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What do we mean by a clinical governance framework? What should a clinical governance framework do?

The word ‘framework’ may be defined as ‘a particular set of rules, ideas or beliefs which you use in order to decide what to do’. It can also mean ‘a structure that forms a support or frame for something.’

In simple terms, a clinical governance framework is a set of principles, values and goals which guide care or services to ensure optimal clinical outcomes. Care or services need not be clinical in nature to be relevant to clinical outcomes. For example, personal care may impact a person’s clinical outcome if there is a failure to recognise and appropriately act upon signs of a decline in their condition.

Rather than being prescriptive, clinical governance frameworks describe an approach. A clinical governance framework is a ‘structure’ that supports best practice, by reminding us of the principles, values and goals which underpin the provision of care. A good clinical governance framework should enable everyone in an organisation, at every level, to understand their roles, responsibilities and accountabilities, by providing a foundation for clinical (or clinically relevant) practice and decision-making. 

A clinical governance framework at the organisational level should not only filter down to frontline workers in a way that is meaningful and makes practical sense, but those activities at the frontline (guided by more detailed policy and procedure) should reflect and align with components of the clinical governance framework. An organisational clinical governance framework should also be adequately flexible to be relevant and applicable to all parts of the organisation that have the potential to impact clinical outcomes.

Let’s take the Victorian Clinical Governance Framework (Victorian Framework) as an example, in the context of a recent Victorian Auditor-General’s Office audit which examined the alignment of four different health services with the Victorian Framework and concluded that they were not consistently consistent, identifying where the gaps were.  

The Victorian Framework applies to all health services in Victoria and was designed to be adaptable to individual services and local requirements.  It consists of five essential domains which rotate around safe, effective, person-centred care, and which are all subject to a cycle of monitoring, evaluation and improvement. These five domains are:

1. Leadership and culture
2. Consumer partnerships
3. Workforce
4. Risk management
5. Clinical practice

All these domains intersect with person-centred care and each other. They provide guidance to personnel at all levels of an organisation, albeit in different ways. For example, staff (and consumers) should be enabled, through the organisation’s culture (reflected in its policy and procedure), to actively participate in strategy, planning and delivery. That is, they do not need to be at Board, Executive or Management level to engage in leadership activities, and should be encouraged and supported to do so.

Consumer partnerships may be achieved by empowering and enabling consumers to contribute to care planning and decision-making. How this is done will depend on a person’s particular role in the organisation. It may be achieved in the process of care provision itself (through direct interactions with the consumer), or by the Board in ensuring robust and integrated platforms which allow the consumer voice to be heard in a manner that is not merely tokenistic.

Ensuring a skilled workforce is also everyone’s responsibility. While human resource strategy and credentialling play a role, it is also up to individuals to ensure their own competencies and participate in learning, development and self-reflection.

Finally, the requirement of risk management and clinical practice is a given. Whilst clinical governance includes mitigating clinical risks to ensure safety, clinical practice must also be appropriate and effective. Mitigating risk and preventing harm is a minimum; good clinical practice supports the delivery of care to the highest standard possible, on the basis of evidence and a strategy for continuous improvement. While Boards, Executives and Managers must drive this, frontline workers also have a duty of care to mitigate risk, and professional responsibility to ensure their practices are appropriate, evidence-based, and subject to ongoing peer review and self-reflection.

The domains of any clinical governance framework form the ‘building blocks’ of optimal clinical care. Clinical governance frameworks should be adequately flexible to accommodate the services and personnel to which they are intended to apply, and connect with those people who are to be guided by them.

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All accessed on 12 December 2021

Collins English Dictionary, accessed at: https://www.collinsdictionary.com/dictionary/english/framework

‘Delivering high-quality healthcare: Victorian clinical governance framework’, Safer Care Victoria, June 2017. Accessed at: https://www.bettersafercare.vic.gov.au/publications/clinical-governance-framework

‘Clinical Governance: Health Services’. Independent assurance report to Parliament 2020-21:22, Victorian Auditor-General’s Office, June 2021. Accessed at: https://www.audit.vic.gov.au/report/clinical-governance-health-services