What is clinical governance?
Definition: what it is and what it isn't
Clinical governance is the totality of structures and processes that are in place to ensure that, as far as practicable, the right person receives the right treatment, in the right way, at the right time, in the right place, with the right outcome.
This goal does not happen by chance; it has to be secured by conscious effort, and that effort—creating and sustaining the required structures and processes—has to be actively and efficiently managed. Further, this active management is not just at the level of the healthcare organization but also at the level of the individual practitioner, and it is not just the business of healthcare managers but is (or should be) at the core of clinical practice.The value of clinical governance
Clinical governance is important for the benefit of service users, hospital staff, the healthcare organization, and the wider health economy. Recipients of healthcare expect to have the treatment that is tailored to their needs and circumstances, delivered in an appropriate and respectful manner, with the best possible prospects of achieving the right outcome. Their family and friends share this expectation and would like to be appropriately engaged by healthcare staff. The morale and productivity of staff is enhanced if their work environment is enabling, and if there is individual and collective accountability for the quality of care delivered. The productivity of the organization is similarly enhanced, as is its standing. The organization’s resources are efficiently deployed. There is less wastage and less money is spent on iatrogenic complications, unnecessary investigations and treatment, and avoidable extensions of inpatient care—these all translate to a healthier population and better health economy.
The domains of clinical governance
To achieve the goals of clinical governance, the organization has to move from a ‘fire-fighting’ position to one of proactive management.
Also, all of the pertinent domains have to be addressed.The structures and processes that constitute clinical governance are encapsulated in the RADICAL framework: Raise awareness, Apply quality improvement (QI) methodology, Design for quality (including safety), Involve service users, Collect and Analyse data, and Learn from incidents—see Figure 5.1.
Implementation and monitoring of clinical governance
The RADICAL framework is an integrative tool for implementing and monitoring clinical governance. It develops and integrates the following activities:
Raising awareness—staff are kept abreast of the basic principles of clinical governance, the current developments, and emerging lessons. This task, and others relating to the coordination of activities, is usually undertaken by designated managers and committees at various levels in the organization. Educational activities and feedback loops are in this domain.
Applying QI methods—whether at an individual or at an organizational level, some change is usually required in order to achieve improvement. Such change has to be managed, using a structured approach. For this purpose, formal QI methods should be applied.
Designing for quality—healthcare should be purposefully designed to ensure that the highest possible level of quality is achieved. One mechanism for doing this is the concept of ‘clinical effectiveness’, discussed in a later section.
Involving service users—in all of these activities, from raising awareness to organizational learning, the service users should be constructively engaged.
Collecting and Analyse data on service quality—once we have designed the way healthcare should be delivered, we should continually check that care is actually delivered to the designated standards. This is done through clinical audit. Data is also collected and analysed as part of risk management.
Learning—data collection and analysis would be a mere paper exercise unless there is individual and organizational learning.
These clinical governance activities are discussed in the following sections.