Clinical governance in operation – everybody's business: a proposed framework

Abstract

PurposeThe purpose of this paper is to describe a framework for the implementation of clinical governance (CG) within a mental health and addictions service at all functional levels within the system (consumer, clinician, team, service and unit level). It aims to include and enlarge on the functional subdivisions of CG (as practised in the National Health Service (NHS)) by identifying 11 component domains of interest.Design/methodology/approachThe paper briefly reviews the varying interpretations of the concept of CG in the literature and associated difficulties in its implementation.FindingsSeveral authors have pointed out the difficulties in the implementation of CG at the operational level. In particular, CG is often seen as top‐down, “managerial” in its focus rather than providing clinicians at the coal‐face with a device for quality assurance and improvement.Practical implicationsThe framework asserts that the 11 component domains are relevant at all levels within a healthcare delivery system; in fact, conversations already occur around these domains at all levels with variable frequency, with a focus that is relevant to that level, determined by the needs at each level.Originality/valueThe paper describes a practical framework for implementation of CG within a mental health and addictions service that addresses some of the criticism levelled against the concept of CG in the literature. This conceptualisation provides a seamless merging of the so‐called managerial and clinical imperatives around clinical governance.