What does clinical governance mean in 2021?
Clinical governance has attracted fresh limelight in recent times in the context of a pandemic, intense public scrutiny of our aged care and disability systems, and concomitant acceleration of digital health.
The focus on clinical governance emerging in aged care following high-profile criticism by way of a royal commission is almost reminiscent; it was notorious healthcare failures in the UK1 that led to the inception of clinical governance discourse, and its first (known) definition as a concept2. First defined in 1998 as ‘a framework through which organisations are accountable for continuously improving the quality of services and safe-guarding high standards of care by creating an environment in which clinical care will flourish,’3 there are now multiple definitions of clinical governance - supporting a proposition that it bears different meanings in different sectors and organisations.
Certainly, clinical governance is not a ‘one size fits all’ concept, however, the same ‘catch-words’ apply – such as systems, processes, relationships, responsibilities, integration, accountability, safety, quality, care, continuous improvement. Importantly, contemporary definitions expressly include the patient, or client/consumer (depending on the sector), as a component of clinical governance4.
But what does ‘clinical governance’ mean in practice? In particular, what does it mean now, in 2021?
Firstly, clinical governance stretches beyond healthcare. It is now a legislated requirement in aged care5, and less obviously, in disability6. Clinical governance is difficult to explain - perhaps because it is implicitly a community expectation. It is an expectation that if we say we will look after someone, and profess to have the skills to do so, we will avoid acts or omissions which could be reasonably foreseen to cause them harm7. Whether in healthcare, aged care, or disability - this is our duty of care.
Clinical governance ultimately concerns our standard of care and therefore supports our duty of care.
Clinical governance is also broad, in that it must be applied at all levels – not just executive and middle management. While often the emphasis is on systems and processes, clinical governance is fundamentally about what happens at the point of care. As such, collaboration with staff, patients and clients/consumers is central to robust clinical governance, regardless of context.
Definitions differ because they must; clinical governance does not cross sectors uniformly, therefore its practical meaning will vary. Even within a sector, organisations must adapt principles of clinical governance to align with their demographics, needs and risk - as well as corporate governance - rather than adopting a template approach. Now with the rapid expansion of digital health initiatives, we must also consider what clinical governance means in the context of health informatics.
While clinical governance has come a long way since 1998, we remain on a journey of continuous improvement in clinical governance itself.
1. The Royal Bristol Infirmary (events between 1984-1995) https://www.bmj.com/content/323/7306/181; Dr Harold Shipman (events between 1972-1998) https://pmj.bmj.com/content/80/944/303
2. Gottwald, M and Lansdown, G, Clinical Governance: improving the quality of healthcare for patients and service users’, Open University Press, first published in 2014.
3. ‘A First Class Service Quality in the NHS’ (Department of Health, 1998), cited in J. Wilson, ‘Clinical Governance’, British Journal of Nursing, Vol, 7, No. 16, published online 27 September 2013: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.19126.96.36.19915
4. See Australian Commission on Safety and Quality in Health Care, National Model Clinical Governance Framework at https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-model-clinical-governance-framework and Aged Care Quality and Safety Commission, Fact Sheet 1: Introduction to clinical governance at https://www.agedcarequality.gov.au/resources/clinical-governance
5. See Aged Care Quality Standards, Quality of Care Principles 2014
6. See for example https://www.dss.gov.au/our-responsibilities/disability-and-carers/publications-articles/policy-research/national-framework-for-reducing-and-eliminating-the-use-of-restrictive-practices-in-the-disability-service-sector, and https://www.ndiscommission.gov.au/providers/incident-management-and-reportable-incidents https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.19188.8.131.5215?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
7. Consider: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front11-wk-toc~drugtreat-pubs-front11-wk-secb~drugtreat-pubs-front11-wk-secb-6~drugtreat-pubs-front11-wk-secb-6-1