Clinical governance: is it coming of age?

Abstract

Clinical governance is no longer in its infancy. Although introduced 3 years ago into the National Health Service (NHS) through the Government’s paper ‘‘The new NHS—modern . dependable’’ [1], it has not reached its final objective in becoming the essential habit of everyone who works in the health service and so it is not yet mature. It is in those terrible teenage years! It is now accepted that clinical governance is the local part of the Government’s national initiative on clinical quality in the NHS, aimed at setting and maintaining standards of clinical care. Since its inception, the principles of clinical governance have been further developed in subsequent papers from the NHS: ‘‘A first class service: quality in the NHS’’ [2] and ‘‘Clinical governance: in the new NHS’’ [3]. The quotation from these documents that I think is most relevant to the understanding of clinical governance is ‘‘the new NHS will have quality at its heart, without it there is unfairness. Every patient who is treated in the NHS wants to know that they can rely on receiving high quality care when they need it. Every part of the NHS and everyone who works in it should take responsibility for working to improve quality’’. Since 1997 we have seen the development of the national framework for clinical quality in the form of the National Institute for Clinical Excellence (NICE), the National Service Frameworks and the Commission for Health Improvement (CHI). Some progress has also been made in identifying patients’ views on the service. The now well recognized diagram (Figure 1) shows clinical governance sitting between the NICE and the CHI, but alongside professional self-regulation and lifelong learning. The fundamental elements of clinical governance (Figure 2) were first enunciated in 1997 and were not unfamiliar to professional staff working within the NHS. However, this reminder of good clinical practice was accompanied by significant organizational change associated with ‘‘governance’’. The concept of governance is now widespread throughout society and originated in relation to the principles of corporate governance in the Cadbury Report of 1992 [4]. Under governance guidance, Trusts are required to ensure that there are mechanisms in place to facilitate high standards of practice. Until clinical governance arrived, governance in the NHS largely related to financial affairs. The responsibility of Trust Boards has been clarified and in particular the Chief Executive has been made fully responsible for ensuring that controlling