What is clinical governance?
The term ‘clinical governance’ was first coined in the context of the National Health Service (NHS) in the United Kingdom, being ‘a system 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 clinical care will flourish.’
In Australia, the contemporary definition of clinical governance (by the Australian Commission on Safety and Quality in Healthcare) is broader, articulated as a ‘set of relationships and responsibilities’. This definition includes ‘systems’, but also acknowledges that clinicians, managers and governing bodies are all equally accountable for high quality care. While New Zealand has not adopted a formal definition of clinical governance it describes it as ‘an organisation-wide approach to the continuous quality improvement of clinical services.’ Its Health Quality & Safety Commission acknowledges that, in simple terms, ‘clinical governance is a collaborative venture between clinicians, managers and consumers that aims to ‘create a culture where quality and safety is everybody’s primary goal’ (Flynn et al 2015)’.
Therefore contemporary clinical governance expressly recognises that everyone is responsible for clinical governance - not least the practitioners who deliver care at the front line. Ultimately, this is where clinical governance starts and ends.
Clinical governance is essentially about how we can deliver the best care we possibly can, and supports a fundamental commitment to high quality. It could therefore be more broadly referred to as ‘care governance’, to capture those sectors which may not necessarily deliver clinical care - such as aged care and disability. Care governance, like clinical governance, involves continually reflecting on how we can do things better, and ensuring we are well-placed to do so throughout all levels of an organisation.
Put simply, care governance is about taking measures to deliver optimal care holistically and fostering the requisite environment and culture to do so. Ultimately, care governance is about the patient (or consumer) experience at the interface of care.
Understanding clinical care governance will facilitate the embedding of a ‘mental framework’ on which practitioners can base their everyday practice - a framework against which to consider how we can ‘do better’ for our patients and consumers. This mental framework reminds us of what we must consider when delivering care.
For example, the concept of person-centred care, which is central to the National Model Clinical Governance Framework, focusses our minds (and practice) on the people for whom we provide care - rejecting long antiquated and paternalistic beliefs that ‘doctor knows best’ - instead, promoting the ethical pillar of autonomy and the right to self-determination. The National Model Clinical Governance Framework reminds each and every one of us that we should be working as a team, and in partnership with patients and consumers to achieve the outcomes they desire - by understanding what quality means for them, while at the same time managing their expectations.
Ultimately, clinical governance - and more broadly, care governance - is an ethical and professional obligation that reflects our commitment to be the best we can, whenever providing care. Understanding clinical and care governance informs us how to do this, and reminds us what is required.
All accessed on 24 April 2022:
G. Scally and L. J. Donaldson. ‘Clinical governance and the drive for quality improvement in the new NHS in England. BMJ. 1998;317(7150):61-65. DOI:10.1136/bmj.317.7150.61. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113460/
‘National Model Clinical Governance Framework’. Australian Commission on Safety and Quality in Health Care, 2017. Accessed at: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-model-clinical-governance-framework
‘Clinical Governance: Guidance for Health and Disability Providers’. Health Quality & Safety Commission New Zealand, 2017. Accessed at: https://www.hqsc.govt.nz/resources/resource-library/clinical-governance-guidance-for-health-and-disability-providers/
M Tan. ‘Law and clinical governance - match or mismatch?’. Published on LinkedIn, 1 April 2022. Accessed at: https://www.linkedin.com/pulse/law-clinical-governance-dr-melanie-tan-/?trackingId=i%2FBuLiESR0er5wWRITGveA%3D%3D
M Tan. ‘For private practitioners: what is clinical governance and why is it important?’ Published on LinkedIn, 5 April 2022. Accessed at: https://www.linkedin.com/pulse/private-practitioners-what-clinical-governance-why-important-tan-/?trackingId=cvLehuxbTAuD%2FTPla1w2pw==
M. Walton. ‘Patients’ autonomy: does doctor know best’. Medicine Today, June 20 02. Accessed at: https://medicinetoday.com.au/2002/june/regular-series/patients%E2%80%99-autonomy-does-doctor-know-best