresh look at its definition

Abstract

Clinical governance was introduced in 1997 as a comprehensive framework to improve the healthcare quality in the National Health Service. Since then, the proliferation of various definitions and models of clinical governance illustrates that different perceptions are emerging on clinical governance. However, none of these definitions captures the essence of clinical governance in terms of its organisation-wide implications for continuous quality improvement. Although there is discrete mention of structure, process and outcomes in the literature on clinical governance, it is hard to find any clear explanation on how clinical governance influences organisational elements. This paper therefore analyses clinical governance in terms of the inputs, processes, structure and the outcomes of healthcare organisations. The fact that the introduction of any new governance framework will have much wider implications for the management of healthcare organisations is illustrated through a refined definition of clinical governance presented in this paper.

Hospitals’ readiness to implement clinical governance

“…In NHS study, 67% of responsible officers reported that they are ready to implement CG with consideration to "proactive risk management" dimension. This finding is in consistent with some of other studies (6,9,25,26). In these studies, preceding dimension has been considered as the most effective factor for quality improvement and facilitation of CG implementation.…”

“…There seen no significant differences between hospitals in this dimension (P> 0.05). Other studies have also found that the existence of a proactive and learning culture within hospitals has the highest correlation with successful CG implementation (25,33,34). Overall, studied hospitals were evaluated "weak to average" for CG implementation.…”

Putting the principles of good governance into clinical practice

“…While each new definition has its own merit, none captured the essence of governance in terms of its impact on the total organisation. [4][5][6][7] It is impossible to circumscribe governance into a particular context. Its fundamental principles apply to all activities involved with the delivery of health care, whether financial, managerial or clinical.…”

Using clinical governance levers to support change in a cancer care reform

“…Starey (2003) and Scally and Donaldson (1998) propose several components to facilitate the operationalization of clinical governance: clinical audit, clinical effectiveness, research and development, openness, risk management, education and training. Implementing clinical governance involves taking into consideration a whole set of organizational dimensions (Vanu Som, 2004;Brault et al, 2008) that will be helpful in making long-term changes to health care organizations. As such, the aims of clinical governance are to align managerial and clinical processes more closely to improve the quality and safety of care (Buetow and Roland, 1999) and to generate a new synergy between managers and clinicians to create new quality improvement initiatives (Pomey et al, 2008).…”